公共卫生研究摘要 (2026-06-25)

共收录 64 篇研究文章

1. DoseBusters: A Fully Immersive Virtual Reality Game for Radiation Protection and Detection.

期刊: Health physics 发表日期: 2026-Aug-01 链接: PubMed

摘要

Virtual reality (VR) technology has been increasingly explored for creating immersive visual and interactive experiences in education and outreach, including applications related to radiation. A video game project named DoseBusters was created by a team of primarily undergraduate students as a method of outreach to attract interest in nuclear sciences while teaching fundamental radiological science and radiation protection principles. DoseBusters employs instructional dialog, experiments, and puzzle-like gameplay scenarios to engage students and the public. The Unity game engine was selected for building and deploying the game application, with Blender used for creating three-dimensional models of game assets. The Meta Quest line of headsets was used for testing. DoseBusters employs simple point-source gamma radiation assumptions for its real-time dose rate calculations. It implements shielding calculations that exclude buildup and scatter. Real-world measured data are used to accurately model detector sensitivities and spectroscopic measurements. A tutorial room environment uses a series of experiments to teach players about radiation physics, also serving to validate certain elements of the radiation physics simulation. Further minigames can be played to provide more depth and experience relating to source surveying and shielding principles. As part of the project’s development, numerous realistic radiation and environmental three-dimensional models were created, enhancing player immersion. Future work will involve using newly created environments for gameplay scenarios. Testing of all game play will ultimately be conducted with user feedback surveyed afterwards. Improvements to the game’s radiation simulation are also planned, including the addition of alpha and beta radiation.

2. Better Together? Learning to Align Medical, Social, and Public Health Systems to Promote Health Equity.

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

摘要

3. Aligning Health and Social Systems to Improve Maternal Behaviors and Birth Outcomes Among Clients Engaged in Evidence-Based Home Visiting.

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

摘要

Objectives. To examine the association between system alignment among Nurse-Family Partnership (NFP) home visitors and other community service providers and maternal behaviors and birth outcomes among NFP clients. Methods. NFP implementation data from 2015 to 2021 were matched to the 2018 to 2021 NFP Collaboration Panel Survey (n = 102 690). We used Poisson-based general estimating equations to examine a measure of cross-sector collaboration (based on relational coordination and structural integration) and the relationship with prenatal smoking cessation, breastfeeding, low birth weight, and preterm birth after adjustment for client-, nurse-, and agency-level covariates. Results. Stronger coordination with women’s care providers (relative risk [RR] = 1.010; 95% confidence interval [CI] = 1.00, 1.02) and greater integration with mental health providers (RR = 1.002; 95% CI = 1.00, 1.00) were slightly positively associated with initiation of breastfeeding. The slight positive association with greater integration with mental health providers was sustained for continued breastfeeding at 6 months postpartum (RR = 1.004; 95% CI = 1.00, 1.01). System alignment was not related to prenatal smoking cessation, low birth weight, or preterm birth. Conclusions. Future implementation studies should explore whether strategies to increase system alignment result in changes in quantitative measures of cross-sector collaboration and meaningful improvement in maternal and child outcomes at a population level. (Am J Public Health. 2026;116(S3): S181-S191. https://doi.org/10.2105/AJPH.2026.308457).

4. Assessing Cardiovascular Disease Prevention Activities in the Denver, Colorado, Metropolitan Area: Building on an Existing Network to Enhance Emphasis on Equity.

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

摘要

Objectives. To summarize and present a visual representation of the complex implementation context of cardiovascular disease prevention interventions and identify opportunities to increase an emphasis on equity. Methods. From May to October 2021, we conducted 24 interviews with people knowledgeable about cardiovascular disease prevention activities in the Denver, Colorado, metropolitan area, guided by the framing of a resource generator network analysis and the levels (clinical, behavioral support, health promotion/access, and regulatory/taxes) of the Prevention Impacts Simulation Model. We selected 4 program examples to demonstrate how subsets of the network carry out cardiovascular disease prevention activities. Results. There were 82 active and 7 inactive programs. We categorized organizations into 10 types. We identified the following health equity topic areas: tracking metrics, making referrals to basic needs services, offering non-health care services, addressing hunger and food insecurity, focusing programs on low-income and minoritized groups, and regulating industry. Conclusions. We recommend increasing the use of systems science methods in public health to reorient efforts toward prevention and equitable allocation of resources and to increase links across levels. (Am J Public Health. 2026;116(S3): S152-S161. https://doi.org/10.2105/AJPH.2026.308537).

5. Longitudinal Changes in Local Public Health Collaboration: Assessing Differences in Governance and Geography.

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

摘要

Objectives. To identify factors associated with longitudinal change in multisector collaboration in the delivery of essential public health services in the United States. Methods. We measured correlates of change in the intensity of collaboration in essential public health service delivery using data from the 1998 to 2023 National Longitudinal Survey of Public Health Systems. We used paired t tests to examine changes in collaboration intensity across sectors. We then estimated 2-part models to identify correlates of change in collaboration probability and intensity. Results. Multisector collaborations did not change significantly between 1998 and 2023. Rural jurisdictions were least likely to have expanded their multisector collaborations across this time period, and they did so at a lesser magnitude. Decentralized local public health department governance was associated with an increase in multisector collaboration but only among urban jurisdictions. Conclusions. Urban jurisdictions showed greater multisector collaboration expansion between 1998 and 2023 than their rural counterparts. Rural jurisdictions may face unique challenges to partnership building and collaboration, and these challenges may be exacerbated under decentralized governance structures. (Am J Public Health. 2026;116(S3): S192-S201. https://doi.org/10.2105/AJPH.2026.308536).

6. The Washington State Prescription Drug Affordability Board's selection of drugs for affordability review.

期刊: Journal of managed care & specialty pharmacy 发表日期: 2026-Jul 链接: PubMed

摘要

The Washington State Prescription Drug Affordability Board (PDAB) is tasked with conducting affordability reviews to identify whether prescription drugs have excess costs, defined as either exceeding therapeutic value or being unsustainable to public and private health care systems. The PDAB also has the authority to set upper payment limits (UPLs). There has been limited reporting of the methods and decisions through which PDABs examine and choose drugs for affordability review. To describe the processes of identifying drugs eligible for affordability review and selecting drugs for affordability review. Branded drugs are eligible for affordability review if their wholesale acquisition cost (WAC) was at least $60,000 or their price increased above certain thresholds. Biosimilar products are eligible if their price was not at least 15% lower than the reference biologic product. Generic drugs are eligible if their WAC was at least $100 per 30-day supply and increased by at least 200% in a 12-month period. Eligible drugs were ranked according to 4 criteria with the following weights: total out-of-pocket costs (0.35), total costs (0.33), mean out-of-pocket costs among users (0.19), and total number of users (0.13). 290 drug products were eligible in the 2023 drug review cycle. The majority (n = 166) were branded drugs, which were eligible because their WAC for a course of treatment was at least $60,000. After the weighted ranking of eligible drugs, the board chose the top 4 drugs for affordability review: Enbrel, Xtandi, Humira, and Cabometyx. The selected drugs have high cost burden for patients and payers in Washington. Affordability reviews of these drugs will evaluate whether they have led or will lead to excess costs, which will inform PDAB decisions regarding the possible implementation of UPLs.

7. US commercial health plan use of corticosteroids in step therapy protocols: Frequency and clinical appropriateness.

期刊: Journal of managed care & specialty pharmacy 发表日期: 2026-Jul 链接: PubMed

摘要

Commercial health plans may include corticosteroids in step therapy protocols for specialty drugs as part of use management. However, alignment with regulatory and clinical guidance is not well characterized. To assess how corticosteroids are incorporated into plan-imposed step therapy protocols and evaluate alignment with US Food and Drug Administration (FDA) labeling, clinical guidelines, and pivotal trials. We analyzed coverage policies from 18 large US commercial health plans in the Tufts Medical Center Specialty Drug Evidence and Coverage Database, reflecting policies active as of August 2024. We identified drug-indication pairs for which at least 1 plan included corticosteroids in step therapy. For each drug-indication pair, we reviewed FDA labeling to determine whether prior corticosteroid failure was consistent with FDA-recommended use. When corticosteroid use was not specified by FDA labels, we examined pivotal clinical trials and clinical guidelines to assess support for corticosteroid use in step therapy. We also examined how health plans operationalized corticosteroid use (eg, systemic vs local use, single vs multiple steps, etc). We identified 201 specialty drug-indication pairs and 2,767 corresponding coverage policies for which at least 1 plan included corticosteroids in step therapy. Of these drug-indication pairs, 33 (16.4%) had an FDA label indication recommending prior corticosteroids use, whereas 168 (83.6%) did not. Among 2,210 coverage policies for the 168 pairs without FDA label-indicated prior corticosteroid use, 952 (43.1%) included corticosteroids in step therapy protocols. In 21% (200/952) of these policies, corticosteroid use was a mandatory step, whereas the remaining 79% (752/952) allowed patients to meet the requirement by failing alternative agents (eg, immunomodulators). In total, 63.8% (607/952) specified the use of corticosteroids to be systemic. Few protocols defined dosage requirements (7.9%, 75/952) or treatment failure criteria (3.8%, 36/952). Among policies in which FDA labeling did not specify prior corticosteroid use, plans were significantly more likely to include corticosteroids in step therapy when corticosteroid use was an eligibility criterion in pivotal clinical trials (χ2 [1, N = 2,198] = 31.2; P < .001) or strongly recommended in clinical guidelines (χ2 [1, N = 1,434] = 128.0; P < .001). Inclusion also varied across plans, ranging from 15% to 74% of policies without FDA label-indicated corticosteroid use. Commercial health plans frequently include corticosteroids in step therapy, including when not specified in FDA labeling. Substantial variation in implementation highlights opportunities to improve transparency and consistency.

8. Hypertransaminasemia Is a Marker of Severity in Children Hospitalized for Influenza.

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

摘要

Elevated transaminases have been associated with increased severity in adult influenza cases, but data in the pediatric population are limited. This study aims to evaluate the prevalence, clinical characteristics and prognostic value of elevated transaminases in children hospitalized for influenza. A multicentre retrospective cohort study was conducted on 543 children hospitalized for acute viral respiratory infections. Demographic, clinical, biochemical, radiological features, and outcome were collected and analyzed, comparing children with influenza to those with other respiratory viruses. The association between elevated transaminases and clinical severity, complications, and intensive care unit (ICU) admission was assessed. Among 543 children, 127 (23.4%) had laboratory-confirmed influenza, with 24.4% showing elevated transaminases versus 7.2% in noninfluenza infections (p < 0.001). Influenza B was associated with a higher prevalence of hypertransaminasemia (40%) than influenza A (20.6%, p = 0.042). Asthenia, myalgia, and hypovolemic shock were more common in the elevated transaminase group (p < 0.05). Biochemical markers indicated muscular rather than hepatic origin of hypertransaminasemia. Elevated transaminases correlated with length of hospital stay (10.2 vs. 5.8 days, p < 0.001), ICU admission (OR 4.4, p = 0.035), high-flow oxygen need (OR 4.6, p = 0.005), and intravenous fluids (OR 6.2, p = 0.001). Two deaths occurred, both in the elevated transaminase group. Elevated transaminases occur in one fourth of children hospitalized for influenza and are associated with more severe disease, systemic complications, and worse outcomes. The findings suggest that transaminase elevation reflects systemic and muscular involvement rather than primary liver injury. Monitoring transaminases provides an early, easy marker to identify children at risk of severe influenza.

9. Mandela Yoga Group Medical Visit: A Culturally Resonant Public Health Intervention for Diverse Communities With Chronic Medical Conditions.

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

摘要

Mandela Yoga Project aims to improve health outcomes and reduce costs for communities with lived experience of chronic illness and systemic racism. Codeveloped with diverse staff at a safety-net health center, the Mandela Yoga Group Medical Visit model was piloted (n = 32) in two five- to six-week groups for patients with multiple chronic conditions. We report qualitative and quantitative findings (reduced pain, increased belonging, healing relationships), and discuss systems alignment to scale this peer-led, trauma-informed, culturally resonant public health intervention. (Am J Public Health. 2026;116(S3): S138-S142. https://doi.org/10.2105/AJPH.2026.308594).

10. AI-driven tripartite classification for optimizing wearable bioelectronics in depression management.

期刊: Science advances 发表日期: 2026-Jun-26 链接: PubMed

摘要

Current disease-sensing devices primarily focus on distinguishing between healthy and diseased states, effective for diagnosis but limited in guiding optimal intervention timing for prevention. We developed a tripartite framework identifying pre-disease state in depression, a reversible phase preceding irreversible onset. Using complex systems theory, we analyzed early-warning signals emerging as biological systems approach critical transitions. Continuous monitoring of nine multimodal biomarkers-spanning electrophysiological, behavioral, and biological-enabled classification into normal, pre-disease, and disease states by quantitatively defining critical points. An artificial intelligence agent classified disease states with 95.2% accuracy using multimodal data, enabled by ultrasoft neural probes for stable, low-damage recordings. Therapeutic validation with a skin-attachable wireless vagus nerve stimulator integrating soft three-dimensional electrodes demonstrated superior efficacy during pre-disease states. Subjects treated during pre-disease showed faster recovery and greater therapeutic responses, while those treated after disease onset failed to achieve full recovery. This framework provides evidence-based rationale for early intervention.

