公共卫生研究摘要 (2026-06-22)

共收录 59 篇研究文章

1. Endometriosis and cardiovascular disease risk: a meta-analysis of cohort studies.

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

摘要

This meta-analysis aimed to evaluate the association between endometriosis (EM) and cardiovascular disease (CVD) risk by synthesizing evidence from large-scale cohort studies, with emphasis on subtype-specific risks and geographic disparities. We systematically searched PubMed, Embase, and Cochrane Library for cohort studies published until December 2024. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using random-effects models. Subgroup analyses stratified CVD subtypes (e.g. ischemic heart disease, atrial fibrillation), continents, and country development levels. Heterogeneity and publication bias were assessed via I2 statistics, sensitivity analyses, and Egger’s test. Eleven cohort studies (n = 3,100,610 participants) were included. EM was associated with a 22% increased risk of all-cause CVD (HR = 1.22; 95% CI: 1.08-1.38; I2 = 94.6%). Subgroup analyses revealed elevated risks for myocardial infarction (HR = 1.29; 95% CI: 1.10-1.50), coronary artery disease (HR = 1.47; 95% CI: 1.29-1.67), and cerebrovascular events (HR = 1.18; 95% CI: 1.12-1.25), but not heart failure. Geographic disparities were significant, with higher CVD risks in Asian (HR = 1.36; 95% CI: 1.25-1.48) and North American cohorts (HR = 1.37; 95% CI: 1.16-1.61) compared to European populations (HR = 0.93; 95% CI: 0.64-1.34). EM is independently associated with an elevated risk of CVD, particularly for coronary artery disease and myocardial infarction. These findings underscore the need for targeted cardiovascular monitoring in EM patients, particularly in high-risk populations.

2. Perceptions of Buprenorphine With Naloxone Treatment and the Fear of Precipitated Withdrawal: A Qualitative Exploration With HIV Prevention Trials Network 094 INTEGRA Participants and Staff.

期刊: Drug and alcohol review 发表日期: 2026-Jul 链接: PubMed

摘要

Uptake of evidence-based medication for opioid use disorder (MOUD), including buprenorphine-naloxone, remains low despite the expanding US opioid crisis. This study examined participants’ and staff perceptions of adopting and delivering buprenorphine-naloxone on a mobile unit providing integrated MOUD and HIV services for people with opioid use disorder who inject drugs in the HPTN 094 INTEGRA trial. We conducted semi-structured interviews with people with opioid use disorder who inject drugs in the intervention or control arm (n = 77) and mobile unit staff (n = 38) of HPTN 094 as part of an embedded qualitative implementation science evaluation across five US cities: Houston, Los Angeles, New York City, Philadelphia and Washington, DC. Interviews were transcribed and analysed using a pragmatic inductive and deductive thematic approach. Fear of precipitated withdrawal was a primary factor shaping perceptions of buprenorphine and other MOUD formulations. This fear was heightened by the widespread presence of fentanyl in the unregulated drug supply. Participants’ MOUD preferences were influenced by their treatment goals and by misperceptions of the role of naloxone in buprenorphine and the risk of precipitated withdrawal. Additional barriers included stigma towards MOUD and infrastructure constraints that complicated buprenorphine-naloxone inductions on a mobile unit. Even with facilitated access, perceptions of evidence-based MOUD were strongly shaped by fear of precipitated withdrawal. Aligning MOUD formulations with the treatment goals of people who inject drugs, along with expanding flexibility in MOUD access, delivery and induction practices across formulations, may improve uptake of these life-saving treatments.

3. Mortality in Castration Resistant Prostate Cancer Patients With and Without Pre-Existing Cardiovascular Disease Receiving Oral Androgen Receptor Pathway Inhibitors.

期刊: Pharmacoepidemiology and drug safety 发表日期: 2026-Jul 链接: PubMed

摘要

Men with castration-resistant prostate cancer (CRPC) who have a pre-existing history of cardiovascular disease (CVD) or other comorbidities are often excluded from clinical trials involving oral androgen receptor pathway inhibitors (ARPi). In this study, we compared all-cause and prostate cancer-specific mortality among CRPC patients, with and without a pre-existing history of CVD, receiving ARPi compared to chemotherapy. Men with CRPC were identified using the Surveillance, Epidemiology, and End Results-Medicare Linked Database from 2004 to 2015. Patients were grouped into two analytical cohorts by drug use. Inverse probability treatment weights (IPTW)-adjusted Cox models and Fine-Gray subdistribution hazards models were used to evaluate associations between ARPi and chemotherapy, and between ENZ and AA for all-cause mortality and cancer-specific mortality separately. The study cohort included 1438 men with CRPC. Nearly 54.4% of patients had a pre-existing history of CVD. Patients with a pre-existing history of CVD had a higher incidence of all-cause and prostate cancer-specific mortality compared to patients without a history of CVD (all-cause mortality: 69.7% vs. 59.3%, prostate cancer-specific mortality: 56.0% vs. 49.5%, respectively). In the pre-existing history of CVD cohort, the IPTW-adjusted Cox model showed a significantly lower all-cause mortality in patients who received APRi, enzalutamide, and abiraterone, versus chemotherapy (IPTW-adjusted hazard ratio [AHR], 0.56; 95% Confidence Interval [CI], 0.48-0.64; p-value < 0.001). Further, the IPTW-adjusted competing risk model showed significantly lower prostate cancer-specific mortality in patients who received ARPi compared with those who received chemotherapy (IPTW-AHR, 0.48; 95% CI, 0.41 to 0.57; p-value < 0.001). In the without pre-existing history of CVD cohort, the adjusted Cox model showed significantly lower all-cause mortality in patients who received APRi than those who received chemotherapy (IPTW-AHR, 0.49; 95% CI, 0.41-0.60; p-value < 0.001). Whereas the IPTW-adjusted competing risk model showed significantly lower prostate cancer-specific mortality in patients who received ARPi compared with those who received chemotherapy (IPTW-AHR, 0.52; 95% CI, 0.42-0.64; p-value < 0.001). In this population-based cohort of older men with castration-resistant prostate cancer, treatment with oral androgen receptor pathway inhibitors was associated with lower estimated risks of all-cause and prostate cancer-specific mortality compared with chemotherapy in patients with and without pre-existing CVD. These findings add real-world comparative effectiveness evidence for patient populations not well represented in randomized clinical trials; however, given the observational design and limitations of administrative data, residual confounding and unmeasured clinical differences may have influenced the results. Prostate cancer that no longer responds to hormone therapy is called castration‐resistant prostate cancer (CRPC). Two commonly used treatments for CRPC are oral androgen receptor pathway inhibitors (ARPis), which are pills, and chemotherapy, which is given by infusion. Many older men with CRPC also have cardiovascular disease (CVD) (such as heart disease or prior stroke), but these patients are often underrepresented in clinical trials. In this study, we used national Medicare data linked with cancer registry records to examine survival outcomes among 1438 older men with CRPC who received either ARPis or chemotherapy between 2012 and 2014. About half of the patients had pre‐existing CVD. After accounting for differences in patient characteristics between treatment groups, men who received ARPis had lower overall mortality and lower prostate cancer–specific mortality compared with those who received chemotherapy. These patterns were similar among patients with and without CVD. Because this was an observational study using administrative data, unmeasured differences between groups may still have influenced the results. Nonetheless, the findings provide real‐world evidence to help inform treatment decisions for older men with advanced prostate cancer.

4. Individual Matching Support in Community Dementia Care: A Reflexive Thematic Analysis of Team Orange in Sapporo City.

期刊: Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society 发表日期: 2026-Jul 链接: PubMed

摘要

This study aimed to clarify the structure of the individual matching support process within Team Orange, a community-based dementia support initiative in Japan. Using reflexive thematic analysis, we qualitatively examined semi-structured interviews with seven coordinators who facilitate matching between people living with dementia and community supporters. We also analysed 14 implementation reports documenting actual support cases from community comprehensive support centres in Sapporo, Hokkaido. Analysis identified seven themes constituting a cyclical support process: ‘diverse triggers for initiating matching’, ‘assessing needs and evaluating support potential’, ‘safe and sustainable support coordination’, ‘building trust relationships to facilitate matching’, ‘reaching consensus among people living with dementia, families and supporters’, ‘implementing individual matching support’ and ‘reviewing and readjusting toward sustainable support’. These findings suggest that individual matching is not simply a combination of volunteer activities, but rather a support process in which the coordinator’s clinical reasoning and relational coordination cyclically support the agency of people living with dementia, family members and supporters. This practice has the potential to serve as an implementation model that flexibly connects informal community resources with individuals whose needs fall outside the scope of formal care services.

5. Burden and Regional Disparities of MASH-Related Liver Cancer in the Asia-Pacific Region From 1990 to 2023.

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

摘要

Metabolic dysfunction-associated steatohepatitis (MASH) is an increasingly significant contributor to primary liver cancer in the Asia-Pacific region, with substantial regional variation. To quantify the burden and temporal trends of MASH-related liver cancer across countries and subregions from 1990 to 2023. Using the Global Burden of Disease (GBD) 2023 dataset, we analysed age-standardized prevalence, deaths, and disability-adjusted life years (DALYs) for MASH-related liver cancer, assessing temporal trends, regional variation and associations with the Socio-demographic Index (SDI). Decomposition analysis estimated the contributions of ageing, population growth and epidemiological changes. In 2023, the high-income Asia-Pacific region had the highest age-standardized prevalence of MASH-related liver cancer (1.19 per 100 000), followed by Oceania (0.98 per 100 000) and Australasia (0.88 per 100 000), with Central Asia the lowest (0.56 per 100 000). Across the Asia-Pacific region, prevalence, mortality and DALYs generally increased with SDI, though patterns varied by subregion. The high-income Asia-Pacific region showed a distinct ‘increase-peak-decline’ pattern in both mortality and DALYs, whereas low- and middle-income regions (i.e., South Asia, South-east Asia and Central Asia) showed steady increases in prevalence. Pacific island nations experienced disproportionately higher DALYs despite their smaller populations. Decomposition analyses showed that ageing and population growth accounted for the largest proportions of the observed changes in East Asia (44.8% and 41.4%, respectively) and South Asia (41.1% and 30.1%, respectively), whereas epidemiological change was the largest contributor in Australasia (58.4%). MASH-related liver cancer is rising across the Asia-Pacific region, with substantial regional variation, underscoring the need for region-specific public health strategies. The burden of liver cancer related to metabolic dysfunction‐associated steatohepatitis (MASH) has been increasing in the Asia‐Pacific region over the past decades, with clear differences between countries. While some high‐income countries have seen improvements in outcomes, many low‐ and middle‐income countries and Pacific island nations continue to experience a growing disease burden driven by obesity, diabetes and limited access to healthcare. These findings highlight the need for better prevention and early detection strategies to reduce future disease impact.

6. Achieving protease substrate-specific inhibition by mAb dual functional selections.

期刊: Protein science : a publication of the Protein Society 发表日期: 2026-Jul 链接: PubMed

摘要

Proteases are promiscuous enzymes acting on multiple substrates. Inhibiting pathogenic proteolysis while sparing physiological ones is essential for the development of effective and safe inhibitors. By engineering β-lactamase and levansucrase as selection and counterselection markers in E. coli periplasm, this study established functional positive and negative selections for the facile discovery of protease inhibitory mAbs rendering substrate specificity. Isolated anti-matrix metalloproteinase (MMP)-14 inhibitory mAbs exhibited nanomolar binding affinities and inhibitory potencies, exclusive selectivity, high proteolysis stability, and substrate-specific (SS) inhibition, that is, blocking MMP-14 mediated proteolysis of pro-tumorigenic syndecan-1 (Sdc-1) while allowing cleavage of anti-inflammatory macrophage chemoattractant protein 3 (MCP-3). Mechanistic studies suggested that the isolated Fabs were active-site competitive inhibitors and their substrate specificity was achieved by recognizing the protease’s prime subsites shared with Sdc-1 but distinct to that of MCP-3. Given the pharmaceutical significance of SS inhibition, we envision the dual functional selection can be widely applicable to important protease targets.

7. Beyond Only Statistical Significance: Understanding and Applying the Minimal Clinically Important Difference in Clinical Research - A Review.

期刊: American journal of physical medicine & rehabilitation 发表日期: 2026-Jun-22 链接: PubMed

摘要

Clinically meaningful outcomes require more than statistical significance; they must also represent an actual benefit to patients. The minimum clinically important difference (MCID) is the smallest change in a patient-reported outcome measure (PROM) that is clinically significant to the patient. Despite the growing use of PROMs in clinical research, considerable variability exists in how MCID is defined, calculated, and interpreted across populations and clinical contexts. The objective of this review is to provide a comprehensive summary of the various methods for estimating and interpreting MCID, including distribution-based, anchor-based, and Delphi approaches, and to discuss their relationship with statistical significance in clinical practice. A literature search was conducted using Web of Science, MEDLINE, Embase, PubMed, and Google Scholar. MCID values may vary depending on the patient population, clinical context, and the PROM administered. Each calculation methodology has its strengths and limitations in evaluating clinically meaningful change from baseline to post-treatment. It is recommended to report both a statistically significant difference, defined as P < 0.05, or equivalently a 95% confidence interval (CI) that excludes the null value (i.e., does not include 0 for mean differences or 1 for odds ratios), and a clinically meaningful difference, defined as an effect size meeting or exceeding the established MCID for the outcome measure. Reporting the effect estimate alongside its 95% CI is encouraged as the primary approach, as this conveys both the magnitude and precision of the finding.

