公共卫生研究摘要 (2026-06-26)

共收录 57 篇研究文章

1. Causal Effects on Nonterminal Event Time With Application to Antibiotic Usage and Future Resistance.

期刊: Statistics in medicine 发表日期: 2026-Jul 链接: PubMed

摘要

Comparing future antibiotic resistance levels resulting from different antibiotic treatments is challenging because some patients may survive only under one of the antibiotic treatments. We embed this problem within a semi-competing risks approach to study the causal effect on resistant infection, treated as a nonterminal event time. We argue that existing principal stratification estimands for such problems exclude patients for whom a causal effect is well-defined and is of clinical interest. Therefore, we present a new principal stratum, the infected-or-survivors ( i o s \(ios\) ). The i o s \(ios\) is the subpopulation of patients who would have survived or been infected under both antibiotic treatments. This subpopulation is more inclusive than previously defined subpopulations. We target the causal effect among these patients, which we term the feasible-infection causal effect (FICE). We develop large-sample bounds under novel assumptions, and discuss the plausibility of these assumptions in our application. As an alternative, we derive FICE identification using two illness-death models with a bivariate frailty random variable. These two models are connected by a cross-world correlation parameter. Estimation is performed by an expectation-maximization algorithm followed by a Monte Carlo procedure. We apply our methods to detailed clinical data obtained from a hospital setting.

2. Drug Interactions of Vebreltinib, a Novel Type I c-Met Inhibitor, Coadministration With Rifampin or Itraconazole in Healthy Participants.

期刊: Clinical and translational science 发表日期: 2026-Jul 链接: PubMed

摘要

Vebreltinib is a novel, highly selective type I c-Met inhibitor developed for treating non-small cell lung cancer (NSCLC) and glioma. As in vitro studies indicate that vebreltinib is primarily metabolized via cytochrome P450 (CYP) 3A4, this study aimed to characterize the drug-drug interaction (DDI) potential of vebreltinib with strong CYP3A4 modulators. Following a preliminary single ascending dose (SAD) study to establish baseline safety and pharmacokinetics (PK) in healthy participants, a DDI study was designed to evaluate the impact of the strong CYP3A4 inducer rifampin and the strong CYP3A4 inhibitor itraconazole on vebreltinib exposure. In the CYP3A4 induction part of the DDI study, participants (n = 14) received 200 mg vebreltinib on Days 1 and 15, with rifampin (600 mg once daily) administered on Days 8-21. In the inhibition part, participants (n = 14) received 200 mg vebreltinib on Days 1 and 11. Itraconazole was administered as a loading dose (200 mg BID on Day 8) followed by maintenance dosing (200 mg QD from Days 9 to 19). PK blood samples were collected at predetermined time points. Vebreltinib plasma concentrations were assessed using a validated liquid chromatography-tandem mass spectrometry (LC-MS) method. Co-administration with rifampin reduced the AUC0-t and AUC0-∞of vebreltinib by ~65% and ~66%, respectively, whereas the Cmax did not change significantly. In contrast, coadministration with itraconazole led to an increase in the AUC and Cmax of vebreltinib by about 56% and 46%, respectively. Vebreltinib, both alone and in combination with rifampin or itraconazole, was well tolerated in healthy participants.

3. Latent density discrepancies in commercial lung-equivalent inserts and their clinical dosimetric impact.

期刊: Journal of applied clinical medical physics 发表日期: 2026-Jul 链接: PubMed

摘要

Accurate heterogeneity correction in high-precision radiotherapy relies on precise computed tomography (CT) number-to-density conversion via the Hounsfield unit look-up table (HLUT). While physical properties of tissue-equivalent materials are generally assumed consistent with manufacturer specifications, an independent audit identified clinically significant density discrepancies in commercially available lung-equivalent phantom inserts. This study evaluates the physical properties of nonconforming lung inserts through mass measurements and stoichiometric analysis, and assesses the clinical dosimetric impact of the associated density discrepancies. Five lung-inhale inserts manufactured in 2010, 2015, and 2024 (10A, 10B, 15A, 15B, and 24A) were analyzed. Mass and physical dimensions were measured in triplicate using a precision balance (1 mg resolution) and vernier calipers. Stoichiometric analysis was conducted using reference materials to evaluate the tissue-equivalence of the inserts and quantify deviations from the theoretical baseline. A nonconforming table and a conforming reference table (RT) were established, derived from inserts 10A and 24A, respectively. For clinical impact assessment, volumetric modulated arc therapy (VMAT) plans for three clinical cases involving centrally located lung tumors (utilizing both inspiration breath-hold (IBH) and free-breathing) were optimized for stereotactic body radiotherapy (SBRT) and recalculated with the RT using the Acuros XB algorithm. Differences in gross tumor volume (GTV) mean dose and planning target volume (PTV) D95% were evaluated to quantify the dosimetric consequences. The 2010 inserts (10A and 10B) exhibited a 17.1% mass reduction and lower CT numbers compared to the reference 24A insert. Dimensional variations were negligible (≤ 0.2 mm) across all samples. Clinical recalculation revealed maximum dose reductions of 2.1% for the GTV mean dose and 3.0% for the PTV D95% in the worst-case scenario. These errors exceed the 2% clinical tolerance, propagated by HLUT interpolation across the low-density range. Substantial inter-lot density variations in commercial calibration phantoms can lead to dosimetric errors that exceed established clinical limits, particularly for centrally located tumors treated with IBH. Medical physicists must not implicitly rely on nominal manufacturer values; independent audits and initial mass screening at acceptance are highly recommended for maintaining dose calculation accuracy.