11. Prevention and Treatment of Peanut Allergy.

期刊: The New England journal of medicine 发表日期: 2026-Jun-25 链接: PubMed

摘要

Early introduction of peanut protein reduces allergy prevalence by approximately 80%, with efficacy diminishing as introduction is delayed. Appropriate prevention involves ingestion of approximately 2 g of peanut protein weekly for infants at low risk and 4 to 6 g weekly for infants at high risk. Population-level implementation that targets all infants achieves greater reduction in disease burden than approaches that target only high-risk groups, although disparities exist among some ethnic groups and groups with restricted access to care. Peanut immunotherapy initiated in younger children (1 to 3 years of age) shows superior efficacy and higher rates of clinical remission as compared with immunotherapy initiated in older children. The natural history of untreated peanut allergy follows a trajectory of increasing peanut-specific IgE levels and clinical reactivity over time, underscoring the importance of early intervention during this narrow developmental window.

12. Weeklong Noise Exposure of 100 College Students Who Participate in Music Activities.

期刊: Ear and hearing 发表日期: 2026-Jun-25 链接: PubMed

摘要

Musicians are routinely exposed to sound levels that place them at risk of hearing loss. Although the dangers of sound overexposure from music are well-known, less is known about which specific types of music activities contribute to this risk. Past study indicated that college musicians experience potentially hazardous sound levels during both musical and nonmusical activities. We now expand this line of investigation to a larger dataset to subtype musicians (based on instrument, ensemble type and number, and music-major status) and capture a wide array of musical engagement (total years of training, total hours of music engagement during the week). Descriptive study of college musicians with hearing thresholds <25 dB HL combining personal noise dosimetry, daily activity diaries, and musician subtyping. The college musicians in our sample showed a wide range of average daily sound exposure, spanning from 2 to 1638% of the National Institute of Occupational Safety and Health daily recommended exposure limit dose. It is important to note that ~70% of the cohort’s average daily sound exposure exceeded the National Institute of Occupational Safety and Health recommended exposure limit dose. We found that total years of musical training did not predict daily dose, but weekly hours of music activities did. When subtyping musicians, we found that music majors and nonmajors experienced similar average daily sound exposure; that brass and woodwind players tended to experience more sound exposure than string musicians; that musicians in multiple ensembles experienced more sound exposure than those in only one ensemble; and that musicians in band ensembles experienced more sound exposure than those in orchestral ensembles. The musician subtypes at lowest risk were vocalists and string players. Musicians who engaged in more hours of musical activity during the week experienced higher levels of sound exposure. Marching band members were more likely to engage in high-sound-intensity nonmusic activities compared with music majors. But even within different musician subpopulations, average daily sound exposure varied across individuals and the type and extent of music engagement accounted for only about half of the variance in average daily sound exposure. The college musicians in this sample varied widely in their sound exposure profiles. Musician subtype accounted for some of this variation, as did total hours of music engagement. However, neither variable captured the full range observed. As such, relying on musician subtype or total hours of engagement as a proxy measure for exposure could lead to erroneous conclusions about risk at the individual level. This finding highlights the need for individualized sound-exposure assessment to evaluate risk and provide appropriate recommendations to musicians to maintain their hearing health.

13. [The effectiveness and costs of the Back At work After Surgery (BAAS) work-integrated care pathway on return to work for patients receiving knee arthroplasty].

期刊: Nederlands tijdschrift voor geneeskunde 发表日期: 2026-Jun-25 链接: PubMed

摘要

To evaluate the effectiveness and costs of the Back At work After Surgery (BAAS) integrated care pathway for workers receiving knee arthroplasty in the Netherlands. Comparative cohort study of the BAAS cohort versus two usual-care cohorts. BAAS included explicit discussion of RTW in orthopedic consultations, workplace assessment, Goal Attainment Scaling, activity monitoring and an interdisciplinary online consult at 4-5 weeks postoperatively. Cohorts shared similar inclusion criteria and return-to-work and cost outcomes. Time to (full) RTW was analyzed with IPTW/Cox regression and costs with propensity score matching. Median time to first RTW was 27 days in BAAS versus 52 and 43 days in controls (HR 2.7 and 1.95). Full RTW took 183 versus 210 days (HR 1.4). Non-RTW within 12 months was 2% versus 16% and 13%. Intervention cost €845 with cost reductions of €4,493 per worker from employer perspective. BAAS accelerates return-to-work and delivers substantial economic benefits.

14. Long-Term Effectiveness of Unguided Internet-Based Cognitive Behavioral Therapy on Major Depressive Disorder in Chinese Adults: Randomized Controlled Trial With a 12-Month Follow-Up.

期刊: JMIR mHealth and uHealth 发表日期: 2026-Jun-24 链接: PubMed

摘要

Unguided internet-based cognitive behavioral therapy (ICBT) is a low-cost and scalable treatment for major depressive disorder (MDD), but its long-term effects in Chinese populations remain unclear. This study aimed (1) to explore the short- and long-term effectiveness of unguided ICBT in treating adults with MDD; (2) to investigate the short- and long-term effects on disease-related symptoms, individual and social functioning, and quality of life; and (3) to assess the acceptability and satisfaction with the ICBT. An 8-week randomized controlled trial (ChiCTR2100046425) was conducted between August 2021 and June 2023 in Shenzhen, China, with 159 participants in the immediate ICBT group (7-module ICBT course plus usual care) and 158 in the waitlist control (WLC) group (usual care). The WLC group later completed the same ICBT course and follow-up assessments. Outcome measures (depressive and anxiety symptoms, psychological distress, social functioning, self-efficacy, quality of life, and stigma) were assessed before and after treatment and at 3-, 6-, and 12-month follow-ups for ICBT participants. Remission and response, adherence, and satisfaction were evaluated by predefined standards. Among 300 participants analyzed (mean age 28.49, SD 7.0 years; female: n=225, 75%), dropout rates were 22.4% (34/152) in the immediate ICBT group versus 6.3% (10/158) in the WLC group. At posttreatment, the immediate ICBT group showed greater reduction in depressive symptoms versus WLC (mean difference -3.65, SE 0.60; P<.001; d=0.50), with higher remission (80/121, 66.1% vs 58/148, 39.2%; P<.001) and response rates (50/121, 41.3% vs 27/148, 18.2%; P<.001). At 12-month follow-up, the depressive symptoms were improved compared with that at pretreatment (mean difference -3.90, SE 0.32; P<.001; d=0.70), and no significant change was observed in comparison with the outcomes at posttreatment (mean difference -0.81, SE 0.33; P=.33; d=-0.15). ICBT treatment also exhibited similar short- and long-term effects on secondary outcomes, with significant improvement of disease-related symptoms, individual and social functioning, and quality of life. Moreover, the majority of the participants treated with ICBT reported high acceptability of and satisfaction with the ICBT course. Unguided ICBT effectively reduces depressive symptoms and enhances functioning in Chinese patients with MDD, with sustained benefits over 12 months. Its scalability and low-cost nature make it a promising option for resource-limited settings.

15. Decoding fibrosis: Transcriptomic and clinical insights via AI-derived collagen deposition phenotypes in MASLD.

期刊: Hepatology (Baltimore, Md.) 发表日期: 2026-Jun-24 链接: PubMed

摘要

Histological assessment is foundational to multi-omics studies of liver disease, yet conventional fibrosis staging lacks resolution, and quantitative metrics like collagen proportionate area (CPA) fail to capture tissue architecture. While recent AI-driven approaches offer improved precision, they are proprietary and not accessible to academic research. Here, we present a novel, interpretable AI-based framework for characterising liver fibrosis from picrosirius red (PSR)-stained slides. By identifying distinct data-driven collagen deposition phenotypes (CDPs) which capture distinct morphologies, our method substantially improves the sensitivity and biological specificity of downstream transcriptomic and proteomic analyses compared to CPA and traditional fibrosis scores. Pathway analysis reveals that CDPs 4 and 5 are associated with active extracellular matrix remodelling, while phenotype correlates highlight links to liver functional status. Importantly, selected CDPs demonstrated prognostic associations in the discovery cohort, with attenuation of discrimination in the external validation cohort. All models and tools are made freely available to support transparent and reproducible multi-omics pathology research.

16. Long-Acting Treatment and Advanced HIV Disease - Addressing a Public Health Priority.

期刊: The New England journal of medicine 发表日期: 2026-Jun-24 链接: PubMed

摘要

17. Bundibugyo Virus Disease in 2026 - Clinical and Public Health Responses.

期刊: The New England journal of medicine 发表日期: 2026-Jun-24 链接: PubMed

摘要

Bundibugyo virus is a relatively rare orthoebolavirus that has caused only two previously recognized disease outbreaks but remains capable of producing severe epidemic disease with substantial mortality. The 2026 outbreak of Bundibugyo virus disease in the Democratic Republic of Congo has highlighted persistent challenges in the detection of filovirus disease outbreaks, as well as in diagnosis, clinical management, and the public health response, particularly in resource-limited settings. As with other filovirus infections, effective control of the Bundibugyo virus disease outbreak depends on rapid identification of cases, laboratory confirmation of infection, isolation of cases, contact tracing, infection-prevention measures, protection of health care workers, and community engagement. Although no licensed vaccines or approved therapeutics specific to Bundibugyo virus disease are currently available, advances in supportive care have improved outcomes during recent filovirus disease outbreaks. Experimental evidence from studies involving nonhuman primates, serologic investigations with human samples, and monoclonal antibody research suggests that vaccines and therapeutics developed against Ebola virus may provide cross-protective activity against Bundibugyo virus. These observations support prototype-pathogen approaches to preparedness while underscoring the need for continued development of pathogen-specific countermeasures. The current outbreak reinforces the principle that a successful response to filovirus disease requires integration of medical countermeasures, clinical care, surveillance, diagnostics, and coordinated multinational public health operations.

18. Fine-Tuning Large Language Models for Motivational Interviewing in Health Behavior Change: Development and Evaluation Study.

期刊: JMIR formative research 发表日期: 2026-Jun-24 链接: PubMed

摘要

Motivational interviewing (MI) is an effective counseling approach for promoting health behavior change, but its scalability is constrained by the need for highly trained human counselors. Large language models (LLMs) may provide a scalable way to support MI counseling, but evidence remains limited, especially for Chinese MI resources and evaluations based on standardized MI fidelity frameworks. This study aimed to develop Chinese large language models for motivational interviewing (MI-LLMs) and evaluate whether MI-focused fine-tuning could improve their ability to generate counseling responses consistent with MI principles. We first curated 5 publicly available Chinese psychological counseling datasets and assessed sampled conversations in terms of comprehensiveness, professionalism, authenticity, and safety. The 2 highest-scoring datasets, CPsyCounD and PsyDTCorpus, were selected for MI-style data construction. Using GPT-4 with a structured MI-informed prompt, we transformed 2040 multiturn counseling conversations into MI-style dialogs. Among these, 2000 dialogs were used for training and 40 for testing. Three Chinese-capable open-source LLMs (Baichuan2-7B-Chat, ChatGLM-4-9B-Chat, and Llama-3-8B-Chinese-Chat-v2) were fine-tuned with low-rank adaptation on the training dataset and were referred to as MI-LLMs. Automatic evaluation was conducted on the testing dataset using Bilingual Evaluation Understudy-4 (BLEU-4) and Recall-Oriented Understudy for Gisting Evaluation (ROUGE) metrics. Manual evaluation was conducted using the Motivational Interviewing Treatment Integrity Coding Manual 4.2.1. Thirty simulated counseling dialogs generated by the MI-LLMs were compared with 30 real MI dialogs sampled from AnnoMI and translated into Chinese. Two trained graduate student raters coded global scores and behavior counts, from which summary scores were subsequently calculated. In automatic evaluation, fine-tuning substantially improved BLEU-4 and ROUGE scores across all 3 models compared with the base models. In manual evaluation, the MI-LLMs achieved technical and relational global scores, as well as total MI-adherent ratios that approached those of real MI dialogs. The MI-LLM based on ChatGLM-4-9B-Chat showed the strongest overall global performance. However, MI-LLMs produced fewer complex reflections and had lower reflection-to-question ratios than real MI dialogs. This study provides preliminary evidence that MI focused fine-tuning can help Chinese LLMs acquire core counseling behaviors consistent with MI principles. It also offers a scalable approach for constructing MI style dialog resources in Chinese. Nevertheless, current MI-LLMs should be regarded as early-stage tools for supporting, rather than replacing human counselors. Future work should expand real MI training data and strengthen the complex reflective skills of MI-LLMs. Further studies are needed to evaluate their effectiveness, acceptability, and safety in health behavior change settings in the real world.

19. Dietary Inflammatory Index and Depressive Symptoms in Chinese University Students Leveraging an Intelligent Ordering System: 3-Year Longitudinal Prospective Cohort Study.