8. Factor Structure of the EDE-Q in Inpatients With Anorexia Nervosa: Stability Over the Course of Inpatient Treatment.

期刊: The International journal of eating disorders 发表日期: 2026-Jun-20 链接: PubMed

摘要

The Eating Disorder Examination-Questionnaire (EDE-Q) is one of the most widely used measures of eating disorder psychopathology; however, its original four-factor structure is not supported in data-driven investigations. This study examined the latent structure of the EDE-Q in a large sample of inpatients with anorexia nervosa (AN) at the beginning and end of hospitalization. Inpatients with AN (ages 13-64 years) were included. Exploratory factor analysis (EFA) was conducted using EDE-Q data collected at admission (n = 320). Confirmatory factor analysis (CFA) was conducted using data collected just prior to discharge (n = 301). Reliability was assessed using internal consistency indices and construct validity of the proposed EDE-Q subscales was explored using correlational analyses with the eating disorder inventory (EDI) and the eating pathology symptoms inventory (EPSI). The original four-factor structure was not supported. A three-factor model (Body Image Dissatisfaction, Discomfort with Body Exposure, and Restrictive Eating Concerns) emerged from the EFA and was supported in CFA with improved model fit (CFI = 0.928, TLI = 0.915, RMSEA = 0.087, SRMR = 0.055). The model showed acceptable internal consistency and convergent validity. The EDE-Q was found to have a three-factor structure, comprising two body image-related domains and one domain assessing restriction and concern about eating. Findings support the emergence of a distinct factor capturing discomfort with body exposure, independent of body dissatisfaction. This highlights the need for empirically derived subscales that better disentangle overlapping eating disorder constructs.

9. High interobserver variability exists in grading appendiceal goblet cell adenocarcinoma using World Health Organization 5th edition criteria.

期刊: Histopathology 发表日期: 2026-Jun-20 链接: PubMed

摘要

Appendiceal goblet cell adenocarcinoma (GCA) is an uncommon malignancy that has been described under various names and grading schemes. The 5th Edition of the World Health Organization (WHO) Classification of Digestive System Tumours provides a three-tiered system for grading these neoplasms, but the reproducibility of this classification scheme has not been studied. We scanned 58 H&E-stained slides from 20 GCA and circulated the whole-slide images among seven pathologists with interest in appendiceal pathology. They evaluated each slide for the presence of 15 histological patterns defined by the WHO as criteria for low-grade (n = 5) and high-grade (n = 10) GCA. Cases were also evaluated for the presence of extracellular mucin. Participants also reported the percentage of high-grade features in each whole slide image and each case. Interobserver variability was assessed statistically. All seven observers agreed on the WHO grade for four of the 20 cases (20%; one grade 1, three grade 3). Using Fleiss’s kappa statistic, overall agreement for cases was fair at 0.29 (95% confidence interval [CI]: 0.14-0.44), and pairwise agreement between observers ranged from 0.00 to 0.82 (median = 0.13). Gwet’s agreement coefficient ranged from 0.10 to 0.87 (median = 0.28), while overall agreement was 0.36 (95% CI: 0.17-0.54). There was significant variability with respect to assessing the presence of individual features. The best agreement was seen for extracellular mucin (neutral feature, κ = 0.43) and tumour sheets (high-grade feature, κ = 0.41), whereas the worst agreement was seen for mild architectural disarray/tubular fusion (low-grade feature, κ = 0.05) and necrosis (high-grade feature, κ = 0.07). We conclude that interobserver agreement for grading GCA using the three-tiered WHO 5th Edition classification system is fair at best. A validated two-tiered system (i.e. low- versus high-grade) may be more reproducible.

10. Prevalence and Patterns of Multiple Injuries Affecting a Single Permanent Tooth (Combination Injuries): A Systematic Review and Meta-Analysis.

期刊: Dental traumatology : official publication of International Association for Dental Traumatology 发表日期: 2026-Jun-20 链接: PubMed

摘要

Combination injuries or multiple traumatic dental injuries (TDI) affecting a single permanent tooth are clinically significant but remain underrecognized. Although the global prevalence of TDI is well documented, the epidemiology of combination injuries has not been clearly established. This systematic review and meta-analysis aimed to assess the prevalence and patterns of combination injuries in traumatized permanent teeth. A review protocol was registered in PROSPERO (CRD1245967). Comprehensive searches of PubMed, EMBASE, Web of Science, and Scopus were conducted without language or date restrictions on December 4, 2025. Observational studies done in clinical settings involving patients older than 6 years with TDI in permanent teeth and reporting combination injuries were included. Two authors independently performed screening, data extraction, and risk of bias assessment using the Joanna Briggs Institute checklist. Random-effects meta-analyses were performed to estimate pooled prevalence and proportions of specific injury combinations. The certainty of evidence was evaluated using the GRADE framework. Thirty studies from 20 countries were included. Among 34,382 traumatized permanent teeth, 7161 presented with combination injuries. Reported prevalence ranged from 2.36% to 48.28%, with a pooled prevalence of 14% (95% CI: 11%-19%; I2 = 98.2%). Denmark demonstrated the highest pooled prevalence among countries represented by multiple studies. The most frequently reported combinations were enamel-dentin fracture with subluxation (25%) and enamel-dentin fracture with concussion (17%). Reporting terminology varied considerably, and many studies did not explicitly document combination injuries. While most studies had a low risk of bias, the overall certainty of evidence was very low. The pooled prevalence of combination injuries was 14%, with the highest country-specific prevalence reported in Denmark, and the most common pattern being enamel-dentin fracture combined with subluxation. Considerable variation in reporting terminology and the very low certainty of evidence highlight an urgent need for standardized nomenclature, calibrated diagnostic protocols, and well-designed studies to accurately capture the complexity of these injuries.

11. 'I Took TB Medicine for Six Months Without Having TB': Personal and Institutional Factors Affecting Trust in Healthcare Among African Immigrants in Florida, United States.

期刊: The International journal of health planning and management 发表日期: 2026-Jun-20 链接: PubMed

摘要

The lack of healthcare trust is strongly associated with low rates of access and utilization of care, adherence to medical advice, and adverse health outcomes, especially among vulnerable populations. We used a descriptive qualitative design and employed thematic analysis to examine the contributing factors to the lack of trust in healthcare among African immigrants in Florida, US. We conducted in-depth interviews with 19 participants selected through purposive and snowball sampling. The interviews were audio-recorded, transcribed verbatim, and thematically analysed using Nvivo14 software. The findings revealed two overarching themes: (a) personal and (b) institutional factors of lack of healthcare trust. Personal factors included language and communication challenges, lack of knowledge, past negative healthcare experiences, fear of losing legal status, and the use of traditional medicine and prayer as a substitute for modern medicine. Institutional factors included providers’ lack of knowledge, wrong assumptions and ignorance, lack of diversity in healthcare, repeated tests and burdensome documentation, malpractice, lack of financial transparency and unfair cost, over-medicalisation, racial divide and discrimination, and unfavourable policy conditions. The findings suggest a holistic approach that involves improving healthcare navigation skills among African immigrants; adopting a patient-centred approach; enhancing health literacy; strengthening cultural competency training and education on tropical medicine for healthcare providers; promoting diversity within the healthcare workforce; and engaging in anti-racism practices that ensure provider accountability. It is also critical to promote policies that ensure financial transparency and coordinated care, reduce unnecessary testing and documentation, and promote safe and equitable access to healthcare for African immigrants.

12. Recent hydromorphone injection and risk of incident infective endocarditis among people who inject drugs in Toronto, Canada: a cohort study.

期刊: Harm reduction journal 发表日期: 2026-Jun-20 链接: PubMed

摘要

People who inject drugs (PWID) are at increased risk of infective endocarditis (IE). While opioid injection is a major risk factor for IE, the risk associated with specific prescription opioids, such as hydromorphone, remains unclear and is inconsistently reported, despite a hypothesized pathway whereby the insolubility of controlled-releaseformulations may promote injection equipment reuse and bacterial contamination. Therefore, we estimated and compared the 1-year incidence rates of IE among PWID reporting injection of hydromorphone versus non-hydromorphone opioid medications and versus other opioids/drugs. Baseline questionnaire data on PWID in the Ontario Integrated Supervised Injection Services cohort (November 2018-March 2020) were linked to health administrative databases. IE incidence was calculated over 1-year post-baseline. Participants were followed until first of IE, death, or 1-year censoring. Exposure was self-reported recent (past 6 months) injection of: hydromorphone, non-hydromorphone opioid medications of interest, or other opioids/drugs. Cox regression estimated associations, adjusting for age, gender, ethnicity, injection drug use, and prior injection-related infections. Among the 514 participants included, 191 reported recent injection of hydromorphone, 32 non-hydromorphone opioid medications of interest, and 291 other opioids/drugs. IE incidence rates were low across groups: 1.6, 3.3, and 1.8 per 100 person-years. Adjusted hazard ratio comparing recent hydromorphone injection versus non-hydromorphone opioid medications of interest was 0.64 (95% confidence interval (CI) 0.06-6.53); versus other opioids/drugs was 0.82 (95% CI 0.19-3.51). In this cohort of PWID, no clear association was found between hydromorphone injection and IE when compared to non-hydromorphone opioid medications or to other opioids/drugs. Due to low event rates and the resulting wide CIs, the findings are limited by low statistical precision. Further research with larger cohorts is warranted to quantify IE risk of specific injected drugs among PWID.

13. Prevalence and risk factors of home delivery among rural women: evidence from 28 African countries.

期刊: Reproductive health 发表日期: 2026-Jun-20 链接: PubMed

摘要

Home delivery continues to be a significant factor contributing to maternal mortality in Africa, particularly among rural women with limited access to skilled birth attendants and healthcare facilities. Factors influencing home delivery operate at individual, household, and community levels. Therefore, this study aimed to examine the prevalence and risk factors of home delivery among rural women in 28 African countries. This retrospective cross-sectional study analyzed the most recent Demographic and Health Surveys (2011-2024) from 28 African countries. The weighted sample included 103,011 rural women of reproductive age. We performed descriptive analysis, chi-square tests, and binary logistic regression. Results are presented as frequencies, percentages, and odds ratios (ORs) with 95% confidence intervals (CIs). Statistical significance was set at p < 0.05. The overall prevalence of home delivery among rural women in Africa was 34.01% [95% CI: 23.33%-35.26%], ranging from 5.91% in Rwanda to 85.19% in Chad. Women with mistimed pregnancy [aOR = 0.79, 95% CI = 0.76-0.82] and those with unwanted pregnancy [aOR = 0.86, 95% CI = 0.81-0.92] had lower odds of home delivery. Risk factors included having four or more births [aOR = 2.04, 95% CI = 1.91-2.17], no/other religion [aOR = 2.41, 95% CI = 2.24-2.56] and those in Central Africa [aOR = 2.09, 95% CI = 1.98-2.19]. This research reveals that home delivery remains prevalent among rural women in Africa, with significant between-country disparities. Key risk factors include high parity, no/other religion, and Central African residence. Programs should prioritize multiparous women and expand maternal health services across all religious groups. Additionally, context-specific policies and targeted investments are needed in Central Africa to address regional disparities.

14. Social psychological dimensions of physical activity: a state-of-the-art review of reviews.

期刊: Health psychology review 发表日期: 2026-Jun-20 链接: PubMed

摘要

The purpose of this state-of-the-art review of reviews was to unify, describe and appraise the relationship between physical activity (PA) and social psychological constructs, using the social dimensions of health behavior (SDHB) framework, which represents a taxonomy of 10 social dimensions applicable to health behaviors. Eligible reviews were published in a peer-reviewed journal in English, included a review in which PA was operationalized as a focal predictor or outcome variable and with data also reported on at least one social construct reported in the results, and published between 2010 and July 2025. Literature searches were completed in August 2025 using seven common databases. The search yielded 54 reviews. We identified limited evidence for reviews of experimental research. Reviews of observational quantitative studies showed associations between PA with injunctive norm, perceived social support, and attachment ties with meta-analysis point estimates in the small, positive effect size range. Reviews of qualitative studies revealed positive associations with PA that covered the entire SDHB framework, yet most were conducted on specific populations so generalizability was not clear. The findings show domains in need of further examination to address gaps in knowledge, opportunities for theoretical integration, and highlight key social dimensions important in PA promotion.

15. Association between physical activity and sociodemographic and behavioural factors among physical education students at a Brazilian public university.