4. A Fully Automated Pipeline for Vertebral Structural Assessment From Medical Images. Application Under Metastatic Conditions.

期刊: International journal for numerical methods in biomedical engineering 发表日期: 2026-Jul 链接: PubMed

摘要

Spinal bone metastases often lead to vertebral fractures and other skeletal events that severely affect patients’ quality of life. Predicting structural failure is essential for guiding treatment and preventing complications. However, conventional assessment tools have limited predictive power, highlighting the need for computational methods capable of simulating disease progression and its mechanical consequences. This study aimed to develop a fully automated, patient-specific methodology to predict vertebral structural behavior from computed tomography (CT) data, supporting clinical decision-making and treatment planning. The proposed pipeline integrates three main components: a deep neural network for semantic segmentation of vertebrae and metastatic regions from CT scans, the Coherent Point Drift (CPD) algorithm to ensure consistent alignment and automated definition of boundary conditions across datasets, and the Cartesian Grid Finite Element Method (cgFEM) to simulate the vertebral mechanical response under metastatic involvement. Model performance was evaluated by comparing the predicted outcomes with reference data, using precision, sensitivity, and specificity to assess reliability. The proposed workflow achieved full automation from CT imaging to fracture risk estimation. The segmentation module showed high accuracy across multiple metrics, enabling robust model generation. Geometric normalization and CPD-based boundary condition assignment standardized vertebral geometries across studies, while cgFEM simulations provided clinically interpretable metrics such as safety factors and stability variations associated with tumor size, location, and density. These analyses enabled the identification of scenarios linked to a higher fracture risk. The main limitations include the use of fixed boundary conditions and a predefined voxel threshold, which may reduce physiological realism and generate false positives. Overall, this work presents an end-to-end, patient-specific framework for automated fracture risk evaluation in metastatic vertebrae. By combining deep-learning-based segmentation, geometric normalization, CPD alignment, and cgFEM simulations, the method produces clinically relevant outputs that can guide therapeutic strategies. Future developments will focus on integrating patient-specific loading data and predictive modeling to support incorporation into clinical decision support systems.

5. Exposure to Polycyclic Aromatic Hydrocarbons, but Not to Dust or Fluorides, in the Norwegian Aluminum Industry Is Associated With Accelerated Annual Decline in Lung Function.

期刊: American journal of industrial medicine 发表日期: 2026-Jun-25 链接: PubMed

摘要

The association between development of chronic airflow limitation and exposures in the aluminum industry is unknown. In a prospective study with nearly 10 years of annual measurements of forced expiratory volume in 1 s (FEV1) and forced vital Capacity (FVC) and concurrent estimates of exposure to dust, total fluorides (TotF) and polycyclic aromatic hydrocarbons (PAH) we investigated the relationship between each of these exposures and annual decline in FEV1 (dFEV1) and FVC (dFVC). Estimates of exposure to dust, TotF, and PAH were obtained from random samples of 8-h shifts using personal samplers at each of seven Norwegian aluminum plants. A total of 18,332 measurements were used to create a job-exposure matrix. The total number of available spirometries was 20,712 in 3872 workers. Data were analyzed using linear mixed modeling with inverse probability weights for dropouts. We found that dFEV1 and dFVC increased during follow-up with linear and quadratic components that were modified by PAH exposure. These linear and quadratic components were estimated at 2.5 mL/year (p = 0.019) and 4.2 mL/year2 (p < 0.001) for dFEV1, and -2.6 mL/year (p = 0.076) and 5.9 mL/year2 (p < 0.001) for dFVC, respectively, per quartile increase in PAH exposure. We found a significant effect modification of the relationship between dFEV1 and dFVC, and follow-up time by PAH exposure, indicating that PAH exposure accelerates the annual decline in FEV1 and FVC.

6. Can the All of Us sample be reweighted to mirror a nationally representative sample? A comparison of mortality predictors.

期刊: Epidemiology (Cambridge, Mass.) 发表日期: 2026-Jun-25 链接: PubMed

摘要

Participants in the All of Us research study differ from the U.S. population in myriad characteristics, limiting the generalizability of findings. A statistical reweighting tool to improve generalizability would enhance the scientific value of the data. To account for differences between All of Us and the nationally representative 1999-2018 National Health and Nutrition Examination Survey (NHANES), we generated selection weights using four models incorporating sociodemographic, self-reported health, and clinical characteristics. We assessed covariate balance and compared predictors of all-cause mortality in weighted All of Us to NHANES using the ratio of hazard ratios (RHRs), where an RHR of one indicates unbiased estimates in (weighted) All of Us relative to NHANES. Weighting improved balance on measured variables between All of Us and NHANES. Among the four weighting models, the most complex model which included sociodemographic, health, and clinical variables and their interactions achieved HRs in All of Us most similar to those in NHANES. For example, the RHR for hypertension for unweighted All of Us vs. NHANES (RHR=1.5; 95% CI=1.4 to 1.7) was reduced to 1.2 (95% CI=0.9 to 1.5) after applying weights from the clinical-interaction model. Even in this model, 17 of 35 HRs evaluated diverged by >20% (RHR <0.8 or >1.2) between weighted All of Us and NHANES. Predictors of mortality in All of Us differ from those in the U.S. population both in their distribution and in their associations with mortality. Reweighting can mitigate selection bias, but no model we tested comprehensively achieved generalizability.