期刊: Journal of medical Internet research 发表日期: 2026-Jun-24 链接: PubMed

摘要

Depression is a major global cause of disability, and depressive symptoms are highly prevalent and increasing among Chinese university students. Mounting evidence confirms that inflammation plays a key role in the pathogenesis of depression, and dietary inflammatory potential regulates systemic inflammation to influence depressive symptom development. However, existing research is limited by cross-sectional designs, recall bias from self-reported dietary surveys, and a lack of long-term prospective cohort evidence on the diet-inflammation-mental health pathway in Chinese university students. This study aimed to examine the longitudinal association between Dietary Inflammatory Index (DII) and the incidence of depressive symptoms in Chinese university students, and to explore subgroup differences by family relationship and socioeconomic status. A 3-year longitudinal prospective cohort study was conducted among 5314 students from a university in Shanghai, China. Eligible participants met the criteria of ≥86 days of annual campus cafeteria dining and at least 1 breakfast, lunch, and dinner in campus canteens per quarter; students with abnormal monthly energy intake, excessive food consumption, or incomplete 3-year dietary/psychological data were excluded. Dietary data were continuously collected via the Intelligent Ordering System (IOS) from April 2020 to March 2023 to calculate DII scores. Depressive symptoms were annually assessed using the Beck Depression Inventory-II from March 2021 to March 2023. Mixed-effects logistic regression (α=.05) was used to analyze the association, with subgroup analyses stratified by family relationship and poverty status. The baseline prevalence of depressive symptoms was 10.75% (571/5314; male: 261/2679, 9.74%; female: 310/2635, 11.76%). After adjusting for covariates, compared with the highest DII quartile (most proinflammatory diet), lower DII quartiles (more anti-inflammatory or low proinflammatory diets) were associated with a reduced risk of incident depressive symptoms in participants without depressive symptoms at baseline: Q1 (odds ratio [OR] 0.27, 95% CI 0.16-0.47), Q2 (OR 0.52, 95% CI 0.33-0.84), and Q3 (OR 0.26, 95% CI 0.16-0.42). Subgroup analyses showed this protective effect was only significant in students with harmonious family relationships and non-poverty-stricken students; no significant association between DII and depressive symptom improvement was found in participants with baseline depressive symptoms. This study is among the first to prospectively examine dietary inflammatory potential and depressive symptoms in university students using long-term objective dietary monitoring. Unlike studies relying on self-reported dietary surveys, this study used an automated and precise campus-based IOS to continuously capture real-world dietary behaviors over 3 years. The findings indicate that sustained anti-inflammatory dietary patterns are associated with a lower risk of depressive symptoms among Chinese university students, although this protective effect was weaker in students experiencing family discord or socioeconomic disadvantage. These findings provide new longitudinal evidence for the diet-inflammation-mental health relationship and support integrated campus interventions combining dietary guidance with psychosocial support.

20. Development and Adaptation of Bilingual Health Text Message Databases for Health Interventions in Hispanic Communities: Protocol for a Scoping Review.

期刊: JMIR research protocols 发表日期: 2026-Jun-24 链接: PubMed

摘要

SMS text messages have been used as part of health intervention research for over a quarter of a century. Given the ease of reaching people via SMS text message, these interventions are important for all groups, including Hispanic individuals. SMS text messaging interventions continue to show promise for improving health in this population. Several reviews have addressed aspects of designing Hispanic-focused digital health interventions. Emphasis has been placed on the linguistic and cultural relevance of SMS text messages in these studies. However, a gap exists in the literature on how SMS text messages are developed and adapted for use in health interventions with Hispanic communities across the life span. The objective of this scoping review is to answer the following question: how are bilingual SMS text message databases developed and/or adapted for use in health interventions for the Hispanic population in the United States? In this scoping review, the framework by Arksey and O’Malley and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines will be used. The review will be conducted in five stages: (1) identifying the research question; (2) identifying relevant studies; (3) study selection; (4) charting the data; and (5) collating, summarizing, and reporting the results. For the inclusion criteria, the population (Hispanic individuals across the life span), concept (development and/or adaptation of bilingual SMS text message databases for health interventions), and context (the United States) framework will be used. There is no age or time limit on the study populations or included articles. In May 2025, we searched 4 databases: PubMed, Embase, Web of Science, and CINAHL. Covidence is being used to collect studies. There are 2 phases, each involving 2 independent reviewers: the title and abstract phase followed by the full-text review phase. One of the authors developed a data extraction tool with 4 sections. These sections include general study information, foundational SMS text message database information, how the development and adaptation of the SMS text message database were informed, and data on cultural and linguistic elements of the database. Each section will be presented in tabular format, with descriptive and numerical summaries. Inductive thematic analysis will be used for the fourth section. This scoping review commenced in May 2025, and titles and abstracts are being reviewed to assess further eligibility. After the full-text review, a determination will be made on which studies to include, and data extraction and results will be documented. We anticipate that this review will be completed by December 2026. This scoping review of the cultural and linguistic elements of SMS text message databases may contribute to the development of more meaningful and concordant databases for use in health interventions among the Hispanic population. DERR1-10.2196/86032.

21. Leveraging Self-Reporting in an Existing e-Cohort to Identify Clinically Relevant Mitral Valve Prolapse: Pilot Questionnaire Study.

期刊: JMIR formative research 发表日期: 2026-Jun-24 链接: PubMed

摘要

Mitral valve prolapse (MVP) is a common valvulopathy associated, in a minority of cases, with heart failure, severe mitral regurgitation (MR), and sudden arrhythmic death. Digital tools hold promise for faster and more efficient recruitment of study participants into a large-scale MVP Registry. This study sought to evaluate the feasibility of surveying participants in an existing e-cohort to identify and clinically characterize MVP cases based on self-reporting and to recruit them in an MVP Registry at the University of California, San Francisco. We surveyed Northern Californian participants of the Health eHeart Study, a large e-cohort using the Eureka digital research infrastructure, about a prior diagnosis of MVP. MVP-positive respondents were asked to provide relevant medical records to confirm their eligibility and were invited to enroll in an MVP Registry if evidence of MVP was confirmed. A follow-up survey was sent after 1 month and after 5 years to collect data about clinical outcomes, including arrhythmias and the need for mitral valve repair. The survey was delivered to 5746 participants, and 520 completed responses were collected. A prior diagnosis of MVP was self-reported by 16.3% (85/520) of respondents. Echocardiograms were obtained from 51.8% (44/85) of participants, and evidence of MVP was confirmed in 32.9% (n=28) of individuals, all of whom joined the registry. Participants with more severe MR had a higher number of correct responses regarding both MVP (odds ratio [OR] 10.58, 95% CI 3.58-63.04; P<.001) and MR diagnosis (OR 4.86, 95% CI 2.11-16.14; P=.002). Longitudinal data were available from most patients through responses to a follow-up survey sent 1 month and 5 years later (18/28, 64.3% and 17/28, 60.7% of MVP confirmed respondents, respectively). Among the patients with electronic health records available, 75% (3/4) had a correct self-reported diagnosis of arrhythmia. e-Cohort methods with self-reported clinical data can be used to prescreen candidates for a research study of MVP. These methods can rapidly identify and retain, among many cases of benign MVP, the minority with clinically relevant presentations such as significant MR and ventricular arrhythmias. These cases may be missed, especially when asymptomatic, by small-scale clinic-based recruitment or family screening methods.

22. Development of Virtual Reality Health Literacy: Delphi Expert Consensus Study.

期刊: Journal of medical Internet research 发表日期: 2026-Jun-24 链接: PubMed

摘要

Virtual reality (VR) is a promising tool in health care, offering immersive and interactive environments that can enhance patient education, rehabilitation, and mental health interventions. However, effective patient engagement with head-mounted display (HMD)-based immersive VR depends on a combination of functional competencies and readiness-related determinants that have not yet been systematically defined. This study aimed to conceptualize an initial framework of VR health literacy, focused on HMD-based immersive VR in clinical settings, and to achieve expert consensus on its definition, domains, and subdomains. A 3-phase modified Delphi study was conducted between January and April 2024, including a literature review in MEDLINE (via PubMed) and Embase (2017-2023) informed by scoping review methodology, a multidisciplinary expert panel formation, and 2 online survey rounds, in which panelists rated each subdomain on a 4-point necessity scale and provided open-ended feedback, with 15 experts from the health care, VR, and health literacy fields. Consensus was defined using IQRs and agreement thresholds; items with moderate consensus were further evaluated through structured internal deliberation. A total of 15 experts participated in Round 1, and 13 continued to Round 2 (retention rate, 87%). An initial structure of 7 candidate domains with 23 subdomains was iteratively refined across the two rounds based on consensus levels, expert panel feedback, and internal deliberation, with consensus thresholds applied as guiding criteria rather than automatic exclusion rules; subdomains with moderate consensus were further evaluated through structured internal deliberation to determine theoretical necessity within the framework. The final framework comprised 5 domains and 14 subdomains: performance expectancy (perceived usefulness of VR for health management; expectations of future VR benefits); effort expectancy (perceived immersion or embodiment; perceived interactivity and responsiveness; understanding of VR-related terms); facilitating conditions (access to VR devices and platforms; digital knowledge and confidence; technical proficiency with VR devices; digital self-efficacy); attitudes toward VR (awareness of VR in health contexts; interest in VR technology; problem-solving ability using VR content); and behavioral intention (intention to use VR technology or services; willingness to engage with VR for health). This study presents an initial consensus-based framework of VR health literacy for HMD-based immersive VR in clinical settings. Developed through a multidisciplinary Delphi process, the framework combines operational competencies with engagement-related determinants to provide both theoretical clarity and practical use, offering guidance for clinicians, educators, and policymakers to design and implement VR interventions that are accessible, equitable, and effective in health care contexts.

23. The Need to Reconstruct "Person-Centeredness" Based on Inherent Tensions.

期刊: Journal of applied gerontology : the official journal of the Southern Gerontological Society 发表日期: 2026-Jun-24 链接: PubMed

摘要

The concept of person-centeredness (PC) is ubiquitous in health and supportive care regardless of recipients’ age and condition, which might suggest that the concept is clear, uniformly understood, and its provision straightforward; however, such is not the case. To more fully understand the concept and challenges inherent in applying PC overall and in the care of older adults, including persons with dementia and receiving long-term care, this special article draws on meetings held with 116 participants representing diverse perspectives and expertise. Six deeply rooted tensions were identified: community (public) versus individual (private); efficiency versus individualization; superficial knowing versus deep knowing; policy compliance versus flexible decision making; safety versus freedom; and expense versus investment. Given these pervasive tensions, full PC can never be achieved, and requires ongoing negotiation. Therefore, the concept of PC must be reconstructed, adopting a more nuanced and realistic approach to practice, policy, and research.

24. Exploring the Role of Early Career Medical Professionals From a Digital-Oriented University in Germany in Promoting Digital Health in Professional Settings: Qualitative Interview Study.

期刊: JMIR medical education 发表日期: 2026-Jun-24 链接: PubMed

摘要

To address care delivery gaps, the health care system must embrace innovative digital solutions. Additionally, the rising integration of digitalization as a topic into medical education is providing students with broader opportunities to engage with digitalization overall. As digital health becomes an increasingly integral component of medical education and health care practice, digitally affine early career medical professionals constitute a vital resource for advancing digitalization within the health care sector. This study examines how early career medical professionals from Witten/Herdecke University in Germany, with various courses focusing on digitalization, acquire digital knowledge, apply it across diverse practical contexts-ranging from start-ups and corporate environments to traditional clinical settings-and how they contribute to the advancement of digitalization within the entire health care sector. Using a qualitative approach, 19 interviews were conducted with early career medical professionals who graduated in the last 15 years at Witten/Herdecke University. Subsequently, the interviews were transcribed and analyzed using a deductive-inductive approach. The findings reveal that medical graduates often acquire digital skills through intensive self-study and learning on the job, integrating them in various ways into their professional lives. Moreover, while graduates recognize their high potential to make their own contribution to the advancement of digitalization, they also face significant barriers such as knowledge gaps, limited resources, and complex regulations, which hinder their ability to contribute to digitalization in a variety of professional settings. Medical graduates report that they face a pressing need for enhanced knowledge access, improved institutional frameworks, and supportive policy measures to maximize their potential in advancing digitalization initiatives. Recent medical graduates represent an underused resource for health care digitalization. Unlocking this potential requires coordinated action across medical education, health care institutions, and policymaking to create appropriate conditions for graduates to actively drive digitalization.

25. Health Promotion for Sun Protection: A Community Approach in a Mountain Setting.

期刊: High altitude medicine & biology 发表日期: 2026-Jun-24 链接: PubMed

摘要

Buja, Alessandra, Sandro Cinquetti, Marco Coller, Angela Padoin, Chiara Trevisiol, Ilaria Pantaleo, Claudio Palmeri, Vincenzo Marcotrigiano, Erica Bino, Silvia Flesia, and Simone Mocellin. Health promotion for sun protection: a community approach in a mountain setting. High Alt Med Biol. 00:00-00, 2026. Alpine regions exhibit high incidence rates of cutaneous melanoma due to increased ultraviolet radiation at higher altitudes. In 2022, the “Montagna SÌ, Melanoma NO” (Mountain YES, Melanoma NO) public health campaign began promoting sun-protective behaviors in these areas. This study aims to evaluate an intervention’s effectiveness 3 years after its launch and assess improvements in sun safety practices. A before-and-after comparative study was conducted by surveying a random sample of 229 Belluno residents in the Veneto Region, Italy, in 2022, and 115 of those same individuals in 2025 using a standardized questionnaire. Data on sociodemographics, phenotypic characteristics, sun exposure habits, sunscreen use, protective clothing/eyewear usage, and campaign awareness were collected. In 2025, 43% of respondents (95% CI: 33.44%-52.17%) reported being aware of the health promotion efforts. A significant increase in sunscreen application during outdoor activities lasting more than 1 hour and during skiing was detected. Nevertheless, other protective measures, such as the use of caps and sunglasses, did not demonstrate any significant improvement. The campaign was effective. It reached its target population and improved sun-protective behaviors, confirming the value of community-engaged, tailored health promotion strategies. Further initiatives are necessary to address the remaining gaps in melanoma prevention adherence.

26. Use and Misuse of GLP-1 Receptor Agonists Among People With Eating Disorders.

期刊: JAMA psychiatry 发表日期: 2026-Jun-24 链接: PubMed

摘要

This cross-sectional study evaluates the prevalence of glucagon-like peptide-1 (GLP-1) receptor agonist use and misuse among people with eating disorders in the US.

27. Compensatory activation of the deltoid and remaining rotator cuff muscles in patients with rotator cuff tears using real-time tissue elastography.