期刊: BMC public health 发表日期: 2026-Jun-20 链接: PubMed

摘要

This study aimed to analyze the prevalence of physical activity and its association with sociodemographic factors and lifestyle indicators among physical education students at a Brazilian public university. This was a cross-sectional observational study with a quantitative approach. A total of 190 students enrolled in on-site undergraduate programs (teacher training and bachelor’s degree) participated, with a mean age of 21.2 ± 4.5 years; 52.1% were men and 47.9% were women. Data were collected in person using an electronic form (Google Forms) comprising sociodemographic variables, physical activity level (IPAQ-short version), and the Fantastic Lifestyle questionnaire. The primary outcome was physical activity level, classified as active (≥150 min/week of moderate-to-vigorous physical activity [MVPA]) or inactive (<150 min/week of MVPA). Sociodemographic characteristics and lifestyle-related variables, including overall lifestyle, diet, smoking, alcohol consumption, leisure, sleep, and health perception, were examined as independent variables associated with physical activity level. Analyses were performed using SPSS version 21.0, employing descriptive statistics, chi-square/Fisher’s exact tests, and binary logistic regression (Odds Ratio - OR; 95%CI; p ≤ 0.05). Among participants, 94.2% were classified as physically active; 82.6% presented an adequate lifestyle; and 37.9% were classified as overweight or obese according to BMI. No significant associations were observed between physical activity level and sociodemographic or behavioural variables, except for health perception, which was significantly associated with physical inactivity. Negative health perception was the only factor associated with physical inactivity (OR = 14.30; 95%CI: 2.48-82.22; p = 0.003), suggesting that subjective health perception may be more strongly associated with physical inactivity than sociodemographic or behavioural characteristics among future health-promotion professionals. In summary, physical education students demonstrated a high prevalence of physical activity and a predominantly adequate lifestyle. Negative health perception was the only factor associated with physical inactivity. Future investigations are encouraged to include additional variables to provide a broader analytical perspective.

16. Aging trends, challenges, and policy framework within the Ghanaian context: a systematic review.

期刊: BMC public health 发表日期: 2026-Jun-20 链接: PubMed

摘要

Population aging has received considerable attention across economies presenting significant social, economic, and health challenges. While research has focused on demographics and health, limited attention has been given to the context, processes and outcomes of active aging in Ghanaian society. An exploration into this is essential to understanding the underlying dynamics between social stability, socioeconomic growth, health promotion and quality of life of older adults in Ghana. We conducted a systematic review to compile and report on existing empirical evidence on population trends, age-related health issues, available support systems, and needs of older adults in Ghana to inform age-friendly services and policies. In accordance with PRISMA guidelines, we screened peer-reviewed articles published between 2015 and 2025 using search terms related to aging in Ghana. Through thematic synthesis, four themes were identified - health utilization, health status, social support, and policy implications. Older adults who had better emotional, relational, and instrumental support from family and the community demonstrated higher levels of wellbeing, greater use of healthcare services, and reduced feelings of social isolation. Individuals reported unmet needs in food insecurity, financial hardship, lack of assistance with daily activities, and limited access to healthcare. Furthermore, older adults who reported multiple chronic conditions reported high levels of functional disabilities and physical difficulties. This review underscores an immediate, coordinated policy intervention and research action to prepare Ghana for its next demographic phase. Priority action should focus on enhancing healthcare access, fostering social inclusion and promoting community engagement among older adults in Ghana to improve their quality of life.

17. Evaluating emerging amyloid-β centric drugs for the treatment of Alzheimer's disease.

期刊: Expert opinion on emerging drugs 发表日期: 2026-Jun-20 链接: PubMed

摘要

The amyloid cascade hypothesis provided a compelling rationale for Alzheimer’s disease (AD) drug development, but many amyloid-β (Aβ)-targeted agents failed to show benefit. The present review article evaluated emerging Aβ-directed therapies, focusing on mechanisms, clinical efficacy, safety, and regulatory progress. The recent approvals of lecanemab and donanemab offered the first convincing evidence that reducing Aβ burden can modestly slow cognitive decline in early AD. Beyond these first-generation monoclonal antibodies, the pipeline includes next-generation antibodies with enhanced brain penetration (trontinemab), therapies designed also for presymptomatic intervention (remternetug tested for secondary prevention), and novel approaches targeting galectin-3 to disrupt Aβ aggregation and neuroinflammation. Active immunotherapies like UB-311 and small molecules such as ALZ-801, avoiding amyloid-related imaging abnormalities (ARIA), broaden the therapeutic horizon with potentially safer and more accessible options, but with no proven efficacy. Clinical benefits for Aβ-centric therapies are modest, ARIA pose ongoing safety concerns, and high costs coupled with intensive monitoring limit accessibility. Regulators have begun to restrict approval to genetically defined subgroups according to apolipoprotein E genotype, underscoring the need for precision medicine. Therefore, while Aβ-centric therapies are incremental, they represent essential steps toward combination and precision strategies in the treatment of AD. Alzheimer’s disease (AD) is a growing global health problem, with no cure currently available. Most existing treatments only relieve symptoms and do not slow the underlying disease process. One of the earliest and most important biological changes in AD is the buildup of amyloid-β (Aβ), a protein that forms plaques in the brain. For this reason, many new drugs have been designed to remove Aβ or prevent it from accumulating. In recent years, several Aβ–targeting therapies have shown that they can successfully reduce amyloid plaques in the brain. These include monoclonal antibodies given by infusion or injection, vaccines that stimulate the immune system, and oral drugs designed to block the formation of toxic Aβ species. Some of these treatments have reached late-stage clinical trials, and a few have received regulatory approval in certain regions. However, while these drugs clearly reduce amyloid levels, their effects on memory and daily functioning are modest, especially when used after symptoms have already appeared. In addition, treatment can be associated with side effects such as brain swelling or small brain bleeds, requiring frequent medical monitoring, costly for healthcare systems. Most evidence so far comes from carefully controlled randomized clinical trials, and real-world experience remains limited. Current research is therefore shifting toward earlier treatment, including prevention in people at high risk, improved drug delivery methods, and combination approaches that also target other disease processes such as tau pathology, inflammation, and vascular or metabolic changes. New blood-based biomarkers are also making it easier to diagnose AD earlier and to select patients more precisely. Overall, Aβ–centered therapies represent an important scientific advance, but they are unlikely to be sufficient on their own. Future progress in AD treatment will depend on better understanding how amyloid may interact with other brain changes, identifying the right patients at the right time, and developing safer, more affordable, and more comprehensive therapeutic strategies.

18. Cognitive and Executive Function Profiles in School‑Age Children with Obstetric Brachial Plexus Injury.

期刊: Physical & occupational therapy in pediatrics 发表日期: 2026-Jun-20 链接: PubMed

摘要

To evaluate cognitive and executive function (EF) in children with obstetric brachial plexus injury (OBPI), and the potential effects of injury severity and surgical intervention. Fifty-two children aged 6-12 years were assessed: 30 with OBPI (Type IIa: n = 10, Type IIb: n = 11, Type III-IV: n = 9) and 22 children with typical development. Cognitive function was measured using the Dynamic Occupational Therapy Cognitive Assessment for Children (DOTCA-Ch), and EF was assessed via parent-reported Childhood Executive Functioning Inventory (CHEXI). Non-parametric tests and subgroup analyses were conducted, with false discovery rate (FDR) correction applied for multiple comparisons. Children with OBPI scored significantly lower on total and domain-specific DOTCA-Ch measures (median [IQR]: 85 [72-95] vs. 125 [115-135]; q = 0.002), with large effect sizes (Cliff’s δ = -0.82 to -0.90). No significant differences were found in CHEXI EF composites. Subgroup analyses showed no statistically significant effects of surgery or Narakas classification, although trends indicated potentially poorer cognitive outcomes in children with Narakas type III-IV. Children with OBPI had lower cognitive function than children with typical development but there was no difference in EF. Findings support integrating cognitive assessments into management of children with OBPI.

19. RNU4ATAC-opathy: Clinical, molecular and transcriptomic insights from a large cohort.

期刊: Genetics in medicine : official journal of the American College of Medical Genetics 发表日期: 2026-Jun-19 链接: PubMed

摘要

We aim to better define the genotype and phenotype spectrum of RNU4ATAC-opathy, demonstrate the utility of RNA sequencing for variant classification, and highlight challenges in detecting variants in this noncoding gene. Sixty individuals with molecularly confirmed RNU4ATAC-opathy were recruited from multiple clinical and research centers internationally. RNA sequencing was available for seven affected individuals. We report the clinical and molecular findings of 60 individuals, including 42 not previously described, and 33 distinct RNU4ATAC variants, 13 of which are novel. Core features in this cohort-present in most individuals assessed and varying in severity-include microcephaly, short stature, skeletal anomalies, developmental delay, cerebral anomalies, skin conditions and immune deficiency. Additional findings such as diabetes, holoprosencephaly, and absence of various core features in some individuals highlight the broad phenotypic spectrum. All individuals with RNA sequencing showed a consistent pattern of minor intron retention. In six, RNA-seq enabled reclassification of variants of uncertain significance as likely pathogenic. While RNU4ATAC variants are generally covered by clinical exomes, they are often overlooked in analysis due to the noncoding nature. This study further highlights the variability of phenotypes and genotypes associated with RNU4ATAC-opathy. Laboratories should ensure RNU4ATAC and other noncoding genes are appropriately assessed by their analysis pipelines.

20. Expanding the clinical spectrum of RNU4ATAC-opathies: more frequent and diverse than assumed.

期刊: Genetics in medicine : official journal of the American College of Medical Genetics 发表日期: 2026-Jun-19 链接: PubMed

摘要

Biallelic variants in the minor spliceosomal gene RNU4ATAC were successively identified in Taybi-Linder/MOPD1 (Microcephalic osteodysplastic primordial dwarfism type I), Roifman, and Lowry-Wood syndromes, characterized by variable microcephaly, short stature, neurodevelopmental impairment, skeletal dysplasia, and immunodeficiency. Two-thirds of the reported individuals present with Taybi-Linder syndrome, the first described and most severe form. We collected clinical and molecular data from individuals with biallelic RNU4ATAC variants through various French and European networks and clinics, to refine the phenotypic spectrum of RNU4ATAC-opathies. We enrolled 69 participants and identified 18 new pathogenic variants. We report a significant proportion of attenuated/atypical presentations, novel rare symptoms, and, unexpectedly, a broad spectrum of autoimmune/inflammatory manifestations, affecting nearly half of the participants. Integrating our data with the 109 published cases, we propose a novel classification based on the main manifestations, immunodeficiency and microcephalic primordial dwarfism. Using computer-assisted facial analysis, we also demonstrated the existence of a specific dysmorphic pattern in RNU4ATAC-opathies, distinct between some sub-syndromes. We present a large cohort of individuals with RNU4ATAC-opathies and expand the phenotypic spectrum to pauci-symptomatic forms, indicating that these diseases are likely to remain underdiagnosed.

21. Uncomplicated Malaria in Infancy and Neurodevelopment at 1 and 6 Years: Evidence From the MiPPAD Birth Cohort Study of Benin.

期刊: Tropical medicine & international health : TM & IH 发表日期: 2026-Jun-19 链接: PubMed

摘要

In malaria-endemic regions, repeated episodes of uncomplicated malaria during infancy are common; however, their associations with neurodevelopment remain unclear. We examined relationships between malaria frequency in infancy and neurodevelopmental outcomes in early and middle childhood, using data from the APEC birth cohort nested within the MiPPAD birth cohort study of Benin. Children were enrolled between January 2010 and June 2011 and followed from birth to 24 months of age. Malaria was assessed at scheduled visits at 6, 9 and 12 months using both PCR and microscopy, and at unscheduled visits for symptomatic episodes using only microscopy; haemoglobin was measured concurrently. Neurodevelopment was assessed at age 1 and 6 years. Analyses included 311 children at 1-year and 248 at 6-year assessments. Malaria exposure was defined as the number of episodes from birth to 1-year neurodevelopmental assessment for three measures: (i) total malaria (PCR- or microscopy-positive), (ii) symptomatic malaria (positive with fever) and (iii) malaria with anaemia (positive with haemoglobin < 11.0 g/dL). Associations with neurodevelopment and haemoglobin’s mediating role were assessed using adjusted generalized linear models and mediation analysis. We found that a higher number of symptomatic malaria episodes during infancy was associated with lower motor scores at age one (β: -2.81, [-4.73, -0.89]) and age six (β: -1.43, [-2.65, -0.22]), partially and potentially mediated by haemoglobin concentration. Malaria with anaemia was associated with lower motor scores at age one (β: -1.57, [-3.04, -0.10]) and age six (β: -0.96, [-1.86, -0.05]). No consistent associations were observed with cognitive outcomes. These findings indicate that uncomplicated malaria in infancy is an important risk factor for impaired child development and should not be overlooked. Integrating anaemia screening and management into malaria control and routine child health services may help mitigate long-term developmental impacts in malaria-endemic settings.

22. Chromosomal and immune dysregulation underlying granular mitosis in glioblastoma.

期刊: Brain pathology (Zurich, Switzerland) 发表日期: 2026-Jun-19 链接: PubMed

摘要

Granular mitosis (GM) is a distinctive form of atypical mitosis characterized by dispersed chromosomal granules within the mitotic figure. Although described morphologically in glioblastoma, its molecular etiology has remained unknown. Data from The Cancer Genome Atlas (TCGA) Glioblastoma Multiforme cohort was analyzed. AI-assisted digital pathology was used to annotate mitotic figures, including GM, on hematoxylin and eosin-stained whole-slide images. Corresponding transcriptomic and genomic data were subjected to differential gene expression and copy number variation (CNV) analyses, followed by overrepresentation testing to identify enriched biological pathways. Clinical data were correlated to assess associations with molecular and pathological findings. Validation was performed on an independent glioblastoma cohort using immunohistochemistry. Sixty-three glioblastoma cases were included (32 GM-positive, 31 GM-negative). Transcriptomic analysis identified 185 differentially expressed genes (FDR <0.05; log2FC >1.5). GM-positive tumors demonstrated broad downregulation of genes involved in nucleosome assembly, protein-DNA complex organization, and centromeric differentiation, alongside significant suppression of PI3K-Akt signaling (p = 5.58 × 10-5). Unexpectedly, immune-related pathways-including Neutrophil extracellular trap (NET) formation and Cytokine-cytokine receptor interaction-were similarly underexpressed, indicating global suppression of innate immune signaling in GM-positive glioblastomas. Two CNVs were associated with a higher proportion of GM, demonstrating chromosomal fragility. Immunohistochemistry revealed a significantly higher density of immune cells, particularly macrophages and antigen-presenting cells, in close proximity to granular mitoses. Spatial correlation analysis demonstrated positive correlations between GM distribution and immune cell density across tumor regions. This study provides the first comprehensive molecular characterization of granular mitosis in glioblastoma. The findings link GM morphology to chromosomal disorganization, PI3K/PTEN pathway alterations, and impaired innate immunity, suggesting that GM represents a histologic correlate of centromeric stress and immune impairment in glioblastomas. Notably, granular mitoses are associated with localized immune cell enrichment and exhibit a positive spatial correlation with immune cell density within their microenvironment.