7. Patterns of One-Year Change in HbA1c and Continuous Glucose Monitoring (CGM) Metrics in Older Adults with Type 2 Diabetes.

期刊: Clinical chemistry 发表日期: 2026-Jun-25 链接: PubMed

摘要

How changes in hemoglobin A1c (HbA1c) and continuous glucose monitoring (CGM) metrics track together over time is poorly understood, particularly in type 2 diabetes. We investigated the patterns of change in HbA1c and CGM metrics among older adults with type 2 diabetes. We analyzed data from 88 Atherosclerosis Risk in Communities (ARIC) study participants (baseline age, 82 years; 28% Black race and 42% women) who had HbA1c and 14-days of CGM assessed by standardized protocols at visit 9 (2021-22) and visit 10 (2023). HbA1c, CGM mean glucose, and time in range (TIR, 70-180 mg/dL) were compared across visits. Discordance was defined as having a different direction or magnitude of change, based on an absolute HbA1c change of 0.5% and the corresponding changes in CGM metrics derived from linear mixed-effect models. Over a median of 1.6 (IQR, 1.3-1.8) years, HbA1c, CGM mean glucose, and TIR showed moderate to strong correlations (r ∼0.5 to 0.7) across visits, and HbA1c had the lowest within-person variability (CVw = 8.4%). Approximately one-third of the participants had discordant changes between HbA1c and CGM metrics, with percentage agreement of 68.2% between HbA1c and CGM mean glucose, and 67.0% between HbA1c and TIR. Similar results were found in subgroups by sex, race, diabetes medication use, and after excluding participants with reduced kidney function. Among older adults with type 2 diabetes, long-term changes in HbA1c and CGM metrics are frequently discordant. This suggests the complementary nature of using HbA1c and CGM together to monitor glucose control.

8. Referral, treatment patterns and change in quality of life in the first twelve months in children and young people with Juvenile Idiopathic Arthritis: an analysis of the association with ethnicity and socioeconomic position using data from a cohort study.

期刊: Rheumatology (Oxford, England) 发表日期: 2026-Jun-25 链接: PubMed

摘要

Delays in Juvenile Idiopathic Arthritis (JIA) diagnosis may impact long-term outcomes and health-related quality of life (HRQoL). This study investigated referral pathways, initial treatment patterns and changes in HRQoL among UK children and young people with JIA stratified by ethnic group and socioeconomic position. Treatment-naive children and young people diagnosed with JIA between 2001 and 2019 were recruited into the Childhood Arthritis Prospective Study (CAPS). Outcomes included duration to first appointment, and change in HRQoL and disease activity following initial presentation. Associations between duration, presentation, and referral source with ethnicity and socioeconomic position, were assessed using adjusted Cox proportional hazards models. Of 1275 patients, 65% were female, 91% White ethnicity (5% Asian, 1% Black, 3% Mixed), and 27% in the most deprived socioeconomic group. Median age was 8 years.Median time to first appointment was 18 weeks, varying slightly by ethnic group but not socioeconomic position. Referral source and initial treatment were similar across groups. While disease activity and HRQoL improved over the first 12 months following first appointment in paediatric rheumatology for individuals with JIA, the overall HRQoL measures remained below population norms for people without JIA, with limited improvement beyond 1 year. Ethnicity and socioeconomic position were not associated with time to appointment, initial treatment, or changes in disease activity or HRQoL. In this national inception cohort, ethnicity and socioeconomic position do not appear to be associated with access to specialist care, initial treatment, or early clinical outcomes. Persistent low HRQoL despite reduced disease activity highlights the need to address physical and psychosocial wellbeing beyond disease control.

9. Rose Bengal Electromagnetic Activation With Green Light for Infection Reduction: Follow-Up of a Randomized Clinical Trial.

期刊: JAMA ophthalmology 发表日期: 2026-Jun-25 链接: PubMed

摘要

Infectious keratitis results in poor outcomes despite maximal medical therapy. While rose bengal photodynamic therapy (RB-PDT) has not been shown to be beneficial at improving best spectacle-corrected visual acuity (BSCVA) or cure rate, decreasing scar size, or complication rate at a shorter period of 6 months, long-term results are essential to evaluate clinically relevant scarring and visual recovery. To evaluate 12-month outcomes from the clinical trial (REAGIR) comparing adjunctive rose bengal photodynamic therapy (RB-PDT) vs sham in treatment of fungal, acanthamoeba, and smear/culture-negative infectious keratitis. This international multicenter, randomized, double-masked, sham-controlled clinical trial took place at Aravind Eye Hospitals in India (Madurai, Coimbatore, and Pondicherry) and the Federal University of São Paulo in Brazil. The study included a total of 330 participants with corneal ulcers who were randomized to the above groups. These data were analyzed from June 1, 2025, to July 15, 2025. Participants were randomized to receive (1) a standardized loading dose of topical 0.1% rose bengal, followed by 15 minutes of green light irradiation (RB-PDT) or (2) identical procedure without activating the green light source (sham). All participants received standard antimicrobial therapy. Prespecified primary outcome was BSCVA (logarithm of the minimum angle of resolution) at 6 months. Prespecified secondary outcomes included BSCVA, infiltrate and/or scar size at 12 months, corneal perforation (CP) and/or the rate of therapeutic penetrating keratoplasty (TPK), and microbiological cure rate at 12 months. Of 330 enrolled patients (mean [SD] age, 50 [13] years; 213 male [65%] and 117 female [35%]), 282 (85%) had BSCVA measurements and 250 (75%) had 12-month infiltrate/scar measurements. There was no evidence of benefit of RB-PDT vs sham for BSCVA at 12 months (mean difference, 0.01; 95% CI -0.13 to 0.14; P = .91). Scar size was not different at 12 months (mean difference, 0.006 mm; 95% CI, -0.32 to 0.33; P = .97). CP/TPK rates were 31 vs 34 events at 12 months (hazard ratio, 1.21; 95% CI, 0.74-1.98; P = .44), indicating no difference. There was no difference in outcomes by organism subgroup. In this study, at 12 months, RB-PDT did not confer a benefit over sham therapy for BSCVA, infiltrate/scar size, or rates of CP/TPK. These findings support 6-month REAGIR results, supporting the likelihood that there is no benefit to adjunctive RB-PDT for infectious keratitis at 1 year. These findings do not rule out the possibility that alternative photosensitizers or treatment algorithms might be beneficial. ClinicalTrials.gov Identifier: NCT05110001.