期刊: Archives of orthopaedic and trauma surgery 发表日期: 2026-Jun-24 链接: PubMed

摘要

Rotator cuff (RC) tears are a prevalent condition leading to dysfunction and shoulder pain. Spatial changes in the behavior of the deltoid and remaining RC muscles during arm elevation in patients with RC tears have not been investigated. The purpose of this study was twofold: (1) to investigate factors related to the changes in the deltoid muscle behavior during scapular plane abduction (scaption) in patients with RC tears, and (2) to examine the functional relationship between the deltoid and remaining RC muscles, particularly remaining infraspinatus (ISP) and teres minor (TMin) muscles, in these patients using ultrasound elastography. Twenty-four patients (mean age, 66 ± 6 years) with RC tears (mean antero-posterior diameter, 17.4 ± 8.3 mm) were evaluated. Antero-posterior and medio-lateral diameters of the posterosuperior RC and Subscapularis (SSC) tears were measured intra-operatively. Muscle elasticity was evaluated at passive and active states, as a proxy for muscle activation, at 30°, 60°, and 90° during scaption for the deltoid, ISP, and TMin muscles using real-time tissue elastography. Based on the deltoid muscle activity ratio at 30° and 90° scaption, patients were divided into normal and abnormal activation groups. Activity of the deltoid muscle in the abnormal activation group exhibited consistently high activity across various elevation angles, significantly higher compared to that of the normal activation group at 30° scaption (p = 0.037). Although there was no statistically significant between-group difference in TMin muscle activity at 30° scaption, TMin muscle activity in the normal activation group was highest at 30° and significantly higher than at 90° scaption (p = 0.032). Abnormal activation group had a higher incidence of SSC tears combined with posterosuperior RC tears (p = 0.009). SSC tears combined with posterosuperior RC tears may be associated with compensatory activation of the deltoid muscle in the early phase of arm elevation, while relatively greater TMin muscle activity in the initial range of elevation may reflect a compensatory contribution of the remaining posterior RC muscles.

28. Emergency Nurse-Led Evidence-Based Practice Initiative: Patient Self-Management of Noncommunicable Disease in the Community.

期刊: Journal of emergency nursing 发表日期: 2026-Jun-24 链接: PubMed

摘要

Emergency department visits are critical touchpoints to engage patients with noncommunicable diseases in self-management support aligned with Hong Kong health care reform and Sustainable Development Goal 3.4. This study examined the effectiveness of an emergency department-based, nurse-led health-promotion intervention to improve chronic disease self-efficacy and strengthen emergency nurses’ contribution to primary health care. In a single-blind, randomized controlled pilot trial in an urban emergency department, 92 adults with noncommunicable diseases were allocated to the interventional (n = 46) or conventional group (n = 46). The intervention comprised personalized education on primary health care resources, onboarding to eHealth and HA Go, and 2 months of WhatsApp reinforcement. The conventional group received standard discharge education and informational leaflets. The primary outcome was chronic disease self-efficacy at 2 months, measured using the Chinese Partners in Health Scale. Secondary outcomes were awareness and use of District Health Centre/Express, the Chronic Disease Co-Care Pilot Scheme, and digital platforms. The interventional group demonstrated significantly higher Chinese Partners in Health Scale scores than conventional care (mean difference, 8.54; 95% CI, 2.53-14.55; P = .0057; Cohen’s d = 0.654). District Health Centre/Express visitation increased from 13.5% to 54.1% in the interventional group, whereas it remained unchanged in the conventional group. Chronic Disease Co-Care Pilot Scheme awareness rose from 43.2% to 100% vs 12.5% in conventional (P < .001). eHealth registration increased by 29.7% vs 12.5% (x2 = 7.433; P = .006), and HA Go adoption was higher (odds ratio, 0.5862; P = .007). Emergency department-based, nurse-led health promotion significantly enhances noncommunicable disease self-efficacy and activates primary health care and digital health utilization, supporting integration of emergency nurses into Hong Kong’s primary care transformation and progress toward Sustainable Development Goal 3.4.

29. Work Ability and Associated Factors Among Nurses in a Teaching Hospital: A Cross-Sectional Study.

期刊: La Medicina del lavoro 发表日期: 2026-Jun-24 链接: PubMed

摘要

Preserving nurses’ work ability (WA) is essential for healthcare sustainability, especially given the current global workforce crisis and an ageing population. This study aims to assess the prevalence of inadequate WA among hospital nurses and to identify the personal, domestic, and organisational predictors that influence it, focusing on modifiable factors to inform targeted retention strategies. A cross-sectional study was conducted at an Italian university hospital (August-October 2022). Data from 182 nurses were collected during mandatory health surveillance visits using the Work Ability Index (WAI), alongside assessments of socio-demographic, occupational, and extra-work responsibilities (caregiving/education). Multivariable binary logistic regression was performed to identify independent predictors of WA, adjusting for confounders such as BMI and lifestyle factors. Inadequate WA was reported by 44.5% of participants (mean age 45.8±11.1 years). A significant health burden was observed, with 41.8% suffering from musculoskeletal disorders. The regression model (χ2(9)=31.026; p<0.001) revealed that the likelihood of adequate WA decreased significantly with advancing age (OR=0.93 per year; p<0.001) and high extra-work burdens (OR=0.97 per hour; p=0.041). Conversely, satisfaction with working conditions emerged as the primary modifiable protective factor, significantly increasing the likelihood of adequate WA (OR=2.41; p=0.010). No significant associations were found for sex, BMI, or smoking status. Nearly half of the nursing workforce exhibits vulnerable work ability. Findings suggest a detrimental ‘double duty’ effect where domestic responsibilities and age intersect. Organisational interventions should prioritise work-life balance and improved work climates to mitigate the impact of demographic shifts and preserve workforce sustainability.

30. Diagnostic Pitfalls in Pediatric Acute Promyelocytic Leukemia: All-trans Retinoic Acid-Associated Hypercalcemia Mimicking Fungal Meningitis and the Risks of Azole Coadministration.

期刊: Journal of pediatric hematology/oncology 发表日期: 2026-Jun-24 链接: PubMed

摘要

To alert clinicians to the risk of severe hypercalcemia arising from the ATRA-azole interaction and to highlight a rare diagnostic pitfall involving a false-positive cerebrospinal fluid (CSF) (1,3)-β-D-glucan (BDG) result. Concurrent use of all-trans retinoic acid (ATRA) and azole antifungals poses a risk of severe hypercalcemia in pediatric acute promyelocytic leukemia (APL). We performed a retrospective clinical and laboratory review of two 10-year-old patients with APL who developed drug-induced toxicity during induction therapy. Both patients developed severe hypercalcemia induced by ATRA combined with fluconazole or voriconazole, presenting with intractable vomiting and headache. Notably, one case was confounded by an elevated CSF (1,3)-β-D-glucan level (a false-positive laboratory artifact), which mimicked fungal meningitis and delayed the correct diagnosis. Clinicians must remain vigilant for ATRA-associated hypercalcemia during azole co-administration. Recognizing diagnostic mimics and implementing routine calcium monitoring are crucial to prevent misdiagnosis and severe toxicity.

31. Chinese Mobile Health Apps for Preventing and Managing Pelvic Floor Dysfunction: Quality Assessment and Content Analysis.

期刊: Journal of medical Internet research 发表日期: 2026-Jun-24 链接: PubMed

摘要

Pelvic floor dysfunction (PFD) is a highly prevalent health problem, encompassing urinary incontinence, emptying disorders of the bladder, fecal incontinence, emptying disorders of the bowel, pelvic organ prolapse, sexual dysfunction, and chronic pelvic pain. Mobile health (mHealth) interventions delivered through apps can provide remote health services to improve patient compliance and enhance treatment effectiveness. Although apps for preventing and managing PFD have been developed and used, the features and quality of these apps in China have not been systematically examined. This study aimed to systematically summarize the functions and evaluate the quality of the existing mHealth apps for preventing and managing all kinds of PFD, such as urinary incontinence, fecal incontinence, and chronic pelvic pain. We systematically searched for potential PFD apps on the Apple App Store, Huawei AppGallery, and VIVO App Store. Apps were included if they were free, designed for preventing or managing PFD, in the Chinese language, could be downloaded and run on Android, Harmony, or iOS operating systems (OS), and incorporated elements of preventing and managing PFD. We excluded apps that were intended for use by health care providers and not relevant to PFD. Apps that met the inclusion criteria were downloaded and included for final analysis. The user version of the Mobile App Rating Scale (uMARS) was used to assess the apps’ quality and summarize the apps’ functionality according to guidelines. Of the 3897 apps screened, 46 apps that met the inclusion criteria were included in the final analysis. All apps were developed by corporations. More than half of the apps had download counts exceeding 10,000, and 24 (52.2%) apps scored 4 or higher in app stores. Furthermore, nearly half of the apps (n=21, 45.7%) had been updated within the past month at the time of retrieval. The overall uMARS scores ranged from 2.29 to 4.50, with a mean uMARS score of 3.46 (SD 0.50), which is considered acceptable quality. Based on uMARS scores, 15.2% (n=7) were rated as poor quality, 65.2% (n=30) as acceptable, and 19.6% (n=9) as good quality. More than half of the apps provided the functions of exercise (n=44, 95.7%), personal information recording (n=31, 67.4%), and health education (n=28, 60.9%). Only 5 apps provided 5 or more functions. The apps for PFD revealed acceptable quality, and the majority provided exercise, personal information recording, and health education functions. However, many apps lacked comprehensive functionalities and did not provide immediate feedback or high-quality educational information. Health care providers should follow international guidelines to create high-quality, evidence-based, multifunctional apps for PFD. Future studies should explore the effects of the apps and real-world user feedback data in clinical settings.

32. IgA is necessary and sufficient to prevent norovirus infection in mice.

期刊: Science translational medicine 发表日期: 2026-Jun-24 链接: PubMed

摘要

Human norovirus is the leading cause of viral gastroenteritis, yet effective vaccines and therapeutics remain elusive. Using murine norovirus as a model, we found that mucosal immunoglobulin A (IgA) is both necessary and sufficient for protection against infection, whereas CD8+ T cells are dispensable. Robust intestinal IgA production requires at least 4 weeks of enteric infection, consistent with kinetics of human norovirus RNA clearance. Systemic vaccination elicits high titers of neutralizing serum IgG but fails to prevent enteric norovirus infection, phenocopying a recent human norovirus vaccine failure. In contrast, prophylactic delivery of dimeric anti-norovirus IgA via mRNA lipid nanoparticles confers sterilizing immunity. Together, these findings define a critical role for mucosal IgA in norovirus protection and identify IgA-based treatments as a therapeutic approach for human norovirus.

33. Perceptions of the Canadian 24-Hour Movement Guidelines among rural adults: awareness, knowledge, and recommendations.

期刊: Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme 发表日期: 2026-Jun-24 链接: PubMed

摘要

Movement behaviour guidelines should be tailored to contextual factors influencing physical activity, sedentary behaviour, and sleep to support effective mobilization. Compared to urban areas, rural communities have distinct environmental characteristics and require context-specific strategies to promote healthy movement behaviours. This study aimed to evaluate awareness and knowledge of the Canadian 24-Hour Movement Guidelines for Adults (18-64 years) living in rural communities and explore how to adapt the Canadian 24-Hour Movement Guidelines Communications Toolkit for greater impact and relevance. We adopted an explanatory sequential mixed methods study design, in which adults living in rural communities of British Columbia, Canada, completed a cross-sectional survey (N = 76) followed by individual interviews (N = 12). Survey data were analysed for awareness and knowledge of Movement Guidelines using descriptive statistics and Chi-squared tests. Interview data were analyzed following a deductive thematic approach using the Behaviour Change Wheel to identify the barriers and facilitators to meeting guideline recommendations. Approximately half of the participants reported being aware of the guidelines (44.7%), 64.5% reported moderate knowledge of recommendations, and 27.6% of participants reported meeting guidelines for physical activity, sedentary behaviour, and sleep. Participants perceived factors associated with physical opportunities and psychological capabilities to have strong influences on their ability to meet movement behaviour guidelines. Recommendations for adapting 24-Hour Movement Guidelines for rural communities include providing additional information on being active outdoors and at home, information on discerning sedentary behaviour and inactivity, and tips to combat seasonal changes in daylight.

34. Polonium-210 levels in placental maternal-fetal barrier: A pilot study conducted in the city of Sao Paulo, Brazil.

期刊: Journal of the Air & Waste Management Association (1995) 发表日期: 2026-Jun-24 链接: PubMed

摘要

The accumulation of detectable amounts of radon progeny in the maternal-fetal placental barrier may be a risk factor for fetal development and lifelong disabilities. In this preliminary study, we analyzed the levels of alpha-emitting radon progeny Polonium-210 (210Po) (in Becquerel/kg) in the maternal-fetal placental barrier from placentas in Sao Paulo, SP, Brazil. Overall, there were higher levels of 210Po at the maternal portion of the placenta 1.45 (0.34) Bq/kg when compared to the fetal placental portion [1.08 (0.35) Bq/kg]. The presence of 210Po in the maternal-fetal placenta may indicate a potential risk of adverse pregnancy and fetal outcomes, including impaired placenta growth and fetus development potentially leading to lifelong disabilities. Future studies are warranted to identify the natural and anthropogenic sources of 210Po in urban areas and 210Po-related adverse pregnancy health outcomes.Implications: Our findings suggest that the presence of environmental 210Po in maternal and fetal placenta tissues may indicate a potential hazard risk of adverse pregnancy outcomes and fetal health. Future studies with a larger number of pregnant women should be able to identify more accurately the biological mechanisms of the exposures to natural and anthropogenic sources of 210Po, and help generate public health policies to mitigate it. This study describes levels of radon progeny (Polonium-210) in the maternal and fetal portion of the placenta.

35. From Metrics to Meaning in Neurological Rehabilitation: Clinicians' Perspectives on Digital Metrics of Upper Limb Functioning-A Focus Group Study.