23. Lower Risk of Developing Gestational Diabetes Mellitus in the Group Prenatal Care Model.

期刊: Paediatric and perinatal epidemiology 发表日期: 2026-Jun-19 链接: PubMed

摘要

Gestational diabetes mellitus (GDM) is a common pregnancy complication with both short- and long-term adverse outcomes for both mothers and their offspring. CenteringPregnancy group prenatal care (CPNC) model has gained popularity due to its unique design to support pregnant individuals in managing multiple risk factors during pregnancy. However, whether participation in CPNC reduces the risk of developing GDM remains uncertain. To compare the GDM incidence between pregnant individuals receiving CPNC and those receiving traditional individual prenatal care (IPNC). This retrospective cohort study included 8313 participants (CPNC: 1832; IPNC: 6481) from South Carolina. GDM was screened and diagnosed between 24 and 30 weeks of gestation with the two-step approach. We applied inverse probability of treatment weighting (IPTW) using stabilized propensity score (PS) weights. The weighted risk ratio (RR) of CPNC relative to IPNC for GDM was estimated using weighted marginal log-binomial models. In the original cohort, the incidence of GDM was 4.7% in the CPNC group and 6.8% in the IPNC group. After applying stabilized IPTW, baseline characteristics were well balanced between groups. In the weighted pseudo-cohort, CPNC was associated with a lower risk of GDM compared with IPNC (RR 0.64, 95% confidence interval [CI] 0.51, 0.81). In subgroup analyses, this inverse association was observed among non-Hispanic White (RR 0.61, 95% CI 0.43, 0.86) and non-Hispanic Black participants (RR 0.69, 95% CI 0.47, 1.00), but not among Hispanic participants (RR 1.05, 95% CI 0.62, 1.77). Results from multivariable logistic regression in the original cohort were consistent in direction but less precise. There was no evidence of additive interaction by race/ethnicity. Pregnant individuals receiving CPNC had a lower risk of developing GDM than those receiving IPNC.

24. Do Mobile Phone Surveys Supplement Other Mortality Surveillance Methods? Results From a National Study in Bangladesh.

期刊: Tropical medicine & international health : TM & IH 发表日期: 2026-Jun-19 链接: PubMed

摘要

To test whether mobile phone surveys conducted remotely might generate data on deaths that are not covered by mortality surveillance systems established in laboratories and health facilities, or in institutions involved in the post-mortem management of corpses (e.g., morgues, cemeteries). We conducted a national survey of mobile phone users in Bangladesh during the COVID-19 pandemic. Respondents were asked to list the deaths that had occurred in their household in recent years. For each death, they were also asked to indicate whether the deceased had been diagnosed with COVID-19 prior to death, whether the death occurred at home or at a health facility, and where the burial took place. Using these data, we represented the overlap between data generated by the mobile phone survey and several potential mortality surveillance systems, which focus on counting deaths in health facilities or communal cemeteries. We described the socio-demographic characteristics of the deaths that were uniquely recorded by the mobile phone survey. From December 2021 to July 2022, 506,659 calls were placed, resulting in 22,731 interviews completed by mobile phone. Respondents reported 1527 deaths that had occurred in their household since 2020. Among those deaths, 99 (6.5%) had received a pre-mortem diagnosis of COVID-19. The proportion of reported deaths that were not covered by other potential mortality surveillance systems, was 32.4% in the large city corporations of Dhaka and Chittagong, 36.3% in other urban areas and 49.6% in rural areas. In urban areas, deaths among men, as well as among youth and the elderly, were more likely to be covered solely by the mobile phone survey. Mobile phone surveys can potentially remedy gaps in the data generated by other recommended mortality surveillance methods.

25. Can the Parallel or Tandem Combination of Questionnaire-Based Risk Assessment and Fecal Immunochemical Test Improve the Efficiency of Colorectal Cancer Screening?

期刊: International journal of cancer 发表日期: 2026-Jun-19 链接: PubMed

摘要

Colorectal cancer (CRC) screening reduces disease burden, but the comparative performance of various screening strategies remains unclear. We evaluated the performance of four screening strategies based on questionnaire-based risk assessment (QRA) and fecal immunochemical test (FIT), followed by colonoscopy. In this population-based study, 14,327 residents aged 40-74 years from 13 regions in Shandong Province, China, were invited to undergo QRA, FIT, and colonoscopy between January 2024 and December 2025. Based on test results, we constructed four strategies: QRA-only, FIT-only, parallel (QRA or FIT positive), and tandem (QRA and FIT positive) combinations. The detection rate of CRC and advanced adenoma (AA), number needed to scope (NNS), and cost per case detected were compared. In total, 4982, 1806, 5970, and 764 individuals were identified as high-risk for each strategy. The tandem strategy detected 33 CRCs (4.32%) and 199 AAs (26.03%), compared with 35 (0.71%) and 553 (11.22%) in the QRA-only strategy, 68 (3.77%) and 340 (18.86%) in the FIT-only strategy, and 70 (1.17%) and 694 (11.62%) in the parallel strategy. Across subgroups defined by older age, male, and early-stage disease, the tandem strategy consistently yielded higher detection rates. The NNS to detect one CRC was 141, 27, 86, and 24, and the corresponding costs per CRC detected were $9874.31, $2097.88, $7084.68, and $1700.71 for each strategy. The tandem strategy combining QRA and FIT demonstrated superior performance in CRC screening. In resource-constrained settings, tandem strategies that jointly integrate risk assessment and FIT may improve the allocation and utilization of screening resources.

26. Long-term evaluation of a comprehensive bullying prevention program starting in preschool: study protocol for a randomized controlled trial.

期刊: Trials 发表日期: 2026-Jun-19 链接: PubMed

摘要

Promoting mental health and psychological well-being from early childhood is a growing priority in global education policy. Bullying has emerged as a major threat to children’s well-being, and while most school-based interventions begin in late childhood or adolescence, research suggests that bullying-related behaviors and peer exclusion emerge as early as preschool. Yet, to date, no bullying prevention program has been rigorously evaluated from the beginning of schooling. This study aims to fill this gap by evaluating Vivre Ensemble-Fri for Mobberi (VE-FFM), a comprehensive, developmentally tailored bullying prevention and social-emotional learning (SEL) program implemented in French primary schools from preschool through elementary school. We will conduct a two-arm cluster-randomized controlled trial involving 210 French public schools and approximately 5250 children, recruited at age 3 and followed for 7 years. Schools will be randomly allocated to either the intervention group (VE-FFM) or a wait-list control group continuing with teaching-as-usual. VE-FFM is a universal, whole-school program targeting students, professionals, and families. It focuses on building inclusive peer communities and strengthening children’s social-emotional skills through structured group discussions, well-being activities, and SEL workshops. Primary outcomes include bullying and peer victimization. Secondary outcomes include psychological well-being, mental health difficulties, empathy, social skills, academic performance, teacher-child relationship quality, school belonging, subjective unsafety, perception of school kindness, and teacher job satisfaction. Data will be collected at six timepoints using teacher- and child-rated measures. Implementation fidelity will be monitored through teacher logs and recorded classroom sessions. This trial is the first to evaluate the long-term impact of a bullying prevention and SEL program beginning at preschool level. By embedding the intervention into the full span of early schooling, VE-FFM may produce stronger and more lasting effects than shorter-term interventions implemented at later stages. Results will inform educational and mental health policy by providing evidence on the effectiveness of early, community-based approaches to preventing bullying and promoting mental well-being. DRKS; DRKS00037553. Registered on 2025/09/11.

27. Preferences for rapid implementation science: a real-time discrete choice experiment.

期刊: Implementation science communications 发表日期: 2026-Jun-19 链接: PubMed

摘要

A persistent challenge in implementation science is the gap between the pace and priorities of academic research and the needs of decision-makers. While traditional research emphasizes methodological rigor, policymakers often require timely, relevant, and stakeholder-engaged evidence to inform decisions. We conducted a real-time discrete choice experiment (DCE) with participants at an implementation science conference in Washington, D.C. during a 75-minute session on rapid implementation science. At the midpoint of the panel, the audience were invited to participate in a 10-minute DCE based on a vignette describing a hypothetical study on implementing a new vaccine facing public hesitancy. Choice sets included six attributes: rapidity of study, study design, primary outcome, level of community engagement, leadership, and costs. We used a mixed logit model to analyze preferences in real time and presented results back to the audience at the end of the session. Ninety-four participants completed the DCE; all reported working in research and 83% reported working in program implementation. Respondents placed high value on timing of results, with strong preferences for receiving results in 6 months compared 12 months (β=-1.1, 95% CI: - 1.6- - 0.6; p < 0.001) and 18 months (β=-1.7,-2.3- - 1.0; p < 0.001). Participants preferred the primary outcome to be vaccine uptake rather than vaccine acceptability (β = 1.7, 1.1-2.2; p < 0.001) and the study to be community-engaged rather than expert-led (β = 1.6, 1.0-2.2; p < 0.001). We found no preference for randomization compared to before and after (p = 0.88), nor leadership by the ministry of health versus academic institutions (p = 0.12). Respondents were willing to wait 11.3 (95% CI 7.0-15.5) additional months for a program developed with engaged stakeholders compared to expert-driven (p < 0.001) and 11.9 months (95% CI 8.1-15.8) for results on vaccine uptake rather than acceptability (p < 0.001). This real-time DCE demonstrated that with adequate preparation, it is feasible-to generate robust, interpretable, and actionable results within an hour. Findings challenge the assumption that randomization is the highest priority in research design, highlighting instead the importance of outcome and community engagement. By aligning more closely with the values of decision-makers, rapid science approaches such as real-time DCEs may help bridge the research-policy gap.

28. An implementation strategy bundle to improve home visit quality of the national child development program in Brazil: an implementation feasibility trial.

期刊: Implementation science communications 发表日期: 2026-Jun-19 链接: PubMed

摘要

Programa Criança Feliz (PCF) is Brazil’s home visitation program aimed at enhancing early childhood development. Evaluations of the program have found significant program challenges and implementation barriers, including the lack of a structured curriculum, insufficient training, and little supervisory support. This study tests the revised content of the home visits and new implementation strategies aimed at addressing these barriers and enhancing the quality of PCF home visits. The implementation strategies were piloted across 8 diverse municipalities in an implementation feasibility trial. The strategy bundle included a 40-hour initial training for home visitors using demonstration and simulation-based methods (based on the Reach Up methodology), an 8-hour supervision-focused training module for supervisors, and standardized home visit guidelines and an activities compendium. The new strategies were assessed using a one group pre-post analysis along with mixed methods to assess the extent to which they were acceptable, feasible, and associated with a change in home visit quality. A paired t-test and an independent t-test analysis were used to assess the change in home visit quality. The implementation outcomes were assessed with qualitative analysis and the Framework Method approach. The proposed home visitation guidelines, material, training, and supervision process were determined to be highly acceptable, feasible, and associated with improved quality of home visits. The home visit quality scores significantly increased by 14.68 points (SD = 14.89, CI 95%: 7.27-22.08, p = 0.0006), according to the paired t-test. The study participants provide insightful suggestions for adaptations that can occur before testing the strategies more broadly. Key suggested adaptations included adjusting activity difficulty to individual developmental levels rather than age alone, shortening training duration to improve staff access, and incorporating guidance for culturally diverse and traditional communities. The findings suggest three transferable design principles for home visitation and paraprofessional-delivered public health programs: reducing excessive discretion through structured, age-appropriate visit guidance; externalizing quality through experiential training methods such as demonstration and role-play; and embedding feedback loops through structured supervision and monitoring. These principles may generalize to programs facing heterogeneous staff preparation, high turnover, and limited supervisory capacity.

29. Cancer care in conflict-affected regions: a scoping review of service delivery challenges, healthcare system adaptations, and policy implications.