10. Opinions on contributing data to research studies: survey results from adults living with juvenile idiopathic arthritis (JIA).

期刊: Rheumatology (Oxford, England) 发表日期: 2026-Jun-25 链接: PubMed

摘要

Many childhood-onset chronic conditions continue into adulthood. Life-course research is essential to understand long-term outcomes in these individuals. Parents/guardians consent children into cohort studies and data-linkage with medical records. However, under UK ethics, linkage must stop at age 16 without specific re-consent. This presents challenges, as many young adults have moved, been discharged, or changed hospitals. This research aims to understand opinions on contributing data to research studies, particularly continuing to use long-term health outcome data into adulthood. A Qualtrics survey was developed alongside patient partners; distributed January-2025 via social media, patient partners, and national arthritis charities. Ethical approval granted by the University of Manchester Research Ethics Committee (2024-21972-38819). 57 adults with childhood-onset arthritis completed the survey; 93% female, 93% White, 56% aged ≥45 years, 46% diagnosed between 11-16 years, 49% previously participated in a research study. Overall, 88% reported they would have joined an arthritis research study in childhood, and 79% would consent for study data to link with medical records. Most (95%) participants would join a research study as an adult, and 50% were happy for continued access to medical records after age 16 without explicit re-consent, and/or assumed it was already happening. These findings suggest that current consent processes for studies spanning from childhood into adulthood are inadequate. There is a need to re-evaluate consent procedures for life-course research to ensure that paediatric and young people’s research remains a priority, and that young adults with childhood-onset conditions are not unnecessarily excluded from research.

11. Association of Fertility Preservation Benefit Mandates with Sperm Bank Network Adequacy: A Mixed Methods Study.

期刊: Urology practice 发表日期: 2026-Jun-25 链接: PubMed

摘要

The effect of states mandating insurance coverage of fertility preservation for those facing iatrogenic infertility is unclear. We sought to qualitatively understand barriers to clinic acceptance of insurance coverage for sperm banking fertility preservation services and quantitatively estimate the association between mandated fertility benefits and clinics accepting insurance. Staff at sperm banks in three “mandate states” completed in-depth interviews regarding patients accessing fertility preservation benefits through their insurance. Recruitment stopped at information saturation. Subsequently, a US-wide “secret shopper” study was completed of andrology/fertility clinics evaluating acceptance of insurance for sperm freezing services and cash costs of services for a fictitious male cancer patient. Seven interviews provided four dominant themes to describe clinic experience in mandated states: 1) coverage gaps/low reimbursement for sperm banking services 2) clinic resources needed to navigate insurance; 3) prior authorization care delays; and 4) need for sperm banks to educate patients and insurers on mandates. 200 of 418 clinics (56%) answered the secret shopper survey with a majority (69.5%, n=153) offering sperm banking services. Only 36.9% of these accepted insurance, with clinics in mandate states being more likely to accept insurance than in non-mandate states (61.0 vs. 27.8%, P-value = 0.0002). Only 37 (24.5%) of clinics provided cash cost of sperm banking (ranging from $50-$2000). The intent of fertility preservation mandates may be limited by barriers at insurer and clinic levels. Strategies to overcome barriers are needed to improve access to the full scope of fertility preservation benefits for male cancer patients.

12. Don't Rock the Boat: Political Participation as a Determinant of Health Equity in Segregated Asian American Communities.

期刊: Journal of racial and ethnic health disparities 发表日期: 2026-Jun-25 链接: PubMed

摘要

Asian Americans experience significant health disparities yet remain politically underrepresented. Political participation-a social determinant of health-may be a mechanism for communities to advocate for health resources and policies. This study examines contextual factors influencing political participation in segregated Asian American neighborhoods, with attention to health equity implications. We conducted 11 virtual focus groups with 42 Southeast Asian American residents (Filipino, Vietnamese, Hmong, Cambodian) in three California regions. Using participatory community mapping and qualitative analysis, we explored political participation patterns, contextual promoters and barriers, and connections to community health. Participants identified both structural, spatial, and social factors affecting political participation with implications for health equity. Structural promoters included community health organizations, which explicitly linked civic engagement to health advocacy, and faith-based organizations providing trusted spaces for political education. Barriers included lack of centralized Asian American spaces and language-inaccessible venues. Social factors included generational differences in political engagement, with older immigrants expressing fear of participation rooted in trauma; and cultural pressure to “not rock the boat,” limiting health advocacy. Political participation inequities in Asian American communities represent a critical but overlooked determinant of health disparities. Low engagement leads to policy neglect and inadequate health resource allocation. Community health organizations provide promising intervention points. Results inform place-based strategies to promote political participation as a health equity approach, particularly urgent given anti-Asian violence and pandemic impacts on these communities.