期刊: JMIR rehabilitation and assistive technologies 发表日期: 2026-Jun-24 链接: PubMed

摘要

Digital assessment technologies, such as optical motion capture and inertial measurement units, enable detailed kinematic analysis and continuous monitoring of upper limb activity in persons with neurological conditions. While such digital metrics of functioning are increasingly recognized in research, their uptake in clinical neurorehabilitation is limited. It remains unclear which digital metrics of functioning clinicians perceive as most meaningful and how these are integrated into patient-centered care. Understanding clinicians’ information needs and reasoning processes is a prerequisite for implementing digital assessment technology. This study aims to characterize how rehabilitation professionals perceive, prioritize, and integrate digital metrics of functioning into clinical reasoning and to identify features that would support their routine use. Three 90-minute focus groups were conducted in 3 Swiss neurorehabilitation centers, involving 11 clinicians with diverse professional backgrounds (5 physiotherapists, 4 occupational therapists, 1 movement scientist, and 1 medical practitioner). Participants discussed essential parameter domains and individually rated the relevance and meaningfulness of 17 kinematic metrics for the well-studied drinking task and 10 established arm use performance metrics. Verbatim transcripts were analyzed using reflexive thematic analysis, and rating data were summarized descriptively. Five main themes were identified. (1) Functional requirements to interpret movement quality and performance (active/passive range of motion, strength, selective muscle control, and grasp) form the basis for interpreting movement. (2) Essential aspects of movement quality (smoothness, efficiency, and compensatory movement) are valued when aligned with observable task execution. (3) Added value of real-world performance (hourly activity profiles, arm-use symmetry, and functional workspace) represents the reference for patient-centered reasoning. (4) Individualizing what matters, including diagnosis-specific preferences, shapes assessment selection. (5) Blending clinical eye and reference data reflects clinicians’ reliance on visual judgment complemented by normative values. Intuitive metrics such as task duration, number of movement units, and range of motion were favored, whereas confidence was lower in more complex metrics (eg, jerk and interjoint coordination). Clinicians value intuitive digital metrics of functioning when they are clearly linked to patient-centered outcomes and supported by normative references. The findings highlight the need for targeted educational strategies and digital competency training that help clinicians interpret digital metrics and integrate them with contextual information and clinical reasoning.

36. Workplace barriers to recovery after mental illness relapse and coping strategies used: a Social Model of Disability perspective.

期刊: Psychology, health & medicine 发表日期: 2026-Jun-24 链接: PubMed

摘要

Returning to work after a mental illness relapse presents significant challenges for teachers, often compromising sustained work participation. This study aimed to explore workplace barriers and coping strategies influencing teachers’ return-to-work experiences in Limpopo Province, South Africa, using the Social Model of Disability. A qualitative exploratory design was used. Semi-structured face-to-face interviews were conducted with 14 teachers, with sample size determined by data saturation. Data were analysed using Tesch’s open coding method. Findings revealed key workplace barriers, including unimplemented healthcare recommendations, persistent stigma, and limited organisational support, which exacerbated vulnerability to relapse. In response, teachers adopted coping strategies such as withdrawing from additional responsibilities, limiting engagement, and seeking alternative support through personal, spiritual, and familial coping mechanisms to manage their mental health. Applying the Social Model of Disability reveals that disabling environments, rather than individual impairments, are central barriers to reintegration. Without systemic intervention, current school environments risk perpetuating relapse and reduced productivity. The study calls for the urgent integration of structured psychosocial support, enforceable workplace accommodations, and rehabilitation-informed policies within the education sector. Coordinated action across policymakers, healthcare providers, and the Department of Basic Education is essential to implement sustainable return-to-work frameworks that safeguard teachers’ mental health and optimise long-term occupational performance.

37. Cost-Consequence Analysis of the Return to Work (RTW) Program for Workers with Disabilities in Indonesia: Health, Economic and Productivity Outcomes.

期刊: Journal of occupational rehabilitation 发表日期: 2026-Jun-24 链接: PubMed

摘要

This study assesses the cost consequence of the Return To Work (RTW) program for disabled workers who suffered from occupational injury in Indonesia in last decade. The question was whether or not RTW programs result in improved health, economic, and productivity results compared with traditional treatments. Retrospective design was conducted to analyze the occupational injury claim records by evaluating the cost consequences of the RTW program in Indonesia. We compared 1353 RTW claims with 10,602 occupational injury claims. Cost-consequence analysis reported disaggregated outcomes (Lost Time Injury Days (LTIDs), RTW rates, medical costs, productivity losses) following CHEERS 2022 guidelines. Costs were adjusted to USD using the Indonesian Consumer Price Index and average exchange rate data in 2022. Occupational injury with RTW claims had higher average direct medical treatment costs (USD 822.50 vs USD 262.25) and greater productivity losses than non RTW claims (USD 46239.60 vs USD 28261.20) due to the complex nature of the cases included in the program. RTW cases had longer LTIDs (350.3 vs 214.1 days) and higher productivity‑related costs, reflecting a more complex casemix, but also markedly higher RTW success rates than usual care where 84.0% RTW vs 20.3% non RTW cases. The RTW program has resulted in different patterns of costs and outcomes than traditional treatments. These differences should be considered by decision-makers when determining how to allocate resources effectively.

38. Stereolithography-printed Bi2O3-reinforced photopolymer nanocomposite samples with antibacterial and radiation shielding properties.

期刊: Radiation and environmental biophysics 发表日期: 2026-Jun-24 链接: PubMed

摘要

Stereolithography (SLA) is an additive manufacturing technique that allows the production of polymer composite samples with high accuracy and smooth surface quality. This makes SLA suitable for functional surface applications. In this study, photopolymer nanocomposite surfaces reinforced with bismuth oxide (Bi2O3) nanoparticles were produced by SLA and evaluated in terms of surface structure, antibacterial activity, electrical properties, electromagnetic shielding, and ionizing radiation shielding performance. Bi2O3 nanoparticles were added to a commercial UV-curable photopolymer resin at contents of 1, 3, and 5 wt% and printed layer by layer with a layer thickness of 50 μm. Surface structure and particle distribution were examined by SEM-EDS. The results showed good particle distribution at low Bi2O3 contents, while particle accumulation occurred at higher contents due to settling during printing. Antibacterial activity was tested according to ISO 22,196, and all Bi2O3-reinforced surfaces showed more than 99% reduction against Escherichia coli and Staphylococcus aureus after 24 h. Surface resistivity measurements performed according to TS EN 1149-1 showed values higher than 1012 Ω, indicating strong electrical insulation. Electromagnetic shielding effectiveness values remained below 5 dB in the 8-12 GHz frequency range. In addition, ionizing radiation shielding parameters, including mass attenuation coefficient, linear attenuation coefficient, half-value layer, and radiation protection efficiency, were theoretically calculated using WinXCOM and EpiXS. The results showed that increasing Bi2O3 content improved photon attenuation, especially at low energies. Overall, Bi2O3-reinforced SLA nanocomposites provide strong antibacterial performance, electrical insulation, and improved ionizing radiation shielding, making them suitable for multifunctional surface applications.

39. Psychiatric public commentary and digital mental health communication in Indonesia: Emerging ethical challenges in the social media era.

期刊: Asian journal of psychiatry 发表日期: 2026-Jun-23 链接: PubMed

摘要

40. PRIoritisation of orthopaedic resources and interventions in trauma (PRIORI-T): A modified delphi consensus study.

期刊: Injury 发表日期: 2026-Jun-23 链接: PubMed

摘要

Operative orthopaedic care in resource-constrained systems is frequently limited by theatre time, staffing, peri-operative support, implants, instruments and bed availability. In the absence of an explicit prioritisation framework, decisions about patients awaiting surgery may vary between clinicians and institutions. This modified Delphi study aimed to establish consensus on factors that should structure prioritisation of operative orthopaedic care in South African public hospitals. A three-round modified Delphi study was conducted among South African public-sector orthopaedic clinicians. Round 1 used open-ended responses to generate candidate prioritisation factors. Round 2 used a structured 1-9 importance scale to rate patient-specific factors, injury-specific factors, red-flag conditions and potential tie-breakers. Round 3 verified operational definitions, anchor levels and red-flag handling. The scope was confined a priori to admitted patients with stable, isolated orthopaedic injuries; polytrauma, spinal cord injuries and unstable vertebral fractures were excluded because they require individualised, time-critical prioritisation through established emergency pathways. Inclusion consensus was defined as a median score of at least 4 with at least 75% of respondents rating the factor 4-9. Strong inclusion consensus required a median score of at least 7 with at least 75% rating the factor 7-9. Binary consensus required at least 75% agreement. Following exclusion, 65, 55 and 63 responses were analysed in Rounds 1, 2 and 3, respectively. Six patient-specific factors reached inclusion consensus: age, diabetes mellitus, severe cardiac or respiratory disease, premorbid functional status, physiological reserve and current psychosis or severe psychiatric instability. All six injury-specific factors reached inclusion consensus. Soft-tissue status, anatomical site and neurovascular status reached strong inclusion consensus; fracture type or pattern, injury energy and time already waited for surgery reached inclusion consensus. Acute compartment syndrome and threatened vascular status of the relevant limb reached consensus as automatic red-flag overrides. No proposed tie-breaker reached consensus. This study provides a consensus framework for factors influencing the prioritisation of patients awaiting operative orthopaedic care in a low- and middle-income country (LMIC) setting. The findings support a preliminary framework, rather than a validated scoring system. Prospective weighting, inter-rater reliability testing and outcome validation are required before implementation as a formal prioritisation tool.

41. Periprosthetic fracture following hip resurfacing arthroplasty: treatment guidance using the 'SAVE' classification system.

期刊: Injury 发表日期: 2026-Jun-22 链接: PubMed

摘要

Periprosthetic fracture following hip resurfacing arthroplasty is an uncommon but important complication and represents a distinct failure mode compared with fractures around conventional stemmed total hip arthroplasty. Existing periprosthetic fracture classifications are useful descriptively, but they do not fully address the biomechanical and biological considerations unique to hip resurfacing. Herein, the epidemiology, risk factors, mechanisms of failure, diagnostic workup, classification, and management of periprosthetic fractures following hip resurfacing arthroplasty is presented. Particular emphasis is placed on early femoral neck failure, avascular necrosis, femoral neck notching, varus component positioning, implant stability, adverse local tissue reaction, metal ion assessment, and the role of cross-sectional imaging. The article also proposes the SAVE classification, a treatment-oriented framework incorporating four key domains: Stability of the implant, Anatomical fracture location, Viability of the femoral head-neck segment, and local Environment. The SAVE classification provides a practical framework for determining whether the resurfacing construct can realistically be preserved or whether revision arthroplasty is more appropriate. By linking classification directly to treatment strategy, it may improve consistency in assessment and guide decision-making in these complex injuries.

42. Rural health disadvantages in the United States: Evidence from nationally representative data.

期刊: Economics and human biology 发表日期: 2026-Jun-20 链接: PubMed

摘要

A gap in mortality rates between rural and urban areas emerged in the late 1990s as rural residents began dying at a higher rate than their urban counterparts. This mortality gap has been widening ever since. The growing mortality gap is pronounced among prime working-age adults (ages 25-54), which has important implications for rural health, productivity, and economic development. Despite the heightened mortality rates in rural areas in recent decades, there is still a limited understanding of the health-related mechanisms fueling this worsening rural-urban mortality disparity. Using nationally representative data from the 1999-2000-2017-March 2020 cycles of the National Health and Nutrition Examination Survey, we combine individual-level data, including biomarkers, and place-based characteristics to create a comprehensive dataset spanning 20 years. In a descriptive analysis, we use linear regression models to estimate the magnitude of rural-urban gaps in health behaviors and outcomes-or mortality risk indicators-for the overall adult and prime working-age populations. We document a suite of rural health disadvantages, which may be informative for understanding the growing rural longevity gap. These disadvantages are often attenuated and no longer statistically significant after accounting for county-level characteristics. A complementary decomposition analysis indicates that county characteristics account for a larger share of the variation in health measures than rural-urban status. Our results can inform decision-makers aiming to improve rural health and economic outcomes and may spur further research using biomarker data alongside place-based characteristics.

43. Early onset pancreatic Cancer: epidemiology, molecular features, and clinical outcomes.

期刊: Cancer treatment reviews 发表日期: 2026-Jun-17 链接: PubMed

摘要

Background Early onset pancreatic cancer (EOPC), defined for the primary analysis as pancreatic ductal adenocarcinoma (PDAC) diagnosed before the age of 50 years, is an increasingly recognised clinical and epidemiological entity. Because published studies use heterogeneous age thresholds, the present review prespecified <50 years as the main definition and interpreted studies using other cutoffs in sensitivity or narrative analyses. Methods We systematically searched PubMed, EMBASE, and the Cochrane Library for studies published between January 1990 and December 2024 that reported outcomes specific to EOPC. Search terms were reformatted with standard quotation marks and included “pancreatic cancer”, “pancreatic adenocarcinoma”, “pancreatic ductal adenocarcinoma”, “early onset”, “young onset”, “young adult”, “age < 50”, “age less than 50”, and “premature”. Meta-analytic procedures and epidemiological interpretation were re-reviewed with statistical/epidemiological input. Results 40 studies encompassing more than 285,000 patients were included. Global incident EOPC cases increased from 24,480 (1990) to 42,254 (2021), representing a 72·6% rise. Age-standardised prevalence rate increased by 17·0% (1·65 per 100,000 in 2021). EOPC patients have a 3·08% per year increase in the youngest age group (20-29 years) over 2010-2021. Germline pathogenic variants were identified in 17·3% of EOPC patients (vs 6·4% in older cohorts; OR 2·41, 95% CI 1·87-3·11). EOPC patients were more likely to receive treatment (OR 2·95, 95% CI 2·54-3·43; I2 = 13%) and showed modestly improved overall survival (pooled HR 0·89, 95% CI 0·80-0·99; I2 = 16%) compared with average or late onset disease. Conclusions EOPC is an increasingly recognised and clinically challenging subset of PDAC. The substantial hereditary and potentially actionable molecular burden supports universal germline testing and comprehensive tumour genomic profiling, particularly in younger patients and in KRAS wild-type disease. PARP inhibitors should be described as improving progression-free survival or disease-control outcomes in selected BRCA-mutated metastatic PDAC rather than as having established a statistically significant overall survival benefit.