期刊: Conflict and health 发表日期: 2026-Jun-19 链接: PubMed

摘要

Armed conflicts severely disrupt cancer care delivery, destroying infrastructure and limiting access to essential diagnostics and treatments. Evidence on service challenges, adaptations, and policy implications remains fragmented. This scoping review of four databases (Scopus, PubMed, ScienceDirect, and CINAHL) was conducted for original peer-reviewed studies published between January 2020 and August 2025. The search focused on the effect of wars on cancer service delivery in conflict zones, and its impact on cancer care. Wars in conflict-affected countries like Palestine, Sudan, Syria, Iraq, Ukraine, and Afghanistan caused widespread destruction of cancer infrastructure, unsafe hospitals, and interruptions in chemotherapy, radiotherapy, and surgery. Countries faced shortages of specialized centers, technicians/radiologists, and medical records, alongside high costs and supply chain disruptions. Despite these challenges, healthcare systems demonstrated resilience through adaptations including Ukraine’s MedEvac program for EU treatment evacuation, cross-border referrals (Iraq→Lebanon, Afghanistan→Pakistan), telemedicine, mobile diagnostic units, and community-based care models. Policy responses emphasized international aid coordination, conflict-sensitive health planning, and supply chain restoration. Conflicts cause infrastructure destruction, workforce depletion/migration, treatment barriers/delays, drug supply disruptions, and psychosocial/economic impacts, which in turn create urgent policy/governance challenges. Although humanitarian aid may provide temporary relief, sustainable solutions require peace and global commitment, grounded in equity and the fundamental right to health.

30. A scoping review of obesity policies and reimbursement landscape: global insights and lessons for Thailand.

期刊: Implementation science communications 发表日期: 2026-Jun-19 链接: PubMed

摘要

Obesity is one of the world’s leading health burdens. The prevalence of overweight and obesity continues to rise globally, creating significant healthcare and socioeconomic challenges. Effective strategies are essential to address this crisis. To thematically map global obesity management strategies and policies, focusing on policy- and system-level features relevant to national implementation, to inform context-sensitive policy considerations in Thailand and similar health systems. A scoping review was conducted to map global obesity management policies and identify key themes, challenges, success factors, and future directions. Electronic databases, including PubMed, EMBASE, and Scopus, were searched for relevant documents published between January 1, 2004, and June 30, 2024. The gray literature was also reviewed to assess the reimbursement status of obesity medications. The analysis identified three main policy domains: public policy, food security and healthy environments, and healthcare system support. Through the scoping review and thematic synthesis, 19 distinct policy themes were identified. High-income countries generally demonstrated more comprehensive and integrated strategies compared to middle-income countries. Regarding medical reimbursement for obesity treatment, coverage for bariatric surgery was more commonly available across settings, whereas reimbursement for anti-obesity medications remained limited. For example, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) were reimbursed for obesity indications in selected high-income countries, including Denmark and the United Kingdom. In contrast, in countries such as the United States, China, and Thailand (restricted to the Civil Servant Medical Benefit Scheme), these agents were reimbursed primarily for type 2 diabetes rather than for weight management. Integrated strategies that combine prevention and treatment, supported by interagency collaboration, are critical for effective obesity management. Additionally, designing policies that align with the social, cultural, and economic context of each country is crucial for achieving sustainable obesity management.

31. "That is why I trust": a qualitative study on acceptability and feasibility of novel tongue swab diagnostics to assess people presenting with tuberculosis symptoms in Viet Nam and Zambia.

期刊: BMC health services research 发表日期: 2026-Jun-19 链接: PubMed

摘要

Millions of tuberculosis (TB) cases are estimated to be undiagnosed and unreported annually. Sputum has been the primary approach for diagnostic testing, but tongue swabs are being investigated as an alternative to expand testing. To understand potential uptake and implementation, we explored the acceptability, usability, and feasibility of tongue swab-based TB testing from the perspectives of healthcare workers, people undergoing TB screening, and caregivers in Viet Nam and Zambia. We interviewed people with symptoms of TB, caregivers of children undergoing TB evaluation, and healthcare workers who collected tongue swabs (n = 76 participants) between September 2023 and February 2024. Interviews were analyzed using framework analysis to elucidate preferences, experiences, and acceptability of tongue swabs vs. sputum. Findings were further organized according to acceptability and feasibility to understand barriers and facilitators to uptake. Most participants preferred tongue swab to sputum collection. The perceived usability and feasibility of tongue swabs were high. Key themes that influenced the acceptability of tongue swabs included ease of use, diagnostic accuracy, diagnostic yield, hygiene, risk of TB transmission during sample collection, time to test result, and trust in healthcare workers and the health system. Across interviews, many participants described tongue swabs as a comfortable and easy way to test for TB, compared to the physical discomfort and difficulty expectorating sputum. Participants described tongue swabs as suitable for everyone, yet perceived diagnostic accuracy was crucial in shaping test preference. Tongue swab-based testing for TB is likely to be highly acceptable and feasible if incorporated into TB diagnostic guidelines. Future integration of tongue swabs in facilities and communities should target drivers of acceptability.

32. Standardized nursing terminologies in primary care: a qualitative approach to the experience of nursing professionals.

期刊: BMC nursing 发表日期: 2026-Jun-19 链接: PubMed

摘要

Standardized Nursing Terminologies are used to describe diagnoses, interventions, and care outcomes. This study explores the use of Standardized Nursing Terminologies among Primary Care nurses, particularly in the context of frailty syndrome, and identifies barriers to and facilitators of their integration into clinical practice. Descriptive-interpretive qualitative study with a phenomenological approach. Purposive and snowball sampling techniques were used to select 33 Primary Care nurses involved in healthcare, teaching, management, and research in Spain. Three focus groups and fourteen semi-structured interviews were conducted in 2024. The qualitative data were transcribed, aggregated, analysed, and interpreted using reflexive thematic analysis. Three 3 main themes related to the use of Standardized Nursing Terminologies were identified: (1) The value of a common language: professional autonomy; (2) From standardization to action: integration into clinical practice; and (3) Skills-building: towards Nursology. Participants described language standardization as a driving force for professional development and the use of real-world data in research. The NANDA-I, NIC, and NOC terminologies were the most widely used; however, they generated certain ambivalence due to their complexity, cost, and need for regular updates, and were seldom used in clinical practice. Study participants identified several facilitators of their use, such as their usefulness in structuring clinical reasoning, improving continuity of care, planning resources, and addressing complex care. They also identified barriers, primarily insufficient training, poor usability, scant enforcement, bureaucratic approach, and the absence of a clearly defined organizational strategy. In the context of frailty syndrome, Standardized Nursing Terminologies were reported to promote comprehensive care, although their use was limited, training scarce, and evidence of their impact lacking. Participants also referred to the role of Nursology in fostering research in person-centred, outcome-oriented care, and highlighted leadership as key to strengthening a professional identity based on a reflective and thoughtful-critical approach to nursing. Standardized Nursing Terminologies hold significant potential to transform nursing care; however, their integration into Primary Care remains limited. Frailty syndrome illustrates the gap between this potential and its practical implementation. Bridging this gap requires targeted training strategies, strong institutional support, and leadership committed to fostering person-centred, evidence-based practice.

33. Self-reported functional and mobility limitations in mid-life: a systematic review of prevalence and association with chronic health conditions.

期刊: BMC public health 发表日期: 2026-Jun-19 链接: PubMed

摘要

Middle age is increasingly recognized as a critical period for the emergence of functional and mobility limitations. However, no prior systematic review has synthesized prevalence or incidence data specifically for this age group. This review aimed to summarize epidemiological evidence on self-reported functional and mobility limitations among middle-aged adults and to examine their associations with chronic conditions. This systematic review was registered in PROSPERO (CRD420251038883) and conducted in accordance with PRISMA 2020 guidelines. A search of PubMed, Scopus, Embase, and Web of Science was performed for studies published between 2000 and 2025. Eligible studies included population-based samples of midlife-related adults reporting prevalence or incidence of functional and/or mobility limitations. When data were available, associations between these limitations and chronic conditions were also examined. Methodological quality was assessed using the Joanna Briggs Institute checklist, and risk of bias was evaluated using the tool developed by Hoy et al. Evidence certainty was assessed using GRADE. Due to conceptual and methodological heterogeneity, a meta-analysis was not performed and findings were synthesized narratively. Twenty-six population-based studies comprising over 500,000 participants from over 30 countries worldwide met the inclusion criteria. Reported prevalence of functional and mobility limitations varied widely by domain, instrument, and task. Across many studies, estimates fell within the range of 15% to 25%, while mobility limitation exceeded 40% in some settings. In studies assessing both domains, mobility limitations were generally reported more frequently than functional limitations. Chronic conditions were associated with functional and mobility limitations, particularly musculoskeletal pain and arthritis (Population-Attributable Risk [PAR]: 15.0%-38.3%), and multimorbidity (PAR: 12.0%-56.5%). In contrast, lower PAR estimates were reported for hypertension (3%). Most evidence was derived from cross-sectional studies, with heterogeneous age ranges and assessment tools, limiting comparability and causal inference. Functional and mobility limitations emerge during midlife worldwide and are associated with chronic conditions. The findings should be interpreted cautiously, given methodological variation across studies, including differences in measurement instruments, midlife age-group definitions, and outcome assessment, requiring standardization. Nevertheless, these findings may support earlier detection of functional and mobility changes and inform future prevention-oriented research and strategies. PROSPERO (CRD420251038883).

34. Uneven integration of health in China's territorial spatial planning 2035.

期刊: BMC public health 发表日期: 2026-Jun-19 链接: PubMed

摘要

Spatial planning plays a pivotal role in shaping the health and well-being of urban populations. Since 2016, most Chinese cities have incorporated health-related elements into their Territorial Spatial Planning (TSP) 2035 Schemes as part of national healthy city initiatives. It is essential to examine how health is represented in these statutory planning documents and whether the level of attention varies across cities. We developed an analytical framework for healthy city planning by synthesizing international scholarly literature and governmental policy documents. Using this framework, the TSP 2035 Schemes of 36 major Chinese cities were examined through a mixed-method design combining thematic dimension analysis, keyword network analysis, and disparity measures. All 36 cities have placed healthy city development on their planning schemes, focusing primarily on eight dimensions: (1) green and open space, (2) climate change and disaster response, (3) physical education (PE) facilities and public services, (4) environmental pollution prevention and control, (5) medical and health services, (6) elderly dimension, (7) health equity, and (8) healthy travel. Of these dimensions, green and open space along with climate change and disaster response receive the most emphasis. Notable healthy city keywords include ‘park’, ‘green space’, ‘healthcare’, ‘livability’, ‘sports’, ‘resilience’, ‘pollution control’, ‘disaster prevention’, ‘walking’, and ‘jogging’. Cross-city comparisons reveal substantial disparities: cities with higher administrative status generally articulated more extensive and more diverse health-related planning content, whereas many lower-tier cities pay relatively little attention to equity-sensitive dimensions. Health has become a visible component of statutory planning discourse in China, but its integration remains selective and uneven across cities. The results suggest that China’s healthy city development has reached an intermediate stage of “health promotion and education”, and in terms of health-spatial planning integration, China has moved beyond a narrow environmental health orientation, yet important gaps remain in equity-sensitive and people-centered dimensions. Recommendations include strengthening legislation to support healthy city planning, improving the openness and transparency of TSP 2035 Schemes, and more differentiated policy support across cities.

35. Representations of mpox in UK news media during the 2022 outbreak: a qualitative analysis.

期刊: BMC public health 发表日期: 2026-Jun-19 链接: PubMed

摘要

The 2022 global mpox outbreak was the first to involve sustained community transmission outside endemic regions, disproportionately affecting gay, bisexual and other men who have sex with men (GBMSM). News media plays a critical role during outbreaks by disseminating information, shaping public perception and influencing health protection behaviours. This qualitative study examined how UK news media represented mpox during the 2022 outbreak, with a particular focus on public health messaging and the discursive framing of affected communities. Using the NexisUK® database, we retrieved UK print and online articles mentioning “mpox”, “monkeypox”, or “monkey pox” in headlines, published between May and December 2022. Five national newspapers were selected based on readership and political stance (The Times/Sunday Times, The Guardian, The Sun, The Daily Mail/Sunday Mail and the Daily Mirror/Sunday Mirror). Following deduplication and screening, we applied a rotating weekday sampling frame and analysed articles thematically in NVivo. We identified 746 articles in the five selected newspapers between May and December 2022. Coverage peaked in May 2022 (n = 223 articles) and then waned, despite incident cases rising in June (n = 1,185) and July (n = 1,453). We analysed 79 sampled articles. Key themes included communication of mpox characteristics, delivery of health promotion, and ‘anchoring’ mpox to other infectious diseases (e.g. COVID-19, chickenpox) to aid understanding. Articles described mpox’s epidemiological origins in Africa, transmission routes, and epidemiological updates, often noting transmission during GBMSM events. Public health messaging focused on advice about transmission reduction, access to care/prevention services, and vaccine availability (including concerns over supply). GBMSM were frequently depicted as being at high risk, sometimes drawing upon stereotypes and language that potentially reinforced stigma. Notably, few articles included perspectives from individuals with lived experience of mpox. UK news media interest in mpox peaked early in the outbreak and waned despite rising cases. News media played a vital role in disseminating information and public health messaging (often drawing parallels with other familiar infections) but the framing of GBMSM may also have reinforced stigma. The absence of personal testimonies represents a missed opportunity for inclusive messaging. Future outbreak reporting should involve affected communities to co-produce and promote accurate, non-stigmatising communication.