13. Psychosocial Preparedness for Disasters: A Scoping Review of International Models and Public Health Priorities.

期刊: Current psychiatry reports 发表日期: 2026-Jun-25 链接: PubMed

摘要

To map international models of psychosocial preparedness for disasters and identify recurrent public mental health priorities for policy, service readiness, and implementation. Following PRISMA extension for scoping reviews (PRISMA-ScR) and Joanna Briggs Institute guidance, we searched PubMed (2015-2025) using two complementary strategies and mapped 35 included studies. Eight model families emerged, including community resilience and governance; non-specialist support and psychological first aid (PFA); integrated mental health and psychosocial support (MHPSS) across the disaster cycle; implementation and scale-up models; organizational and health-system preparedness; digital continuity models; monitoring and evaluation frameworks; and behavioral emergency response models. Across model families, preparedness was concentrated mainly on community and non-specialist levels, and emphasized trust, community capacity, task-sharing, workforce readiness, and continuity of care. The mapped literature supports psychosocial preparedness as a layered public health function rather than a post-event specialist intervention. Core priorities include pre-event governance, community engagement, supervised non-specialist delivery with referral pathways, workforce protection, digital continuity with clinical safeguards, and minimum monitoring standards. Future work should prioritize implementation-focused research and outcome evaluation across diverse disaster settings.

14. Results from a peer recovery coach-delivered future orientation intervention for returning citizens in substance use treatment: feasibility and preliminary outcomes.

期刊: Health & justice 发表日期: 2026-Jun-25 链接: PubMed

摘要

Returning citizens with substance use disorders (SUD) make numerous decisions that involve engaging in behaviors with short-term, immediate rewards (i.e. the pleasurable effects of returning to use) relative to those with longer-term, but delayed, benefits (i.e. engaging in treatment), often in the context of resource-poor and unstable environments. Successful navigation of the reentry period may require making future-oriented decisions; yet previous research suggests that incarcerated individuals and those with SUD evidence steeper rates of delay discounting, or tendency to devalue something as a function of the delay of its receipt. Episodic future thinking has been shown to reduce delay discounting and improve decision-making, suggesting it may be particularly well-suited to support healthy decision-making among justice-involved populations. The current study evaluated the implementation potential and preliminary effectiveness of an episodic future thinking intervention adapted for individuals during the reentry period to reduce delay discounting and improve related clinical outcomes. Returning citizens (n = 40) who identified as in recovery from SUD and had experienced incarceration within 12 months prior to enrollment were recruited to participate in a randomized controlled trial. Participants received either a brief (60-min) adapted episodic future thinking intervention or a control intervention that did not activate future thinking. Both interventions were administered by a peer recovery coach in a community setting. Participants then completed weekly check-ins for up to four weeks and were assessed one month after the intervention. Findings suggest that peer-delivered episodic future thinking was feasible and acceptable, and could be delivered with fidelity. Additionally, participants in the active condition experienced significant decreases in delay discounting, significant increases in considerations of future consequences, and increases in the presence of protective factors that may support longer-term recovery. Participants in the control condition did not experience changes in clinically-relevant outcomes. Results of this study provide preliminary support for the implementation potential and effectiveness of brief, peer-delivered intervention focused on improving decision-making during the reentry period.

15. Persistent disparities in head and neck cancer survival in the United States.

期刊: Cancer causes & control : CCC 发表日期: 2026-Jun-25 链接: PubMed

摘要

Head and neck cancer (HNC) is a heterogenous disease with substantial mortality. This study assesses the long-term epidemiologic landscape, demographic disparities, and survival outcomes of HNC. Adult patients with primary HNC were identified in the Surveillance, Epidemiology, and End Results (SEER) database by International Classification of Diseases for Oncology (ICD-O) codes. The primary outcomes of this study were overall survival (OS) and cancer-specific survival (CSS). Secondary outcomes included primary tumor site distributions and rates of surgery by race and ethnicity. Multivariable Cox regression modeling was utilized to determine predictors of all-cause and HNC-specific mortality. In this cohort of 117,893 head and neck cancer patients, significant racial and ethnic disparities were observed in tumor site, treatment, and outcomes. Black patients were less likely to receive surgery even when accounting for tumor subsite and stage (OR 0.672, 95% CI 0.641-0.705). Five-year overall survival (OS) and cause-specific survival (CSS) were lower in all minority groups (p < 0.001), with Black patients showing the lowest OS (31.3%) and CSS (58.8%). Multivariable analysis confirmed race/ethnicity, low income (HR 1.043, 95% CI 1.018-1.068), and unmarried status (HR 1.327, 95% CI 1.305-1.350) as independent predictors of increased all-cause and HNC-specific mortality. In this most comprehensive and up-to-date analysis of HNC, we demonstrate profound racial and ethnic disparities in tumor sites, treatments, and survival. This study provides critical evidence to guide health policy, resource allocation, and clinical practice aimed at closing longstanding equity gaps in head and neck cancer care.