44. Life-course psychological trauma and cardiovascular disease risk in patients with metabolic dysfunction-associated steatotic liver disease at early cardiovascular-kidney-metabolic stages.

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

摘要

To examine whether distinct life-course patterns of psychological trauma are associated with incident cardiovascular disease (CVD) among individuals with metabolic dysfunction-associated steatotic liver disease (MASLD) in early stages of the cardiovascular-kidney-metabolic (CKM) spectrum. Prospective cohort of 34,815 UK Biobank participants with MASLD and without baseline CVD (CKM stages 0-3). Latent class analysis identified life-course psycho-trauma patterns from measures of adulthood psychological symptoms, adulthood stressful life events, and childhood adverse experiences. Incident CVD (coronary heart disease, stroke, atrial fibrillation, heart failure, peripheral arterial disease, and cardiovascular death) was ascertained via linked health records. Fine-Gray competing-risk models estimated subdistribution hazard ratios (sHRs) for CVD across trauma classes. Restricted cubic spline analyses evaluated the dose-response relationship between a cumulative psycho-trauma score and CVD risk. Median follow-up was 13.9 years. Three classes emerged: Asymptomatic; Life-course Psychopathology (high adulthood symptoms plus stressful events and childhood adversities); and Childhood Adversity (predominantly childhood exposures). Over follow-up, 6285 incident CVD events occurred. Compared with the Asymptomatic class, the Life-course Psychopathology class had sHR 1.298 (95% CI 1.142-1.475) and the Childhood Adversity class had sHR 1.175 (95% CI 1.087-1.271). The cumulative trauma score showed a positive, approximately linear association with CVD risk. Distinct life-course psychological trauma patterns (i.e. notably adulthood psychopathology and childhood adversity) are independently associated with higher CVD risk in MASLD patients at early CKM stages. Incorporating trauma-informed assessment into cardiometabolic care may improve risk stratification and prevention.

45. SPELL: A scalable NLP method using regular expressions and large language models for clinical information extraction.

期刊: Computer methods and programs in biomedicine 发表日期: 2026-Jun-14 链接: PubMed

摘要

Electronic health records (EHRs) contain valuable information for research and decision-making, but much resides in unstructured notes that are challenging to analyze at scale. We developed SPELL (Snippet-Primed rEgex LLM Pipeline), a scalable natural language processing workflow that combines regular-expression-based snippet retrieval with locally hosted large language model (LLM) inference to extract structured variables from large collections of clinical narratives. SPELL uses task-specific regular expressions to retrieve short context windows (“snippets”) from unstructured texts and applies task-prompted LLM inference on snippets rather than full documents. All processing occurs within institutional computing environments. Accuracy was evaluated on randomly sampled, clinician-annotated benchmark sets of 50 documents per obstetric task, with separate retrieval-recall audits of 20 regex-negative documents per task. We evaluated accuracy and efficiency across three obstetric information-extraction tasks: numerical value (blood loss volume), date (estimated due date), and diagnosis (hemolysis, elevated liver enzymes, and low platelets [HELLP] syndrome). We quantified computational scalability using elapsed time, out-of-memory events, energy consumed, and GPU telemetry, and audited retrieval recall using clinician-annotated regex-negative notes enriched with relevant structured metadata. Generalizability was assessed on the public MT Samples corpus (5013 notes across 40 specialties) for ventricular tachycardia detection. SPELL processed 31 million clinical notes spanning 1976-2024 from eight hospitals. Snippet-based inference reduced processing time by 71-87% versus full-document LLM inference and by >95% versus manual physician annotation. On the 50-document benchmark sets, snippet-based evaluation achieved 98% exact-match accuracy for blood-loss extraction, 92% exact-match accuracy for estimated-due-date extraction, and 94% accuracy with an F1-score of 0.97 for HELLP syndrome classification. As an exploratory external evaluation on MT Samples, ventricular tachycardia detection achieved 84% accuracy and an F1-score of 0.67. A hybrid regex-snippet-LLM pipeline can enable accurate and computationally efficient extraction from unstructured EHR narratives.

46. 'Veni, Vidi, Vaccini': consensus-based vaccination pathway implementation in a paediatric tertiary hospital in Tuscany, Italy.

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

摘要

Fragile paediatric patients are at higher risk of vaccine-preventable diseases, yet coverage remains suboptimal. Hospitalisation offers an opportunity to review and update immunisation, but fragmented practices create inequities, with access depending more on hospital context than clinical need. This study aimed to design, implement, and evaluate an in-hospital vaccination pathway for these patients. A mixed-methods approach was undertaken at Meyer Children’s Hospital IRCCS, Florence, Italy. Baseline assessment included nine focus groups and an online questionnaire with healthcare professionals from units managing fragile patients, exploring practices, barriers, and needs. Findings informed the co-design of a pathway integrating documentation review, catch-up planning, and in-hospital delivery coordinated by the Immunology Unit. Administrative data on non-SARS-CoV-2 vaccinations in fragile patients (2022-2025) were analysed. Most respondents supported hospital-based vaccination (94.2%) but reported gaps in registry access, spaces, and training. Only 67.6% collected vaccination history systematically, 14.4% always mentioned vaccination in discharge letters, and 15.9% always recommended family immunisation. Despite acknowledging low influenza coverage (60.9% declared coverage <50%), 15.9% expressed hesitancy in administering non-live vaccines, mainly due to efficacy concerns (55.9%). After implementation, vaccine administrations increased from 361 in the 2022-2023 season to 752 in the 2024-2025 season (+108.3%; P < .0001). Increases were observed after staff sensitisation, with further growth following the creation of the hospital vaccination centre. A structured hospital-based vaccination pathway for fragile paediatric patients is feasible, well accepted, and associated with increased vaccine administrations within the hospital care pathway. Broader adoption could reduce inequities and strengthen vaccine access for high-risk children.

47. Trends in injuries over 20 years: a cross-national study of 954 298 adolescents from 31 European countries.

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

摘要

Injuries are a leading public health priority within adolescent populations; however, few cross-national studies have examined their epidemiology over time. We described time trends in adolescent self-reported medically treated injury across 31 mainly European countries over 20 years, then explored whether observed temporal trends varied according to the prevalence of known behavioral risk factors. The data source included six cycles of the Health Behavior in School-aged Children study (2002-22; weighted n = 954 298, participants aged 11-15 years). Outcomes included self-reports of any and multiple medically treated injuries. Measures of behavioral risks included indicators of violence, substance use, and physical activity. Within countries reporting increases in injuries, variations in reported engagement in known behavioral risk factors were examined. Nearly half of adolescents reported at least one medically treated injury (47%-53% of boys; 38%-44% of girls) and nearly one quarter reported multiple injuries (23%-30% of boys; 16%-22% of girls). In the pooled analysis, temporal trends included increases in any medically treated injury for girls (all age groups) and boys (11 years only) and multiple injuries (boys and girls, all age groups). At the country-level, we observed more temporal increases than decreases. Increases in physical activity were observed coincident with observed injury trends. In one of the largest European analyses of its kind, we demonstrated the ongoing burden of adolescent injury. Persistently high rates of adolescent injuries are concerning, and the origins of temporal increases require an initial focus on sport and physical activity.

48. Occupational class differences in daily sitting time among young and early midlife public sector employees-a follow-up study.

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

摘要

Longitudinal and domain-specific changes in sitting time (ST) across occupational classes are poorly understood. We examined changes in occupational class differences in total and domain-specific ST over a 5-year follow-up among young and early midlife employees. We used Helsinki Health Study survey data from 2017 to 2022 (n = 2762; 81% women; aged 19-39 years). Self-reported ST (min/day) was assessed across total ST and its five subdomains (work, leisure screen time, reading, transport, and other). Occupational class was categorized as manual and routine non-manual, semi-professional, and professional. Linear mixed models were used to estimate changes, with ST as the dependent variable and time, occupational class, and their interaction as the main independent variables. Analyses were stratified by gender and adjusted for sociodemographic and health-related factors. Total ST increased across occupational classes (+46 min/day, 95% CI: 37.6-54.4), driven by work-related ST (+24 min), and leisure screen ST (+21 min). Among women, manual and routine non-manual employees showed larger increases in total ST (+25 min vs. professionals) and leisure screen ST (+14 min), narrowing the total ST but widening screen time occupational class differences. Semi-professional women increased work ST (+21 min vs. professionals), narrowing occupational class differences in work ST. Among men, statistical significance of the associations could not be confirmed. ST increased across occupational classes, with domain-specific changes suggesting behavioural patterns. Increase in leisure screen time among manual and routine non-manual women employees may contribute to socioeconomic inequalities in health, highlighting the need for targeted, domain-specific interventions.

49. Real-World Epidemiology, Treatment Patterns, and Outcomes of Hepatocellular Carcinoma in Brazil: A Multicenter Retrospective Study.

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

摘要

The treatment landscape of hepatocellular carcinoma (HCC) has evolved substantially; however, limited access to novel therapies and regional epidemiologic differences lead to heterogeneous real-world treatment patterns worldwide. The purpose of this study was to describe the epidemiology, treatment patterns, and outcomes of patients diagnosed with HCC in Brazil between 2017 and 2022. This was a national, multicenter, retrospective, real-world observational study including patients with confirmed HCC and first diagnosis between 2017 and 2022. Data were collected from 10 centers across four geographic regions in Brazil. Of 318 patients screened, 303 were included: 107 with early-stage disease Barcelona Clinic Liver Cancer (BCLC 0-B) and 196 with advanced-stage disease (BCLC C-D). The median age was 71 years (64-77); 77.6% were men, 48.5% self-identified as Black or mixed race, and 62% were treated in public institutions. Main etiologies were hepatitis C virus (35%), alcohol-related liver disease (27.4%), hepatitis B virus (7.6%), and metabolic dysfunction-associated steatotic liver disease (MASLD; 10.9%). Among early-stage patients, 57% was classified as Child-Pugh A and 85% received local therapy (26.7% surgery or ablation; 58.8% transarterial chemoembolization [TACE]/Drug-Eluting Bead-TACE). The median progression-free survival was 10.4 months (95% CI, 8.7 to 15.7), and the median overall survival (OS) was 19.6 months (95% CI, 15.9 to 29.0). In advanced disease, 41% was classified as Child-Pugh A, portal vein thrombosis was present in 39.8%, and extrahepatic disease was present in 42.9%. Systemic therapy was administered to 48.5% of patients. The median OS was 8 months with systemic therapy versus 3 months without treatment. In this Brazilian real-world cohort, hepatitis C and alcohol were the predominant etiologies, whereas MASLD accounted for 10% of cases. Although most localized cases received locoregional therapy with outcomes consistent with the literature, access to modern systemic treatments for advanced disease remained limited.

50. Cancer Frequencies and Screening in Individuals With Down Syndrome: A Comprehensive Nationwide Cross-Sectional Analysis.

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

摘要

Down syndrome (DS) (trisomy 21) presents a distinctive cancer profile requiring risk-adapted surveillance strategies. This study examined cancer prevalence and screening participation patterns in individuals with DS to inform clinical care protocols. This large-scale retrospective cross-sectional study analyzed German nationwide statutory health insurance outpatient data, comparing 46,362 individuals with DS (International Classification of Diseases [ICD]-10: Q90) with 463,620 matched controls without intellectual disability (including DS), stratified by age, sex, and residential district. Logistic regression analysis evaluated cancer occurrence and screening program participation between groups. Cancer prevalence was lower in the DS group compared with the matched control group (2.4% v 2.8%; odds ratios [OR], 0.85 [95% CI, 0.80 to 0.91]; P < .00001; corrected: P = .00002) and occurred at younger age. However, individuals with DS demonstrated markedly elevated odds for hematologic malignancies: unspecified cell type leukemia (OR, 10.32), lymphatic leukemia (OR, 6.12), and myeloid leukemia (OR, 6.32), and testicular cancer (OR, 4.25). Conversely, breast cancer (OR, 0.36), digestive system tumors (OR, 0.39), and malignant melanomas (OR, 0.52) were significantly less frequent. Notably, individuals with DS participated less frequently in cancer screening programs (17.03% v 26.17%; OR, 0.58 [95% CI, 0.56 to 0.59]). The distinctive cancer profile in DS reflects elevated leukemia and testicular cancer risks alongside protection against solid malignancies, consistent with the chromosomal biology of trisomy 21. Reduced screening participation may partially explain lower overall cancer prevalence and warrants future research. These findings underscore the need for syndrome-specific surveillance protocols targeting high-risk malignancies and further molecular characterization of cancer predisposition and protection mechanisms.

51. Trust in Cancer Information Sources and Awareness of Human Papillomavirus as a Cause of Cervical Cancer Among US Adults.