36. Modulating Host Lipid Metabolism via Gut Microbiota: Therapeutic Potential of Plant-Derived Compounds.

期刊: Phytotherapy research : PTR 发表日期: 2026-Jun-19 链接: PubMed

摘要

Lipid metabolic imbalance is a major contributor to metabolic disorders in humans and livestock, creating an urgent need for safe and effective regulatory approaches. Plant-derived compounds, characterized by favorable bioavailability and low toxicity, serve as promising candidates that regulate host lipid metabolism through dynamic crosstalk with the gut microbiota. This review systematically investigates the bidirectional crosstalk between plant bioactive compounds (e.g., polysaccharides, flavonoids, saponins and polyphenols) and the gut microbiota. We detail how gut microbes metabolize these compounds to enhance their bioactivity and bioavailability, while plant extracts reshape microbial community structure to enrich beneficial taxa. Furthermore, we elucidate the mechanisms underlying lipid metabolism regulation, focusing on three critical signaling pathways: (1) SCFAs-GPR43/41 signaling, (2) TLR4/NF-κB inflammation suppression, and (3) bile acid-FXR axis modulation. Collectively, this review synthesizes emerging evidence on plant-microbiota interactions as a novel therapeutic strategy to restore lipid homeostasis in animal models, offering foundational insights for agricultural and biomedical applications.

37. Project Sickle Cure: A Prospective, International Observational Study of Hematopoietic Cell Transplantation for Sickle Cell Disease.

期刊: European journal of haematology 发表日期: 2026-Jun-19 链接: PubMed

摘要

Sickle cell disease (SCD) is a chronic and life-limiting hemoglobin and systemic vascular disease. While over 1000 people have undergone hematopoietic cell transplantation (HCT) over the last 40 years, long-term disease-specific and health-related quality of life data are lacking. The American Society of Hematology 2021 Guidelines for SCD emphasized the need for more detailed registry data to inform patients and providers with decision-making and practice recommendations. In January 2021, the Sickle Cell Transplant Advocacy and Research Alliance (STAR) launched Project Sickle Cure (PSC). This multi-center, prospective study of patients who have undergone HCT for SCD includes baseline demographics and SCD-specific post-HCT outcomes, serial neurocognitive testing, health-related quality of life measures, health equity evaluations, a neuroimaging bank, detailed evaluation of neurologic status pre- and post-transplant, and chronic pain evaluation. A biorepository is in the planning stage of development. As of November 2025, 115 participants have enrolled at 18 STAR sites with enrollment ongoing. PSC is a STAR prospective study which will address a major gap in our understanding of outcomes post-HCT specific to SCD. WeDecide, a larger study comparing HCT health-related quality of life outcomes to those who receive non-transplant disease modifying therapy (NT-DMT) is in development, and PSC will provide the HCT comparator data. These data will also be highly relevant as other curative and transformative therapies, such as gene therapy, become more widely used.

38. Sporadic Progressive Ataxia and Palatal Tremor: An Autopsy Case without Tau Pathology.

期刊: Movement disorders clinical practice 发表日期: 2026-Jun-19 链接: PubMed

摘要

Sporadic Progressive Ataxia with Palatal Tremor (PAPT) is an extremely rare movement disorder syndrome with only three autopsy reports published in the literature to date. Previously described cases showed hypertrophic olivary degeneration with tau-positive neuronal inclusions, although differences were noted in tau isoforms and the presence of additional neurodegenerative pathology. We report an additional autopsy case with morphological similarities in pathology but without tau inclusions. To describe clinically, radiologically and neuropathologically a case of PAPT. Retrospective clinical data collection from electronic records, authorized video material and postmortem neuropathology study. A 74-year-old women presented with a gait ataxia and parkinsonism at the age 67, followed three years later by rhythmic chin and palatal tremor. Probable REM sleep behavior disorder was reported approximately ten years before symptom onset. MRI demonstrated bilateral T2/T2-FLAIR hyperintensity and enlargement of the inferior olivary nuclei. The clinical progression was dominated by the ataxia, and the tremor remained throughout the disease course. Neuropathological findings showed hypertrophic olivary degeneration with glomeruloid bodies, without tau pathology and occasional neuronal and dendritic p62 immunoreactivity. Focal neuronal loss and gliosis were observed in cerebellar dentate nucleus. There was substantia nigra neuronal loss with Lewy pathology in neocortical stage (Braak stage 5), but without involvement of inferior olivary nucleus or cerebellum. Our findings confirmed hypertrophic olivary degeneration as the pathologic substrate of PAPT. The absence of tau pathology distinguishes it from previously reported cases, indicating heterogeneity in the underlying pathophysiological disease mechanisms. Concomitant Lewy body pathology may have contributed to parkinsonism and REM sleep behavior disorder.

39. Delineating the clinical and molecular spectrum of the neurodevelopmental disorder associated with SET.

期刊: Genetics in medicine : official journal of the American College of Medical Genetics 发表日期: 2026-Jun-19 链接: PubMed

摘要

SET is a member of the inhibitor of histone acetyltransferases (INHAT) complex, involved in transcriptional silencing and gene regulation. Pathogenic variants in SET are postulated to cause neurodevelopmental disorder (NDD) phenotypes, but as only few individuals are described, detailed clinical information is scarce. Hence, currently counseling on phenotype and prognosis of this condition remains challenging. Here we describe the clinical phenotype and mutational spectrum of 23 unreported individuals harboring (likely) pathogenic variants in SET. Phenotypes include global developmental delay with often pronounced hypotonia, delayed motor development and speech and language delay, ultimately evolving into (mild) intellectual disability. Comorbidities include behavioral concerns, sleeping disturbance and variable unspecific ocular problems. Next generation computer-assisted phenotyping using GestaltMatcher showed limited overlapping facial features between affected individuals and differences compared to disorders caused by related chromatin modifying genes. In addition, we generated a DNA methylation signature, able to distinguish individuals carrying pathogenic variants in SET from individuals with other NDDs and healthy controls. We used this DNA methylation signature to assess pathogenicity of two variants of uncertain significance in SET found in two additional individuals. Together, this expands the knowledge on the SET-related disorder and provides novel approaches for its diagnosis.

40. Cigarette Smoke Promotes Lung Cancer Progression by Mediating EMT Through the IL-9-Regulated STAT3/miR-155-5p/SOCS1 Feedback Loop.

期刊: Journal of applied toxicology : JAT 发表日期: 2026-Jun-19 链接: PubMed

摘要

Lung cancer is among the most common malignancies globally, exhibiting the greatest rates of incidence and death compared to all other cancers. Cigarette smoking is a significant causal factor in lung cancer; yet the molecular mechanisms via which smoking facilitates lung cancer development remain mainly ambiguous. In this study, we used different concentrations of cigarette smoke extract (CSE) to A549 cells. Compared with the control group, the total STAT3 expression remained basically unchanged. However, we found that phosphorylated STAT3 (p-STAT3), interleukin-9 (IL-9), and miR-155-5p all increased obviously, while the expression of suppressor of cytokine signaling 1 (SOCS1) decreased greatly. Moreover, the epithelial marker E-cadherin was downregulated, while the mesenchymal markers Vimentin and α-SMA were upregulated, indicating the induction of epithelial-mesenchymal transition (EMT). Interventions with STAT3 siRNA, a miR-155-5p inhibitor, or a SOCS1 overexpression plasmid reversed these changes. Similarly, co-treatment with an IL-9-neutralizing antibody attenuated CSE-induced alterations in p-STAT3, SOCS1, miR-155-5p, and EMT markers. In a nude mouse xenograft model, CSE exposure significantly enhanced tumor growth and EMT phenotypes, whereas IL-9 neutralization reduced tumorigenicity of CSE-treated A549 cells. Collectively, these findings demonstrate that cigarette smoke promotes lung cancer progression by inducing EMT through the IL-9-regulated STAT3/miR-155-5p/SOCS1 feedback loop, providing novel mechanistic insight and potential therapeutic targets for smoking-related lung cancer.

41. A Comprehensive Assessment of Pollutant Exposure (Cu2+, Cr6+ and Cd2+) in Adult Zebrafish.

期刊: Environmental toxicology 发表日期: 2026-Jun-19 链接: PubMed

摘要

Copper (Cu2+), hexavalent chromium (Cr6+), and cadmium (Cd2+) are pervasive heavy metal pollutants in aquatic ecosystems, often coexisting and posing potential risks to aquatic organisms. While the individual toxicity of these metals is well documented, their combined effects at environmentally relevant concentrations remain poorly understood. This study investigated the chronic toxicity of a ternary mixture of Cu2+, Cr6+, and Cd2+ in adult zebrafish (Danio rerio) across multiple biological endpoints. In the chronic toxicity test, the toxicity of Cu2+, Cr6+, and Cd2+ was set up in five concentration groups, namely the control group, 1/40 (Cu2+ 0.013 mg/L, Cr6+ 4.610 mg/L, and Cd2+ 0.471 mg/L), 1/30 (Cu2+ 0.017 mg/L, Cr6+ 6.147 mg/L, and Cd2+ 0.628 mg/L), 1/20 (Cu2+ 0.026 mg/L, Cr6+ 9.220 mg/L, and Cd2+ 0.942 mg/L), and 1/10 (Cu2+ 0.052 mg/L, Cr6+ 18.440 mg/L, and Cd2+ 1.884 mg/L) of the 96 h-LC50 values. Each group had three replicates, with 25 fish in each replicate. Under the exposure of different concentrations of Cu2+, Cr6 +, and Cd2+, the liver, intestine, and gill tissue induced different degrees of pathological damage, and caused oxidative damage and immune system disorder in liver and gill tissue. In the 1/10 and 1/20 concentration group, the relative abundance of Bacteroidetes and Firmicutes in intestinal tissue increased, while the relative abundance of Actinobacteriota and Proteobacteria decreased. The residual amounts of Cd2+ and Cr6+ in muscle tissue are positively correlated with their concentrations, while the residual amounts of Cu2+are negatively correlated with their concentrations.

42. Early-life lung injury and the developing brain: a lung-brain axis perspective on neurodevelopmental disorders.

期刊: Journal of neuroinflammation 发表日期: 2026-Jun-19 链接: PubMed

摘要

Emerging evidence indicates that early-life lung injuries-including bronchopulmonary dysplasia, childhood asthma, recurrent respiratory infections, and environmental tobacco smoke exposure-are significantly associated with an increased risk of neurodevelopmental disorders such as cognitive impairment, autism spectrum disorder, attention-deficit/hyperactivity disorder, and emotional or behavioral affections. The developing brain is particularly vulnerable during infancy and childhood, and pulmonary insults during this critical window may disrupt normal neurodevelopment through multiple interconnected mechanisms along the lung-brain axis. These mechanisms include the hypoxia-oxidative stress axis, which impairs oligodendrocyte maturation and myelination; pulmonary microvascular injury leading to neuronal energy metabolism dysregulation; systemic inflammation-mediated disruption of the blood-brain barrier; and a cascade from pulmonary inflammation to neuroinflammation, characterized by microglial activation, synaptic dysfunction, and impaired myelination. Together, these pathways converge to produce long-lasting neurodevelopmental consequences. Understanding the lung-brain axis provides a novel theoretical framework for explaining this comorbidity and highlights the need to integrate neurodevelopmental risk assessment and early intervention into the clinical management of early-life lung diseases. Future research should focus on longitudinal cohorts, identification of critical developmental windows, and targeted therapeutic strategies that address both pulmonary and neurological health.

43. Pathway-level epigenetic modeling illuminates the methylation architecture to asthma risk across tissues.

期刊: Epigenetics & chromatin 发表日期: 2026-Jun-19 链接: PubMed

摘要

Asthma is a clinically heterogeneous airway disorder characterized by complex interactions between environmental exposures, immune activation, and molecular regulatory programs, whose underlying mechanisms are not fully elucidated by known genetic loci. DNA methylation serves as a mechanistic interface bridging genetic predisposition and environmental influences; however, most epigenetic studies remain confined to isolated CpG sites, lacking robust biological interpretability. We developed a cross-tissue, multi-cohort, and mechanistically interpretable epigenetic framework to delineate pathway-level methylation mechanisms underlying asthma. Leveraging data from 908 participants across one combined training cohort and three independent validation cohorts, we constructed a linear support vector classifier based on pathway-derived methylation scores. Additionally, SHapley Additive exPlanations (SHAP) were applied to quantify the contributions of individual pathways. To assess the statistical significance of pathway contributions, one-sample t-tests were performed for each pathway’s SHAP values against zero, followed by Benjamini-Hochberg false discovery rate (FDR) correction to obtain adjusted p values. The model exhibited reproducible and cross-tissue performance, achieving area under the curve (AUC) values of 0.792 (95% CI: 0.782-0.799; GSE65163) and 0.980 (95% CI: 0.974-0.990; GSE201872) in two airway epithelial cohorts, and 0.736 (95% CI: 0.690-0.771; GSE104471) in peripheral blood samples. Pathway interpretability analyses identified dominant roles of amino acid metabolism, epithelial and mesodermal developmental programs, metabolic-immune transport pathways, and neuroimmune signalling in shaping asthma-associated methylation patterns. Mediation analyses further revealed that these pathways influence asthma both directly and indirectly via eosinophil activity, epithelial proliferative dynamics, and nitric oxide-linked airway inflammation. Notably, pathways annotated by GO:0061205 and GO:0098727 exerted significant direct effects independent of immune intermediates. This study describes a pathway-level methylation model designed for biological interpretability that shows associations with both clinical severity and latent molecular heterogeneity. It provides statistical evidence contributing to the understanding of epigenetic, immune, and metabolic signatures in asthma, offering a potential framework warranting further validation for precision respiratory medicine.