16. The rare disease tree: adolescent voices, family narratives, and health professionals' views in Greece.

期刊: European journal of pediatrics 发表日期: 2026-Jun-25 链接: PubMed

摘要

Adolescents with rare diseases and their families navigate challenges that extend well beyond clinical symptoms, intersecting with educational, social, and structural constraints. In this qualitative study, we examined the lived experiences of adolescents with rare conditions, their caregivers, and healthcare professionals, focusing on the interpersonal and systemic factors that shape well-being and form care pathways within the Greek National Healthcare System (NHS). A constructed interpretive framework for this study integrates ecological, dialogical, and relational dimensions of rare disease experiences. Ten focus groups were conducted, each including two adolescents, two parents, one to two pediatricians and one allied health professional (physiotherapist, speech therapist, occupational therapist, nurse). Semi-structured group interviews were audio-recorded, transcribed verbatim and analyzed using the approach of qualitative content analysis. Adherence to the COREQ-32 criteria supported the systematic design, documentation and presentation of research findings. Analysis yielded eight themes: (a) family dynamics and caregiving burden, (b) educational and occupational challenges, (c) social participation and financial strain, (d) healthcare accessibility and effectiveness, (e) conflicting priorities among adolescents, caregivers and providers, (f) future planning and goal setting, (g) emotional strain as a shared burden, and (h) parental advocacy and activism.  Rare disease experience emerges from the interplay of structural conditions, relational processes and policy dynamics. Ecological forces shape daily life, while dialogical interactions influence how illness is understood and managed and power relations determine whose perspectives are prioritized. Despite these constraints, adolescents, families and healthcare personnel demonstrate resilience and agency, mobilizing resources and developing networks to navigate difficulties within the available healthcare settings. • Adolescent care for rare diseases is often fragmented, adult-oriented, and insufficiently responsive to young people’s social, educational, and familial realities. • Young people’s lived experiences and meaning-making around rare disease care remain insufficiently explored in research and practice. • An integrated adolescent care framework combines ecological context, dialogical construction of meaning, and critical reflexivity to center adolescents’ voices and include the lived experiences of both families and therapists. • Through qualitative study, these concepts are translated into preliminary suggestions, offering an approach for more equitable, youth-friendly care situated in the Greek National Healthcare System.

17. How adolescent depressive symptoms are associated with premature mortality: Behavioral and socioeconomic pathways across the life course.

期刊: European child & adolescent psychiatry 发表日期: 2026-Jun-25 链接: PubMed

摘要

Premature mortality in young adulthood has become a growing public health concern in the United States, yet it remains unclear whether vulnerability to early death originates as early as adolescence. Although depressive symptoms are highly prevalent during adolescence and linked to long-term health and socioeconomic disadvantages, their prospective association with premature mortality remains poorly understood. This study examined whether depressive symptoms experienced during adolescence predict premature mortality in young adulthood and whether health behaviors and socioeconomic status in early adulthood help explain this association. Data were drawn from Waves I and III of the National Longitudinal Study of Adolescent to Adult Health, along with the Mortality Outcomes Surveillance System established in Wave V (N = 14,320). Cox proportional hazards models estimated the association between adolescent depressive symptoms and premature mortality, and cause-specific Cox proportional hazards models evaluated deaths due to disease, suicide, and external causes. Mediation analyses tested health behaviors and socioeconomic factors as mechanisms. Higher adolescent depressive symptoms were associated with increased risk of all-cause premature mortality in young adulthood. Cause-specific models showed that this association was concentrated in deaths due to external causes, with no significant associations for disease-related deaths or suicide. Cigarette smoking, marijuana use, lower educational attainment, and reduced employment in early adulthood accounted for part of the association for all-cause mortality. For external-cause mortality, however, health behaviors-specifically cigarette smoking and marijuana use-emerged as the prominent mediating pathways. Findings suggest that adolescent depressive symptoms may be associated with an increased vulnerability to premature mortality, in part through behavioral and socioeconomic pathways that emerge in early adulthood. Strengthening early mental health identification and support could reduce long-term disparities in survival.

18. Cardiovascular Efficacy of GLP-1 Receptor Agonists by Kidney Function: An Updated Meta-Analysis of Randomized Trials Including the SOUL Trial.

期刊: Diabetes, obesity & metabolism 发表日期: 2026-Jun-25 链接: PubMed

摘要

To evaluate the cardiovascular efficacy and absolute benefit of glucagon-like peptide-1 receptor agonists (GLP-1RAs) by baseline estimated glomerular filtration rate (eGFR). PubMed and EMBASE were searched to 29 April 2026 for randomized placebo-controlled trials of GLP-1RAs in adults with type 2 diabetes or overweight/obesity that reported eGFR-stratified major adverse cardiovascular events (MACE). Hazard ratios (HRs) were extracted for eGFR < 60 and ≥ 60 mL/min/1.73 m2. Random-effects meta-analyses estimated pooled HRs within each eGFR stratum and the pooled ratio of HRs (RHR) comparing eGFR < 60 versus ≥ 60 mL/min/1.73 m2. Exploratory absolute risk reduction (ARR) and number needed to treat (NNT) were derived from placebo-group MACE risk and the corresponding pooled HR. Nine publications from eight trials were included, comprising 70 822 participants; 70 534 had eGFR-stratified MACE data. GLP-1RAs similarly reduced MACE risk among participants with eGFR ≥ 60 and < 60 mL/min/1.73 m2, with pooled HRs of 0.83 (95% CI 0.77-0.90; p < 0.001; I2 = 35.6%) and 0.83 (95% CI 0.74-0.93; p < 0.001; I2 = 40.9%), respectively. The pooled RHR showed no evidence of effect modification (1.02, 95% CI 0.85-1.21; p = 0.84). ARR was larger with eGFR < 60 than ≥ 60 mL/min/1.73 m2 (2.6% vs. 1.6%), corresponding to NNTs of 39 (95% CI 26-91) versus 62 (95% CI 46-101). GLP-1RAs reduced MACE risk similarly across eGFR strata, while lower eGFR was associated with a larger estimated absolute cardiovascular benefit. These findings support GLP-1RA therapy in individuals with reduced kidney function.