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

摘要

Religiosity, trust in physicians, and trust in government health agencies influence individual decision-making and behavior toward public health programs. However, trust in information about cancer from these sources and their association with public awareness of human papillomavirus (HPV) as a cause of cervical cancer remain understudied. To assess the association of trust in cancer information sources with awareness that HPV causes cervical cancer among US adults. This cross-sectional study used the nationally representative 2022 Health Information National Trends Survey (HINTS) data on noninstitutionalized US adults aged 18 years or older collected between March 7 and November 8, 2022 and analyzed between July 23, 2025 and April 9, 2026. Trust in government health agencies, physicians, and religious organizations for cancer information. The primary outcome was awareness of HPV as a cause of cervical cancer among US adults who have heard of HPV. Our study included 3914 respondents who had heard of HPV. Of these, 625 (15.0%) were Hispanic, 558 (10.0%) were non-Hispanic Black, 2290 (65.2%) were non-Hispanic White, and 2557 (55.8%) were female. Overall, 2910 (75.1%), 1173 (30.3%), and 157 (3.5%) US adults had a lot of trust in physicians, government health agencies, and religious organizations for cancer information, respectively. The prevalence of awareness that HPV causes cervical cancer was 870 (70.2%), 1922 (64.8%), and 86 (48.9%) among individuals with a lot of trust in government health agencies, physicians, and religious organizations for cancer information, respectively. In the logistic regression model, compared with individuals with a lot of trust, those with some trust (aOR, 0.71; 95% CI, 0.52-0.96) and little or no trust (aOR, 0.68; 95% CI, 0.49-0.95) in government health agencies for cancer information had lower odds of awareness that HPV causes cervical cancer. Similarly, compared with individuals with a lot of trust, those with some trust in physicians (aOR, 0.71; 95% CI, 0.52-0.98) had lower odds of awareness that HPV causes cervical cancer. In contrast, individuals with little or no trust in religious organizations (aOR, 1.88; 95% CI, 1.10-3.24) had higher odds of awareness of HPV as a cause of cervical cancer. Compared with non-Hispanic White respondents, non-Hispanic Asian respondents had lower odds of awareness of HPV as a cause of cervical cancer (aOR, 0.31; 95% CI, 0.18-0.52). Compared with female respondents, male respondents had lower odds (aOR, 0.62; 95% CI, 0.47-0.81) of awareness of HPV as a cause of cervical cancer. Compared with individuals who had college or postgraduate education, individuals with up to high school (aOR, 0.42; 95% CI, 0.30-0.60) and after high school or some college education (aOR, 0.47; 95% CI, 0.35-0.62) had lower odds of awareness of HPV as a cause of cervical cancer. In this cross-sectional study of US adults, trust in government health agencies and physicians was positively associated with public awareness of HPV as a cause of cervical cancer. Through public health promotion campaigns, we must address the decreasing trends in trust in physicians and government health agencies to achieve the goal of cervical cancer elimination in the US.

52. The experiences of living with dementia within an under-served geographical area: a systematic review and qualitative synthesis.

期刊: Age and ageing 发表日期: 2026-Jun-01 链接: PubMed

摘要

Dementia affects millions globally and presents diverse challenges shaped by personal, social and environmental factors. People living in under-served rural, coastal and deprived communities often face additional barriers to diagnosis, care and support, limiting person-centred approaches. These inequalities can negatively impact quality of life, social inclusion and health outcomes. Whilst dementia experiences have been widely studied, the influence of geographical context remains underexplored. Understanding this is essential to improving equitable, person-centred care across diverse settings. MEDLINE, PsycInfo, Cochrane Library and Web of Science were searched from inception in February 2025 for qualitative studies on people’s experiences of living with dementia in rural, coastal or deprived areas. The review was not limited by country or date. Data were coded and thematically synthesised using NVivo. Seventy-three full texts were screened using Rayyan and 15 studies were included in the review. Thirteen studies were based in rural areas and two in deprived areas. No included studies were set in coastal areas. Four analytical themes were developed: navigating stigma, privacy and disclosure, navigating fragmented healthcare systems and services, lack of appropriate and accessible services and positive experiences of managing dementia. Key barriers to managing dementia included limited service availability, unsuitable support, stigma and logistical challenges. Findings underscored the need for person-centred, context-sensitive care that considers geographic, social and cultural factors. Future research should further explore diverse under-served settings to inform equitable dementia care particularly in deprived and coastal areas.

53. Evaluating acute and post-acute COVID-19 symptoms among patients with and without alcohol-related cirrhosis: implications for quality management.

期刊: Alcohol and alcoholism (Oxford, Oxfordshire) 发表日期: 2026-May-13 链接: PubMed

摘要

Patient-reported symptoms following COVID-19 exposure have been understudied in cirrhosis. This study evaluated type, severity, and persistence of symptoms along with impact on quality of life (QOL) post-SARS-CoV-2 infection in a cohort with and without alcohol-related cirrhosis. Patients with cirrhosis receiving care in hepatology clinics at three institutions were surveyed for symptoms and liver disease QOL (LDQOL) using standardized instruments following SARS-CoV-2 infection. Acute (<30 days), post-acute (≥30 days since onset), and Long COVID (≥3 months) symptoms were compared by cirrhosis etiology and decompensated status. Associations between severe COVID-19 symptoms and LDQOL were examined using multivariable models. 156 patients with prior COVID-19 exposure had a median age of 66.5 years; 18% were female; 43% had alcohol-related liver disease (ALD); and 42% decompensated cirrhosis. Among 208 surveys conducted, the median (Q1, Q3) number of symptoms reported was 6 (3, 10), with 66% reporting at least one severe/very severe symptom and 21% had Long COVID. There were no significant differences in symptoms by cirrhosis etiology or decompensation except those with ALD had higher post-acute symptoms compared to non-ALD (RR 2.17, P = .04). Moreover, the total number of severe symptoms was inversely associated with LDQOL. For each additional severe symptom reported, LDQOL decreased by 1.12 points after adjusting for age, sex, ALD, decompensated cirrhosis, and MELD-Na score (95% CI -1.70 to -0.53, P = .001). Assessing severity and persistence of post-COVID-19 exposure symptoms can help clinicians address patient-reported QOL concerns, optimize cirrhosis management, and inform integrated care for ALD and AUD.

54. Hospital and surgeon volume versus outcomes after colorectal cancer surgery: umbrella review and meta-analysis.

期刊: BJS open 发表日期: 2026-May-12 链接: PubMed

摘要

An inverse relationship between surgical volume and outcomes has been suggested, with higher-volume hospitals and surgeons achieving better results, prompting debate over the centralization of surgical services. However, minimum volume thresholds are unclear, and volume is a poor proxy for quality. Despite the significant global burden of colorectal cancer, the benefits of high-volume care remain uncertain. This umbrella review synthesized the evidence on volume-outcome associations in colorectal surgery. An umbrella review (PRISMA 2020) was conducted to evaluate systematic reviews and meta-analyses of the hospital/surgeon volume-outcome relationship in colorectal cancer. The Cochrane Library, PubMed, Embase, and MEDLINE were searched to 1 October 2025. Volume definitions and outcomes were extracted and meta-analysed by subgroup. A MeaSurement Tool to Assess Systematic Reviews 2 and Risk of Bias in Systematic Reviews were used for analysis of bias. A total of 150 unique records was identified, with 10 systematic reviews meeting the inclusion criteria. High- versus low-volume hospitals demonstrated an inverse relationship in terms of postoperative mortality following resection for rectal cancer (fixed- and random-effects models: odds ratio 0.73, 95 per cent confidence interval 0.64 to 0.82), colon cancer (fixed-effect model: odds ratio 0.74, 0.70 to 0.78; random-effects model: odds ratio 0.75, 0.69 to 0.81), and colorectal cancer (fixed- and random-effects models: odds ratio 0.77, 0.67 to 0.88). High- versus low-volume surgeons demonstrated an inverse relationship with respect to postoperative mortality following resection for rectal cancer (fixed- and random-effects models: odds ratio 0.69, 0.59 to 0.81), colon cancer (fixed-effect model: odds ratio 0.70, 0.63 to 0.77; random-effects model: odds ratio 0.68, 0.55 to 0.85), and colorectal cancer (fixed- and random-effects models: odds ratio 0.67, 0.60 to 0.74). There were no consistent significant differences in rates of the secondary outcomes (anastomotic leak rate, permanent stoma formation, local recurrence rate, rate of abdominoperineal excision of the rectum). High-volume hospitals and surgeons are associated with both improved short- and long-term outcomes for patients undergoing colorectal cancer surgery. However, a specific cut-off definition for high- versus low-volume hospitals and surgeons is yet to be elucidated owing to the heterogeneity of existing volume definitions. Future studies are required to confirm a threshold for this dose-response relationship.

55. Genitopelvic pain in racially/ethnically, sexually, and gender/sex minoritized samples in Canada and the United States: a scoping review.

期刊: Sexual medicine reviews 发表日期: 2026-Apr-02 链接: PubMed

摘要

Very little research exists on genitopelvic pain in racially/ethnically, sexually, and gender/sex minoritized samples despite its high prevalence among these groups. Existing frameworks of genitopelvic pain are based largely on White, heterosexual, cisgender women samples; applying these frameworks to minoritized samples may be prone to inaccuracies, as they do not account for minority stress and strength, social safety, and broader social determinants of health that structure exposure to pain, access to care, and health outcomes among marginalized populations. The main purpose of this scoping review was to synthesize findings of genitopelvic pain research published on racially/ethnically, sexually, and gender/sex minoritized samples in Canada and the United States. After removal of duplicates, the abstracts of 1330 articles were independently screened for eligibility for full-text review, of which 974 were excluded. Of the remaining 356, 59 studies were included for data extraction and synthesis. Results were organized according to the underrepresented sample of interest (racially/ethnically, sexually, or gender/sex minoritized) and subcategorized according to study aims focusing on prevalence, pain characteristics and experiences, minority stressors and strengths (eg, stigma, coping, resilience), social safety (eg, relational and healthcare contexts), and social determinants of health. Results indicated that genitopelvic pain is prevalent, there are similarities and differences in pain characteristics and experiences, and variables related to minority stress and strength, social safety, and social determinants of health-when examined-were associated with pain prevalence, severity, coping, and care trajectories in racially/ethnically, sexually, and gender/sex minoritized samples. Genitopelvic pain is common in racially/ethnically, sexually, and gender/sex minoritized individuals and is meaningfully shaped by minority stress processes, minority strength adaptations, social safety, and social determinants of health, underscoring the need for theory-informed and equity-oriented pain frameworks.

56. Exploring compassionate care in rehabilitation among individuals who are involved with the criminal-legal system with traumatic brain injury: A scoping review.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Traumatic brain injury (TBI) is disproportionately prevalent among individuals who are involved with the criminal-legal system and can impact one’s ability to critically think and emotionally regulate, thereby increasing risk of aggressive behaviour and recidivism. Considering and providing compassionate care can improve healthcare experiences and outcomes for this population. This scoping review aimed to answer the question: “To what extent is compassionate care considered or provided in rehabilitation for individuals who are involved with the criminal-legal system with TBI?” A systematic search through MEDLINE, Embase, APA PsycINFO, Cochrane Central Register, Nursing and Allied Health Premium, Criminal Justice Abstracts, CINAHL Complete, and Applied Social Sciences Index & Abstracts was established, and articles that met predetermined inclusion criteria were identified. A descriptive numerical summary and qualitative analytical techniques were applied to analyse the data. Twenty-five articles met the inclusion criteria and 24% (n = 6) of included articles were identified to provide/consider compassionate care through awareness of suffering, judgement and consideration, and motivation to alleviate suffering in rehabilitation programs, interventions, or services provided by healthcare providers or professional disciplines. While findings indicate dominance of Western contexts and a lack of routine consideration and/or provision of compassionate care, it highlights the following opportunities to integrate compassionate care in rehabilitation programs or services for those who intersect the criminal-legal system with TBI: (1) routine TBI and criminal-legal system-related education and TBI screening to increase awareness of patient suffering, (2) person-centred frameworks to address judgement and consideration of patients’ suffering, and (3) establish relationships between patients and service providers and monitor progress throughout rehabilitation to alleviate patient suffering. Research on the role of compassionate care in rehabilitation outcomes, how compassionate care may be routinely integrated, and its impact (positive or negative) on individuals are encouraged. Research globally is also encouraged, as many of the included articles/studies in this review were published in Western countries, with most of them originating from the United States. As such, findings from this review may represent a Western perspective on compassionate care and may not be generalizable to other countries.

57. Food for thought? The effects of the Healthy Primary School of the Future on children's educational outcomes.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

There is limited empirical evidence regarding the effects of school-based health-promoting interventions on educational outcomes, highlighting a need for further research in this area to understand their broader impact on academic performance. The Healthy Primary School of the Future (HPSF) is a Dutch intervention aimed at improving children’s health by providing healthy school lunches and structured physical activity (PA) sessions. While HPSF’s positive impact on physical health has been well-documented, its effects on academic outcomes, particularly in mathematics and reading comprehension, remain less understood. This study evaluated the influence of HPSF on children’s performance by using national standardised tests for these academic domains. A longitudinal quasi-experimental design was employed involving eight Dutch primary schools over a four-year period. Schools included two full HPSF schools (implementing both PA and healthy lunches), two partial HPSF schools (PA only), and four control schools (all in the same region). Scores from biannually taken national standardised tests in mathematics and reading comprehension were combined within the same year to decrease the number of missing values. The data were analysed using mixed model for repeated measures to assess the intervention effects over time. Children in full HPSF schools demonstrated significant improvements in mathematics performance compared to control schools (standardised effect size (ES) = 0.30, p = 0.011 after one year, increasing to ES = 0.66, p < 0.001 after four years). Mathematics gains in partial HPSF schools were smaller and non-significant (ES ≤ 0.23, p ≥ 0.137). For reading comprehension, small but significant improvement was observed in year 1 for full HPSF schools compared with control schools (ES = 0.28, p < 0.001), but this effect was diminished by year 4. Partial HPSF schools showed sustained small gains in reading comprehension over time (ES between 0.06 and 0.39). The HPSF intervention significantly enhanced mathematics performance when both healthy lunches and PA sessions were implemented, underlining the importance of a holistic approach to health promotion in schools. However, the intervention’s impact on reading comprehension was limited, indicating the need for additional and/or more targeted strategies to improve literacy outcomes. These findings highlight the potential of integrated health interventions to boost academic performance and address both health and educational inequities.