44. Dynamic responses in the human methylome to exertional heat exhaustion, heat injury, and heat stroke.

期刊: Human genomics 发表日期: 2026-Jun-19 链接: PubMed

摘要

Exertional heat illness encompasses a continuum from heat exhaustion (EHE) to heat stroke (EHS), yet the molecular mechanisms remain poorly understood. DNA methylation offers a stable epigenetic signature linking environmental stress to gene regulation and long-term physiological outcomes. We profiled genome-wide DNA methylation in blood from active-duty service members hospitalized for EHE (n = 36), heat injury (EHI; n = 18), or EHS (n = 50). Blood was collected longitudinally and analyzed using the Illumina 850 K array, with normalization and time-course clustering (TCseq) to identify co-regulated CpG networks. Ingenuity Pathway Analysis was applied differentially methylated probes (p < 0.01, Δβ > 0.04). At diagnosis, both EHI and EHS shared hypomethylation in pathways regulating heat sensing, oxidative defense, and vascular tone. Over time, EHI exhibited adaptive methylation changes supporting neuronal repair, glucocorticoid regulation, and cytoskeletal stability. In contrast, EHS demonstrated sustained downregulation of metabolic and cardiovascular regulators, persistent inflammasome activation, and oxidative imbalance. Early patterns were shared between EHI and EHS, reflecting a common acute stress response, but later responses diverged: EHI showed partial epigenetic recovery, while EHS exhibited sustained metabolic suppression and inflammasome activation. These time-dependent methylation signatures identify potential molecular targets for promoting recovery and preventing long-term complications of heat illnesses.

45. Integrating yoga as a holistic intervention in male infertility management: improved sperm parameters and stress reduction: a case report.

期刊: Journal of medical case reports 发表日期: 2026-Jun-19 链接: PubMed

摘要

Male infertility, particularly severe oligozoospermia, presents a significant challenge in reproductive health, often associated with high oxidative stress and poor lifestyle practices. This case report highlights the potential therapeutic role of a structured yoga regimen in improving semen quality, reducing stress, and enhancing quality of life in a male with long-standing infertility. The novelty lies in documenting comprehensive improvements across semen parameters and psychological well-being following a nonpharmacological intervention. A 30-year-old Indian male diagnosed with severe oligozoospermia presented with a four-year history of primary infertility. His 30-year-old Indian female partner had no identifiable reproductive abnormalities. The couple sought consultation at a tertiary care centre. The male patient reported a high-stress lifestyle due to his occupation as an architectural researcher involving extensive travel and irregular routines. He underwent a six-month structured yoga intervention (five days per week) comprising guided sessions involving breathing exercises, meditation, and specific physical postures, supervised by a certified yoga therapist. Pre- and post-intervention assessments included semen analysis, sperm DNA integrity, oxidative stress markers in seminal fluid, and quality of life using a standardized assessment tool. Post-intervention, the patient exhibited notable improvements in semen parameters, including increased sperm count and motility, reduced morphological abnormalities, and decreased seminal oxidative stress levels leading to sperm DNA fragmentation index decline. Improvements were also observed in quality-of-life scores across physical, psychological, social, and environmental domains. Following these outcomes, intrauterine insemination was advised as a fertility treatment option. This case illustrates the potential of yoga as an adjunctive, noninvasive therapy for managing male infertility, particularly in individuals with stress-related reproductive dysfunction. The structured yoga program led to substantial improvement in semen quality and quality of life, suggesting a mind-body connection that may influence reproductive health. This single case provides preliminary insight into the potential link between lifestyle factors and reproductive health, though broader studies are required. Further studies involving larger cohorts are needed to validate and expand upon these promising results.

46. The impact of symptoms and illness insight on treatment adherence in first-episode psychosis: a one-year follow-up study using therapeutic drug monitoring.

期刊: BMC psychiatry 发表日期: 2026-Jun-19 链接: PubMed

摘要

Despite extensive research on adherence in first-episode psychosis (FEP), reliance on self-report or clinician judgment has limited accuracy and obscured nuanced clinical associations. This longitudinal study examined the predictive value of psychopathology, insight, and functioning for objectively measured treatment adherence across a one-year follow-up using therapeutic drug monitoring (TDM). Seventy-eight FEP patients were assessed at baseline, 2 months, and 12 months. Clinical measures included the Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Negative Symptoms (SANS), Social and Occupational Functioning Assessment Scale (SOFAS), and the Schedule for the Assessment of Insight-Expanded version (SAI-E). Adherence was defined by comparing plasma antipsychotic concentrations to prescribed doses according to international consensus guidelines. Generalized linear mixed models (GLMMs) were used to model time-dependent associations. While overall adherence declined, time alone was not a significant predictor. Instead, current positive symptom severity (approximately 4-5% lower odds of adherence per BPRS point) was associated with lower odds of adherence, while prior non-adherence predicted subsequent adherence. In contrast, insight, negative symptoms, and functioning showed no consistent association with adherence. A marginal association between improved functioning and better adherence was observed at 12 months. Adherence in FEP appears to fluctuate in relation to current clinical state rather than follow a stable linear pattern. These findings highlight the value of objective TDM monitoring and early intervention, supporting predictive models that incorporate evolving symptom patterns rather than static baseline measures. Clinical trial number: not applicable.

47. Associations between transformational leadership, work engagement, and occupational well-being among Finnish paramedics in prehospital emergency medical services: a cross-sectional study.

期刊: BMC health services research 发表日期: 2026-Jun-19 链接: PubMed

摘要

Paramedics in emergency medical services (EMS) work in high-demand environments in which occupational well-being is closely linked to patient safety and workforce sustainability. While transformational leadership has been associated with positive staff outcomes in health care, evidence regarding its associations with work engagement and occupational well-being in prehospital EMS remains limited. This study examines transformational leadership in Finnish EMS in relation to paramedics’ work engagement and occupational well-being, including whether the association between transformational leadership and occupational well-being is statistically consistent with an indirect pathway involving work engagement. A cross-sectional online survey was conducted among 322 Finnish paramedics working in EMS at basic or advanced levels. Transformational leadership was assessed using the 43-item Transformational Leadership Scale, work engagement using the Utrecht Work Engagement Scale (UWES-9), and occupational well-being using a single-item self-rated numeric scale (4-10). Descriptive statistics, Pearson correlations, and hierarchical multiple regression analyses were conducted, adjusting for age, gender, education level, professional title, and years of EMS experience. Bootstrap resampling (5,000 samples) was used to examine whether the association between transformational leadership and occupational well-being was statistically consistent with an indirect pathway involving work engagement. Transformational leadership had a mean score of 2.75 (SD = 1.03, range 1-5). Leadership ethics received the highest ratings, whereas feedback and rewards were rated lowest. In multiple regression analyses, transformational leadership was positively associated with work engagement (β = 0.437, p <.001) and occupational well-being (β = 0.501, p <.001) after controlling for demographic factors. Work engagement was positively associated with occupational well-being (p <.001). When work engagement was added to the model, the association between transformational leadership and occupational well-being decreased but remained statistically significant, suggesting that the association was statistically consistent with an indirect pathway involving work engagement. Transformational leadership was positively associated with work engagement and occupational well-being among Finnish paramedics in EMS. The association between transformational leadership and occupational well-being was statistically consistent with an indirect pathway involving work engagement. However, causal or mediational conclusions cannot be drawn due to the cross-sectional design. From a health services perspective, the findings suggest that leadership may represent a key organizational resource for supporting workforce well-being and performance in high-demand EMS systems.

48. Anatomical structure of pulmonary vessels and bronchi in the right upper lobe based on three-dimensional reconstruction.

期刊: BMC surgery 发表日期: 2026-Jun-19 链接: PubMed

摘要

The aim of this study was to evaluate the anatomical patterns of the right upper lobe pulmonary segments through three dimensional reconstruction and to describe the frequency of observed variant types. Three-dimensional reconstruction of images of the pulmonary structures was performed in 67 patients with ground-glass pulmonary nodules who were due for segmentectomy in our hospital, from August 2021 to June 2025. Incidentally, the reconstructed models were used for the statistical analysis of the anatomical structures in the right upper lobe. In terms of results, the most common anatomical variant of the bronchus right upper lobe was trifurcate (51/67). This was followed by bifurcate (16/67). Bifurcation was the most common configuration (36/67) in the right upper lobe pulmonary artery followed by trifurcation (16/67) and singled branching (8/67). The most frequent configuration of the right upper lobe pulmonary veins was anterior vein + central vein (42/67), followed by anterior vein + posterior vein (7/67) and isolated central vein (7/67). Furthermore, a set of 12 rare variations were also observed, which includes 4 bronchial cases, 2 pulmonary artery cases, and 7 pulmonary vein variations cases. The lung has complex anatomical structures with various variations. The surgeon must have a proper knowledge of the segmental anatomy of the area of the operation. The study offers a descriptive reference of anatomical variations that may assist in preoperative planning and intraoperative orientation for right upper lobe segmentectomy.

49. Expanded antigen-specific donor regulatory T cells for GVHD prevention.

期刊: Blood 发表日期: 2026-Jun-18 链接: PubMed

摘要

Minor histocompatibility antigen (mHAg)-specific alloreactive donor T cells cause graft vs. host disease (GVHD) in matched related donor allogeneic hematopoietic cell transplantation (HCT). In a phase I trial, we expanded and infused (on day -2) mHAg-specific donor regulatory T cells (Treg) together with sirolimus-based pharmacologic prophylaxis to examine safety and preliminary efficacy of this GVHD prevention approach. We employed a 3+3 phase I design escalating Treg dose in 4 levels: 0.5 x 105/kg, 1 x 105/kg, 2 x 105/kg, and 4 x 105/kg. Dose-limiting toxicity (DLT) included grade 4-5 related infusion reaction, grade 4-5 unexpected organ toxicity, grade III-IV acute GVHD, or treatment-related death. Secondary and exploratory measures examined acute and chronic GVHD, survival outcomes, and Treg clone (TCR-Seq) expansion in culture, and in-vivo longevity and expansion post-HCT. 15 subjects were included (N=3 each per dose levels 1-3, and N=6 in dose level 4). No DLT were observed, and 4 x 105/kg Treg was identified as MTD. Median follow up for survivors was 41.7 months (range 14.5-72.8). The day 100 cumulative incidence of grade II-IV acute GVHD was 13% (95% CI 2-35%). NIH moderate/severe chronic GVHD by 1 year was 6.7% (95% CI 0.36-27%) and by 3 years was 20% (95%CI 4.4-44%). Overall survival was 73% (95% CI 54-100%). Treg clones expanded in culture, and demonstrated post-HCT lineage fidelity, persistence, and in-vivo expansion. This translational trial supports mHAg-specific expanded donor Treg as a novel GVHD prevention strategy, and demonstrates expanded donor Treg clones can persist and expand through one-year post-HCT. NCT01795573.

50. Preventive Dental Care Utilization and Infective Endocarditis Among Georgia Medicaid Beneficiaries With Congenital Heart Defects, 2008-2019.

期刊: Birth defects research 发表日期: 2026-Jun 链接: PubMed

摘要

Preventive dental care is recommended in children with congenital heart disease (CHD) to prevent infective endocarditis (IE). We examined average annual preventive dental care utilization and the association between preventive dental care and IE in children with CHD. We conducted a retrospective cohort study examining children (1-18-year-olds), covered by Georgia Medicaid, with at least one CHD-related ICD code and a healthcare encounter between 2008 and 2019. Preventive dental care encounters were based on Current Dental Terminology (CDT) codes (D1000-D1999). CHD native anatomy was captured based on ICD-9-and-10-CM codes. Log binomial regression estimated adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) for IE risk, controlling for sex, race and ethnicity, birth year cohort, rurality, and Social Deprivation Index. Of 61,024 children with CHD, 65.64% (n = 40,058) had at least one annual preventive dental visit on average, of which 0.30% (n = 181) had IE. For subgroups with valve or shunt lesions, having at least one annual preventive dental care visit showed a significantly lower risk of IE (aRR = 0.32; 95% CI = 0.18, 0.58, and aRR = 0.17; 95% CI = 0.07, 0.38, respectively) compared to no dental visits. No association was found between preventive dental care and IE in those with severe CHD (aRR = 0.81; 95% CI = 0.51, 1.26). Although dental health is important for patients with CHD, and despite universal dental coverage, many children with CHD do not seek annual preventive dental care. Integrating dental health assessments into routine CHD management protocols is imperative not only to promote oral health but also to prevent IE.

51. Using Pragmatic Co-Design Processes in a Resource-Constrained Regional Health Service: Insights From the TROPICAL-VIC Early Referral to Palliative Care Project.

期刊: The Australian journal of rural health 发表日期: 2026-Jun 链接: PubMed

摘要

To describe an evidence-informed, experience-based co-design process used to adapt metropolitan early palliative care referral models for implementation in a regional Australian health service. A scoping review of palliative care delivery and early referral models to inform evidence-informed, experience-based co-design workshops involving consumers, clinicians, and health service staff. Sequential mixed-methods development study comprising evidence synthesis to identify model components, followed by two iterative workshops to construct and refine a context-appropriate outpatient early referral model. A regional public health service in Victoria, Australia, seeking to establish an outpatient early referral palliative care clinic for people with advanced cancer. Purposefully sampled stakeholders (patients/carers, oncologists, palliative care clinicians, cancer care coordinators, Aboriginal health worker, managers, and researchers) took part in two online workshops. Co-designed model structure and components, perceived feasibility in a resource-constrained regional context, and agreed service scope and patient eligibility. The process generated a regionally tailored early referral pathway incorporating needs-based screening, prioritisation to manage limited capacity, and staged roll-out initially focused on selected cancer groups. These adaptations, while pragmatic, highlight the resourcing disparities faced by rural and regional services and the equity implications of resource-driven variation in care delivery. Evidence-informed co-design enabled pragmatic adaptation of metropolitan palliative care models to a regional setting and offers a transferable approach for other rural and regional services.