19. Effects of the Fit2Thrive technology-supported physical activity promotion intervention components on sedentary behavior and light physical activity in breast cancer survivors.

期刊: Journal of cancer survivorship : research and practice 发表日期: 2026-Jun-25 链接: PubMed

摘要

Less sedentary time (ST) and more light physical activity (LPA) are associated with improved health outcomes among breast cancer survivors. However, less is known about whether interventions designed to increase moderate-to-vigorous physical activity (MVPA) also influence time spent sedentary and in LPA. This study explored the overall and component-specific effects of the Fit2Thrive technology-supported MVPA intervention on ST and LPA in breast cancer survivors. Physically inactive breast cancer survivors (n = 269; Mage = 52.5; SD = 9.9) received a core intervention (Fitbit and Fit2Thrive smartphone app) and were randomized to five components (“on” vs. “off”): Support Calls, Deluxe App, Fitbit Buddy, Online Gym, and Text Messages for 12 weeks. Mixed-effects models examined accelerometer-assessed ST and LPA changes, overall, and by intervention component at 12 and 24 weeks. We also examined relationships between changes in MVPA with ST and LPA, and moderating effects of demographic and disease characteristics on component effects. Compared to baseline, ST significantly decreased at 12 weeks (β = -14.2 min/day; p < 0.01); reductions were maintained at 24 weeks (β = -11.0 min/day; p < 0.01). LPA significantly increased at 24 weeks (β = 7.4 min/day; p = 0.04), but not at 12 weeks. No component effects were significant. Greater increases in MVPA were associated with greater ST decreases and LPA increases. Time since diagnosis moderated effects of the Deluxe App on ST and LPA. Participation in an mHealth MVPA promotion trial was associated with modest reductions in ST and increases in LPA, while also increasing MVPA. Findings suggest the core intervention may have been sufficient to support favorable changes across movement behaviors. Future research should investigate how to enhance effects while maximizing MVPA and health outcomes. Participation in an mHealth MVPA promotion trial may also result in reduced ST and increased LPA.

20. Systems-Level Developmental Reprogramming Under Waterlogging Stress in Cowpea Revealed by Integrated Phenotypic, Physiological, and Transcriptomic Analysis.

期刊: Plant, cell & environment 发表日期: 2026-Jun-25 链接: PubMed

摘要

Cowpea (Vigna unguiculata (L.) Walp.) is a climate-resilient grain legume that contributes to nutritional and food safety in a variety of production regions around the world; however, many of these regions are becoming more vulnerable to climate-driven flooding and waterlogging, endangering productivity and seed quality. In this study, we used RNA-seq to assess transcriptional responses to waterlogging in different cowpea genotypes during the vegetative, flowering, and maturity stages. Using measured phenotypic/physiological, biochemical, yield, and seed-quality traits, RNA-seq expression profiles were combined with differential expression analysis, KEGG pathway enrichment/Pathview mapping, transcription factor profiling, weighted gene co-expression network analysis (WGCNA), and XGBoost-based machine-learning prediction. The tolerant genotype UCR369 demonstrated stronger physiological recovery and more dynamic transcriptional adjustment than EpicSelect.4, whereas flowering and maturity exhibited the clearest divergence in waterlogging responses, which were strongly stage- and genotype-dependent. Waterlogging caused stage-dependent alterations to soluble sugars, phenolics, flavonoids and seed-quality traits while decreasing pigment status, gas exchange, chlorophyll fluorescence, membrane stability, and yield components. Pathway analysis revealed four prominent response axes: phenylpropanoid biosynthesis, flavonoid/isoflavonoid biosynthesis, starch and sucrose metabolism, and cutin/suberin/wax biosynthesis. KEGG pathway and Pathview analyses revealed activation of antioxidant and wall-associated phenolic metabolism, carbohydrate reallocation, and surface-lipid/barrier remodelling in UCR369, with a stronger integration of these responses, particularly during flowering and maturation. Transcription factor expression dynamics exhibited stage-specific activation of the MYB, bHLH, ERF/AP2, WRKY, HD-ZIP, and HSF families, which is compatible with redox buffering, hormone-linked stress signalling, and membrane/cuticle protection. WGCNA detected 35 co-expression modules, with the top five modules as the most closely linked to phenolics/starch, sucrose, plastid/pigment functions, and membrane stability. These transcriptome-scale patterns were condensed by XGBoost into a compact collection of trait-linked predictors, with the strongest cross-layer support centred on LTP3, CER1/CER22, and CASPL1D1 for cuticle/barrier remodelling, NIA2/NR2, ICL, and SAG12 for carbohydrate and redox reprogramming, HSP21 for plastid protection, and ACS6 for ethylene-associated stress signalling. Additional recurrent predictors, such as Vigun07g271600 and Vigun08g155100, point to cytochrome P450 and HSP20-related stress-protective activities. These findings establish a trait-anchored, systems-level framework for cowpea waterlogging tolerance, as well as biologically grounded targets for marker development, functional validation, and breeding in waterlogging-prone regions.