58. Effect of a patient-driven perioperative intervention on health literacy: A stepped-wedge cluster randomised sub-study.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

We hypothesised that a patient-driven safety checklist would enhance patients’ health literacy. This study was conducted as a sub-study of a multicentre cluster trial with a stepped wedge design. Data were collected between March 2022 and February 2024. Healthcare personnel were partially blinded to group allocation and fully blinded to the health literacy questionnaire outcome. The study included seven surgical specialties (clusters) from a tertiary teaching hospital and two community hospitals in Norway. The patients were included from a pool within the cluster trial. In each of these seven clusters, 50 patients were randomly selected from 100 eligible patients both the control and the intervention group using a computer-generated randomisation procedure. This resulted in a total sample of 700 patients: 350 in each group, response rate 49.3%. Adults (≥18 years) undergoing elective surgery, fluent in Norwegian, living at home, and without cognitive impairment were included. Standard surgical information combined with a patient safety checklist consisting of items with instructions and information (medication safety, preparations, activity restrictions, complications, and follow-ups). The checklist was delivered preoperatively (≤ eight weeks). Controls received standard surgical information. No significant differences were observed in mean scores across the nine health literacy questionnaire outcome domains between the control and intervention groups. In this stepped wedge cluster trial, a preoperative patient safety checklist did not improve health literacy scores compared to standard care. Nevertheless, an interaction effect with time for the domain “Actively managing my health”, may indicate that the patient-driven checklist could support elective surgical patients’ health management. This finding aligns with qualitative feedback and warrants further investigation using larger samples and more sensitive and context-specific measurement tools. Trial registration: Registration date in the ClinicalTrials.gov, 20 March 2017, ID: NCT03105713.

59. A comparative analysis of the oral microbiome of Amish and non-Amish individuals to strengthen our understanding of variation within the oral microbiome.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

More than 700 phylotypes associated with the oral cavity collectively comprise the oral microbiome. Study of microbiomes has advanced our understanding of human health. Little is known about the oral microbiome of the Old Order Amish population, a distinct ethnoreligious group who choose to stay separate from mainstream society to preserve their traditional, faith-based way of life. This research was to generate a novel characterization of the Amish oral bacterial microbiome and, using a comparative study design, provide metagenomic analyses of potential variations between generated profiles of the Amish and non-Amish. Next-generation sequencing of 16S rRNA genes of supragingival plaque and saliva samples was used. Analysis between oral health habits from surveys (e.g., fluoride use, frequency of dental visits) and markers within the microbiomes were used to assess the extent of variation due to oral health habits or other factors. Samples were analyzed from 14 Amish and 13 non-Amish individuals. Using non-parametric analyses, alpha and beta diversity were measured to assess core microbiomes, abundance, and sample dissimilarity. Compared to non-Amish, Amish experienced significantly lower frequency of dental visits (p < 0.001) and fluoride use (p < 0.001), but no difference in frequency of teeth brushing (p = 0.198) was observed. Alpha-diversity of observed species differed significantly between Amish and non-Amish samples (H = -3.89, p = 0.002). Beta-diversity which accounted for relative taxon abundance and presence, as well as other metadata such as fluoride use, frequency of dental visits, and teeth brushing indicated, for both saliva and plaque, samples clustered by grouping and their covariates. The five primary phyla typically associated with the oral microbiome were the dominant phyla in both Amish and non-Amish individuals, although Proteobacteria were proportionally fewer in Amish samples. We conclude the oral microbiome between the Old Order Amish and rural non-Amish are distinctly different, which may reflect observed differences in lifestyle and oral health habits.

60. Prevalence of heart failure and coronary artery disease in older adults experiencing homelessness: A systematic review and meta-analysis protocol with a consultative exercise.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Heart failure (HF) is a major global public health challenge and a leading cause of morbidity and mortality, particularly among older adults. The rising prevalence of HF is driven by aging populations and the increasing burden of chronic conditions such as hypertension, diabetes, and obesity. In Canada alone, over 750,000 individuals live with HF, with over 100,000 new cases diagnosed annually. Despite advancements in pharmacological and device-based treatments, HF remains a primary cause of hospital admissions, with readmission rates exceeding 20% within 30 days. The associated healthcare costs are projected to reach $2.8 billion annually by 2030. Older adults experiencing homelessness represent a particularly vulnerable population at risk for HF. Homelessness is associated with increased exposure to cardiovascular risk factors, including inadequate access to preventive healthcare, high rates of comorbid conditions, and environmental stressors. Evidence suggests that individuals experiencing homelessness have a significantly higher incidence and earlier onset of HF compared to the general population, yet this intersection remains underexplored in the literature. This paper outlines the protocol for a systematic review and meta-analysis that aims to address this gap by synthesizing the prevalence, incidence, and mortality of HF among older adults who have experienced homelessness. This systematic review will follow the PRISMA and MOOSE guidelines and has been registered on the Open Science Framework. We will include studies examining the prevalence, incidence, or mortality of HF among older adults (aged 50 and above) with a history of homelessness. The decision to lower the age threshold to 50 reflects the accelerated aging process observed in this population, who often experience age-related conditions at a younger chronological age. Eligible study designs include cross-sectional, cohort, and case-control studies. Quantitative data from peer-reviewed publications and grey literature will be included, with no language or date restrictions. A comprehensive search strategy will be applied across major electronic databases, including Medline, Embase, Cochrane Library, and ISI Web of Science. We will also perform grey literature searches through Google Scholar and governmental websites. Backward citation tracking will be conducted to identify additional relevant studies. Study selection will involve independent screening by three reviewers, with disagreements resolved by consensus. Data extraction will include study characteristics, participant demographics, and HF-related outcomes. Risk of bias will be assessed using the Joanna Briggs Institute Checklist for Prevalence Studies and the ROBINS-E tool for non-randomized studies. The review will estimate pooled prevalence, incidence, and mortality rates of HF in older adults experiencing homelessness. Where possible, we will conduct subgroup analyses based on age, sex, and comorbidities. Meta-regression and sensitivity analyses will be performed to assess the robustness of the findings. This systematic review and meta-analysis will provide the first comprehensive synthesis of HF epidemiology in older adults experiencing homelessness. By identifying disparities in cardiovascular health outcomes, this study aims to inform public health policies, healthcare delivery, and future research to improve cardiovascular care for this marginalized population.

61. Revitalizing contaminated soils: The combined power of modified biochar and intrinsic bacteria for heavy metal and petroleum hydrocarbon removal and plants performance.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Soil contamination with heavy metals and petroleum hydrocarbons poses a critical environmental challenge, threatening food security, human health, and ecosystem sustainability in various regions by reducing crop yields and introducing toxic pollutants into the food chain. Therefore, sustainable remediation strategies are essential to protect agricultural productivity. This study aimed to isolate native bacteria capable of degrading these contaminants from Kerman’s polluted soils and assess their synergistic effects with microbially modified biochar (MB) on soil bioremediation, quality enhancement, and maize performance. A total of 30 soil samples were collected from industrially contaminated sites in Kerman, Iran, and analyzed to isolate native bacterial species using biochemical and molecular tests. Biochars, prepared from rice husk and inoculated with the bacterial consortium, and were evaluated in a factorial greenhouse experiment. The experiment utilized a completely randomized design with 90 pots containing 4 kg of artificially contaminated soil (Cr, Pb, Cd, Cu; petroleum hydrocarbons) and four treatments: control, pristine biochar (PB), bacterial inoculants, and MB. Maize was grown for 90 days under controlled conditions, and soil and plant parameters, including physicochemical properties, contaminant levels, growth characteristics, transfer factor (TF), and bioaccumulation factor (BAF), were assessed. Five bacterial species (P. fluorescens, R. qingshengii, B. metallica, B. cereus, S. pactum) were isolated from 30 soil samples and tested with MB in a greenhouse experiment. Results showed MB reduced heavy metal bioavailability by 45-55% and hydrocarbons by 70% (p < 0.001), enhanced soil organic carbon, lowered metal uptake (e.g., TF for Cd: 0.27 vs. 0.95), and increased maize biomass (shoot: 30 g, root: 18 g vs. 15 g, 8 g, p < 0.001), offering a sustainable remediation strategy. These findings demonstrate the potential of integrating novel bacterial strains with modified biochar for effective, sustainable soil remediation for arid regions like Kerman, Iran.

62. Optimal control of Typhoid fever transmission under environmental and public health interventions.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

This study investigates the transmission dynamics of typhoid fever and assesses the impact of environmental factors and public health interventions on disease spread. Typhoid fever, caused by Salmonella Typhi, remains a major public health concern in regions with poor sanitation, high population density, and limited access to clean water. Although environmental contamination plays a critical role in sustaining transmission, its contribution is often under explored in mathematical modeling studies. We developed a deterministic compartmental model incorporating environmental transmission pathways to better understand the role of contaminated water sources and human-environment interactions in the spread of typhoid fever. The model is formulated as a system of nonlinear ordinary differential equations. The basic reproduction number, R0 was derived using the next-generation matrix approach to determine the threshold conditions for disease persistence. We analyzed the existence and stability of the disease-free and endemic equilibrium points, establishing local and global stability results for [Formula: see text] and R0 > 1, respectively. Sensitivity analysis on the reproduction number and the endemic equilibrium was conducted to identify parameters with the greatest influence on disease transmission. Furthermore, the model was extended to an optimal control framework incorporating two intervention strategies: public health education campaigns and treatment of contaminated water bodies. Pontryagin’s Maximum Principle was applied to characterize the optimal controls and derive the associated optimality system. Model parameters were estimated using reported typhoid fever data from Ethiopia obtained through the World Health Organization. Numerical simulations were performed to evaluate the impact of individual and combined intervention strategies. Simulation results indicate that the combined implementation of environmental sanitation measures and educational interventions significantly reduces disease burden, particularly during outbreak periods. These findings highlight the importance of integrating environmental management and community-based public health strategies in typhoid control programs.

63. Suicide of the Work-Disabled Individual Affected by Neoplasia with Unfavorable Prognosis: Evidence-Based Legal Medicine in Reconstructing the Causal Link.

期刊: La Clinica terapeutica 发表日期: 2026 链接: PubMed

摘要

Despite the undeniable improvements made by research and therapy that have led to better prognosis and quality of life for many cancer patients, when the prognosis remains unfavorable, both in terms of survival and residual quality of life, the risk of suicide increases. If depression or another psychiatric disorder arises, the reconstruction of the causal link is more straightforward. The path appears less straightforward when this evidence is lacking, and one must question the awareness of the inevitability of the prognosis. Starting from cases of occupational neoplastic disease, in which annuity holders committed suicide, the Authors reconstruct the correct investigative methodology to follow for reconstructing the causal link, necessary to ensure Inail protection to the heirs. According to evidence-based medicine, the admissibility in the specific case of what is postulated in general must be evaluated. This requires some fundamental requirements: the diagnosis of occupational disease with unfavorable prognosis; the precise and documented knowledge of one’s fate by the insured (through the development or not of a psychiatric illness already diagnosed and documented at the time of death); the absence of pre-existing (or subsequent) alternative causes independent of the occupational disease. The methodological framework adopted for neoplasias with unfavorable prognosis could also be applied to traumatic events that cause severe and drastic irreversible impairment in the subject’s autonomy or to diseases that involve a progressive and worsening loss of autonomy, but in this case, the need for a well-documented psychiatric disorder, causally correlated to the consequences of the accident/disease, within which to inscribe the suicidal behavior, appears unavoidable. Some reflections from the Inail indemnity perspective must be formulated in recently observed cases of “assisted suicide,” to understand how the Institute should behave if the subject’s choice is related to the disability derived from a work accident or occupational disease. The Authors finally emphasize the importance of interventions useful for preventing suicidal events, measures that INAIL is beginning to implement, as demonstrated by the recent Implementation Agreement with the National Council of the Order of Psychologists.

64. Occupation-related morbidities and their determinants among security guards in southern India.

期刊: La Clinica terapeutica 发表日期: 2026 链接: PubMed

摘要

Security guards working in the health sector are vulnerable to various occupational health problems and face physical violence from patients and their bystanders. Objectives: To identify various occupational health problems and their determinants among security guards. This cross-sectional study was performed at various institutions affiliated with a private medical college in Mangalore. Data were collected by interviewing 157 participants. The Chi-square test, Fisher’s exact test, unpaired t test, and binary logistic regression analysis were used to test associations. The mean age of the security guards was 41(SD=8.6) years. The median work experience was 10 years (IQR 6, 13). A total of 119(75.8%) of them were either overweight or obese. A total of 105(66.9%) of them did not exercise every day. 47(29.9%) did not drink sufficient water daily. Thirty-eight (24.2%) of them had inadequate sleep duration per day. Among the morbidities, heat exhaustion [83(52.9%)], lower backache [42(26.7%)], and dehydration [41(26.1%)] were the most common. Symptoms suggestive of sciatica were present in 14(8.9%) participants. Sleep deprivation was significantly present among those security guards on shift duty or doing only night duty (P=0.023). Symptoms suggestive of sciatica were present significantly more often among those who performed duties mostly in a sitting position (P=0.05). Most of the security guards were either overweight or obese, and the majority did not exercise every day. Approximately one-fourth of them did not drink adequate water per day and did not have sufficient sleep per day. Morbidities such as sleep deprivation and sciatica were associated with shift patterns and work-related postures, respectively, among the participants.