52. SARS-CoV-2 Infection, Vaccination Status, and Dementia Risk: A Nested Case-Control Study.

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

摘要

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) may affect cognition, but its association with incident dementia remains inconsistent. We explored the association of SARS-CoV-2 infection and its vaccination with dementia risk in a nationwide sample of middle-aged and older adults. This nested case-control study used electronic healthcare data from Israel’s largest health provider. Participants were dementia-free individuals aged ≥ 50 years at baseline (March 2020), followed up until May 2022. Incident dementia cases were matched to dementia-free controls using density sampling by age, sex, and date of entry to the study, with a ratio of 1:10. SARS-CoV-2 was defined by positive polymerase chain reaction (PCR) or institutional antigen tests. Multivariable conditional logistic regression models evaluated the association of SARS-CoV-2, its severity and vaccination, and pneumonia as a comparator, with dementia risk. Among the 1,145,322 eligible participants, 27,280 dementia cases were matched to 272,800 controls. SARS-CoV-2 infection was associated with increased dementia risk (OR = 1.18; 95% CI 1.12-1.24; p < 0.001). This association was confined to hospitalized individuals with mild (OR = 2.39; 95% CI 2.07-2.76) and moderate-to-severe disease (OR = 1.93; 95% CI 1.70-2.20), was comparable to pneumonia (OR = 1.89; 95% CI 1.80-1.99), and was no longer evident after 6 months (OR = 1.04; 95% CI 0.96-1.12). COVID-19 vaccination was associated with 7%, 15%, and 31% lower dementia risk after two, three, and four doses, respectively. Unvaccinated individuals with prior COVID-19 had the highest dementia risk. Dementia diagnoses are increased after COVID-19, especially in hospitalized patients. Risk is comparable to other respiratory infections.

53. Solasodine, a Natural Steroidal Alkaloid, Attenuates RANKL-Induced Osteoclastogenesis and Bone Resorption: A Study Based on Network Pharmacology and Experimental Validation.

期刊: Journal of cellular and molecular medicine 发表日期: 2026-Jun 链接: PubMed

摘要

Osteoporosis is characterized by excessive bone resorption driven by aberrant osteoclast activation. Solasodine (SOL), a natural steroidal alkaloid, has undefined roles in bone metabolism. This study investigated SOL’s effects on RANKL-induced osteoclastogenesis and its underlying mechanisms. Pharmacological targets predicted via network pharmacology and validated by molecular docking identified 81 overlapping targets, which were primarily enriched in MAPK, NF-κB, and JAK-STAT pathways, confirming robust affinity between SOL and core targets including NFκB1, JAK1/2, and STAT3. In vitro, bone marrow-derived macrophages (BMMs) were stimulated with M-CSF and RANKL. Evaluation via TRAcP staining, F-actin immunofluorescence, and hydroxyapatite assays showed that SOL dose-dependently inhibited RANKL-induced osteoclast formation, fusion, and resorptive activity without cytotoxicity. Mechanistic investigations through RT-qPCR, Western blotting, luciferase assays, ROS detection, and live-cell calcium monitoring revealed that SOL suppressed key markers, including NFATc1, c-Fos, CTSK, Atp6v0d2, and Integrin β3. Specifically, SOL attenuated MAPK (p38, JNK, ERK) and STAT3 phosphorylation, inhibited NF-κB activity, and prevented IκB-α degradation. Furthermore, SOL curtailed RANKL-induced ROS generation, intracellular calcium oscillations, and subsequent CaMKIV activation. Ultimately, SOL inhibits RANKL-induced osteoclastogenesis and bone resorption by suppressing the NFATc1/c-Fos axis through coordinated modulation of the MAPK, NF-κB, and JAK-STAT pathways, alongside mitigation of ROS production and calcium signalling, representing a promising natural candidate for treating osteolytic bone diseases.

54. What Is Inclusive Occupational Therapy for People Living With Dementia? Lessons From Collaborative Workshops With Diverse Communities.

期刊: Australasian journal on ageing 发表日期: 2026-Jun 链接: PubMed

摘要

Occupational therapy interventions for people living with dementia have been shown to have positive outcomes for the person and family carers. However, people from culturally diverse communities and Aboriginal and Torres Strait Islander peoples are largely missing from research studies. People with dementia from these communities have unique needs, and they can experience health inequity. The aim of this study was to use inclusive methods to explore key factors contributing to and identify potential adaptations required for culturally inclusive and acceptable occupational therapy interventions for people living with dementia. We adopted best practice research methodology for working with people living with dementia from diverse communities. We conducted three collaborative workshops using co-design techniques. Attendees discussed a hypothetical vignette using group problem-solving. Findings were mapped to the key cultural adaptation framework elements using content analysis. Twenty-one people from diverse communities with living experience of dementia attended one of three collaborative workshops. Participants were accepting of occupational therapy intervention components. Priority areas for delivering inclusive interventions were knowing the person, establishing a therapeutic relationship and expressing cultural humility. The therapist themselves is the key factor that supports the delivery of inclusive interventions. They should be aware of and be responsive to the cultural needs of diverse communities, adjust their therapeutic approach and be prepared to offer flexibility. Working in partnership fostered successful research collaboration, showcasing how people living with dementia from diverse communities can be supported to contribute to research and potentially influence ‘higher order’ healthcare issues.

55. Prevalence of Getah Virus in Mammals in East and Southeast Asia: A Systematic Review and Meta-Analysis.

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

摘要

Getah virus (GETV) has reemerged as an important mosquito-borne pathogen affecting livestock health in East and Southeast Asia. To quantify its epidemiological patterns, we conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant meta-analysis of literature published between 2000 and September 2025. Analysis of 24 observational studies covering swine, equine, bovine, caprine, and wildlife populations using a random-effects model revealed a pooled mammalian seroprevalence of 26% (95% confidence interval [CI]: 0.17-0.38) and a pooled nucleic acid positivity rate of 2% (95% CI: 0.01-0.05), consistent with broad past exposure but limited detection of active viremia in cross-sectional surveys. Swine were identified as the main amplifying hosts, particularly in intensive farming regions of eastern and southern China, where herd seropositivity exceeded 60%. Results indicate a significant prevalence increase over the past 25 years. The established mosquito-swine-mosquito transmission cycle confirms GETV has transformed from a sporadic pathogen into a persistent threat within intensive farming environments.

56. Clinical Characteristics and Prognostic Risk Factors in Breast Cancer With Liver Metastasis.

期刊: The breast journal 发表日期: 2026 链接: PubMed

摘要

Liver metastasis is a key adverse prognostic factor in breast cancer patients. This research was aimed to assess the development, risk factors, and prognostic determinants of breast cancer liver metastasis (BCLM). We retrospectively analyzed the data of breast cancer from the Surveillance, Epidemiology, and End Results (SEER) (N = 560,908) and Jiangsu Province Hospital (JSPH) database (N = 294). The risk factors for BCLM were identified via multivariate logistic regression, and overall survival (OS) was assessed with Kaplan-Meier (KM) survival curves and Cox regression models. In the SEER cohort, liver metastasis attacked 1.3% of patients, and the highest incidence was found in the HR-/HER2+ subtype (4.4%). The risk factors for BCLM include young age, high pathological grade, concurrent bone, lung or brain metastasis, and HER2-positive or triple-negative subtype. The median OS of BCLM patients was short (SEER: 22 months; JSPH: 33.5 months). OS was shorter in patients with concomitant metastasis to other organs or with HER2-negative subtype. Hepatic resection remarkably prolonged survival (SEER: 90 vs. 35 months; JSPH: not reached vs. 31.3 months). In the JSPH cohort, molecular subtype changed in 27.5% of patients during metastasis. The occurrence of BCLM is affected by age, tumor grade, other organ involvement, and molecular subtype. Survival was improved in BCLM patients with liver-only metastasis, HER2-positive subtype, or those who underwent hepatic resection. The number and molecular characteristics of liver metastasis are important prognostic predictors, and receptor conversion highlights the need for reassessment of therapeutic strategies during metastatic progression.

57. Harmonic Fowlkes-Mallows Index for Medical Diagnostics Tests and Optimal Cut-Off Point Selection of Binary Diseases.

期刊: Pharmaceutical statistics 发表日期: 2026 链接: PubMed

摘要

Accurately distinguishing between healthy and diseased states is fundamental to clinical diagnostics. This paper introduces the Harmonic Fowlkes-Mallows (HFM) index, a novel and robust metric for assessing diagnostic accuracy and identifying optimal cut-off points. The proposed HFM index integrates performance across both positive and negative classes by combining the traditional Fowlkes-Mallows Index (FM) with the proposed Negative Fowlkes-Mallows Index (NFM), using a weighted harmonic mean. Unlike conventional measures such as the F1-score or Youden Index, HFM provides a more comprehensive evaluation of classification performance by simultaneously addressing sensitivity and specificity. Additionally, it incorporates a tunable β parameter to adjust for asymmetries in class importance. Through simulation studies, the HFM index demonstrates strong performance in binary classification tasks and proves effective in selecting optimal decision thresholds. To further demonstrate its practical utility, we apply the HFM index to real-world breast cancer data and compare its performance with other diagnostic accuracy measures.

58. Longitudinal Interplay Between Team Resilience and Team Stress in Low-Stability Clinical Nursing Teams: A Cross-Lagged Panel Network Analysis.

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

摘要

To estimate longitudinal predictive relationships between team resilience and team stress among low-stability clinical nursing teams, identifying core driving factors and bridging mechanisms using cross-lagged panel network analysis. Chronic instability in clinical nursing teams disrupts workflows and triggers systemic team stress, which is further exacerbated by digital health technology burdens and moral distress. Understanding how specific dimensions of team resilience interact with these facets of team stress over time is essential for developing precise organizational interventions. A two-wave longitudinal panel study. Data from the Nurse Team Health Management Research Cohort across two waves (October 2024 and December 2025) included 5164 clinical nurses aggregated into 285 low-stability nurse teams. Team resilience and team stress were assessed using the Analyzing and Developing Adaptability and Performance in Teams to Enhance Resilience Scale and a customized Nursing Job Stressor Inventory. A cross-lagged panel network was estimated to identify influential nodes and network conduits. Digital health technology burden exhibited the highest predictive power, driving team stress and significantly predicting subsequent moral distress. Moral distress emerged as a potentially destructive bridge, which may negatively predict multiple resilience dimensions over time. Conversely, cooperation with other departments appeared to serve as a protective bridge, mitigating subsequent subjective work stress and digital technology burden. Monitoring exhibited a potentially paradoxical effect, positively predicting subsequent subjective work stress. Digital health technology burden drives occupational stress in low-stability nursing teams. Moral distress may erode team resilience, whereas cross-departmental cooperation acts as a potential protective shield. This study shifts the focus of occupational stress management from the individual to the team level. To stabilize nursing teams facing chronic instability and high turnover, healthcare administrators should move beyond generic stress reduction. Targeted interventions must focus on alleviating digital workflow burdens, instituting routine ethical debriefings to resolve moral distress, and formalizing boundary-spanning cooperation protocols.

59. Occupational Formulation: A Scoping Review of Its Development and Use.

期刊: Occupational therapy international 发表日期: 2026 链接: PubMed

摘要

Occupational formulation offers a way to synthesise assessment information to understand a person’s occupational participation and needs. Although increasingly recognised in professional guidelines, there has been limited exploration of its development and application in occupational therapy. A scoping review was conducted following Arksey and O’Malley’s framework and PRISMA-ScR guidelines. Comprehensive searches were undertaken across five databases (AMED, CINAHL, Emcare, PsycInfo and Google Scholar), a global theses repository, and multiple grey literature sources. Inclusion criteria focused on English sources describing the use by occupational therapists of formulation or conceptualisation related to occupational concepts. One hundred and two eligible sources were identified, from which data were extracted, tabulated and synthesised narratively. The reviewed sources spanned 2002-2025, mainly originating from the United Kingdom and United States, and mental health settings. Sources included some evaluations and practice reflections but limited empirical research. Four strands of occupational formulation development were identified: formulation associated with the Model of Human Occupation, descriptions of the occupational therapy practice process, psychological formulation approaches and bespoke occupational approaches. Identified key features of occupational formulation were as follows: its grounding in occupational theory, inclusion within the practice process between assessment and goal development/therapy planning, collaborative emphasis, narrative approach, provision of a structure and being an ongoing process. Reported purposes included synthesising assessment findings, supporting reasoning, supporting shared understanding and therapy planning, enhancing communication and promoting an occupational focus. Benefits for the person, therapeutic relationship, occupational therapist and team were reported. Occupational formulation is both a process and a written product that can strengthen occupational therapy practice by linking theory to practice, enhancing reasoning and supporting collaborative care. Definitions are proposed to support consistent use in research and practice. Occupational formulation shows promise for enhancing occupational therapy practice. Further research should evaluate its effectiveness across diverse practice settings and populations.