21. Building healthier communities: effectiveness and cost-sustainability of the ASL3 GENESIS program for chronic diseases prevention.

期刊: Aging clinical and experimental research 发表日期: 2026-Jun-25 链接: PubMed

摘要

Population aging leads to rising chronic disease burden and healthcare costs. The metropolitan area of Genoa (Liguria), the oldest in Italy, is particularly affected. Since 2017, ASL3 has implemented a comprehensive health promotion strategy including risk-factor reduction initiatives and multidisciplinary care pathways for multimorbid patients. To evaluate the impact of the comprehensive health promotion program on the prevalence of heart failure (HF), chronic kidney disease (CKD), and chronic liver disease (CLD), and on healthcare resource use. Using the ASL3 data warehouse, we analyzed trends in HF, CKD, and CLD prevalence from 2011 to 2023 and compared yearly prevalence between 2011 and 2019 and 2020-2023. Hospitalization, outpatient activity and drug-prescription data were assessed; production and pharmaceutical costs were calculated. Regression models evaluated changes in prevalence trajectories. The resident population and average age increased slightly (from 704,355 to 711,133 people; from 49 to 51 years old). The unadjusted and standardized prevalence of HF, CKD and CLD rose significantly over the study period. However, after regression analysis, significance was confirmed only for the period 2011-2019. In 2020-2023, prevalence continued to rise, but at a substantially slower rate, suggesting an attenuation of the upward trend. A multifaceted, system-wide prevention and care model may attenuate the upward trend in chronic-disease prevalence in highly aged populations. These findings support integrated health-promotion strategies as a sustainable approach to chronic disease management and resource stewardship.

22. Knowledge, Attitude, Practice, and Motivation for Compliance With Infection Prevention and Control Procedures Among Undergraduate Nursing Students in Taiwan.

期刊: ANS. Advances in nursing science 发表日期: 2026-Jun-25 链接: PubMed

摘要

New infectious disease outbreaks underscore the importance of infection prevention and control (IPC) for health care safety. This study examined IPC knowledge, attitudes, practices, and motivation among 140 nursing students. Validated questionnaires assessed these variables, with data analyzed using Mann-Whitney, Kruskal-Wallis tests, Spearman correlation, and regression. Results showed limited proficiency in IPC practices and knowledge of precautions, despite positive attitudes and high motivation. Attitude predicted motivation for IPC compliance. Targeted training programs are needed to improve students’ IPC skills. Simulation-based learning, reflective practices, role modeling, and peer-led activities can enhance proficiency, ensuring patient safety and professional accountability.

23. International Trends in Head and Neck Cancer Mortality.

期刊: JAMA otolaryngology– head & neck surgery 发表日期: 2026-Jun-25 链接: PubMed

摘要

Head and neck cancer (HNC) accounts for nearly 1 million new cases and approximately half a million deaths annually worldwide, representing a substantial global health burden. Despite an overall decline in mortality in many regions, patterns vary across anatomical subsites and countries. To evaluate international and national mortality trends in HNC and its major anatomical subsites from 2001 to 2023. This observational epidemiologic study analyzed population-based mortality data from the World Health Organization (WHO) Mortality Database for 73 countries between 2001 and 2023. Data collection was conducted in May 2025, and the data were analyzed between May and October 2025. Eligible countries had medium- to high-quality vital registration data. Age-standardized mortality rates (ASRs) were calculated using the new WHO World Standard Population. Country-specific trends from 2010 to 2023 were assessed using joinpoint regression among countries with at least 7 years of available data. ASRs and average annual percentage change in HNC mortality overall and by anatomical subsite using population-based analysis. From 2001 to 2023, 2 000 066 HNC-related deaths (450 657 females; 1 549 409 males) were recorded. Internationally, ASRs decreased by 38.9%, with greater reductions among male individuals than among female individuals. Substantial divergence was observed across subsites: laryngeal cancer mortality decreased markedly (-50.1%), whereas increasing trends in oropharyngeal cancer mortality were observed in many countries in recent years, particularly in high-income countries such as the UK (average annual percentage change, 4.30%) and the US (average annual percentage change, 3.26%). Results of this study suggest that, although overall HNC-related ASRs have declined internationally, marked variation across subsites and countries persists. The contrasting trends between laryngeal and oropharyngeal cancers underscore the need for subtype-specific prevention strategies and continued global surveillance.

24. Seymour Plan For Disease Prevention.

期刊: JAMA 发表日期: 2026-Jun-25 链接: PubMed

摘要

25. Clinical and Economic Inpatient Burden of Influenza and Influenza-Like Illness in Germany 2019-2025: Analysis of Nationwide Hospital Data.

期刊: Infectious diseases and therapy 发表日期: 2026-Jun-25 链接: PubMed

摘要

Data on the influenza burden in Germany during and after the global COVID-19 pandemic are limited. This study presents nationwide trends in the clinical and economic inpatient burden of influenza and influenza-like illness (ILI) in the German population from 2019 to 2025. We conducted a descriptive, retrospective analysis of nationwide hospital data from the German Institute for Hospital Reimbursement covering six consecutive influenza seasons (2019-2020 to 2024-2025). Influenza/ILI hospitalizations were identified using the International Classification of Diseases version 10 (ICD-10) codes J09-J11 recorded as primary diagnosis. Outcomes included hospitalization counts, incidence rates, mean length of stay, ICU admissions, in-hospital mortality, and estimated costs, and were reported for three age groups (0-17 years, 18-59 years, ≥ 60 years). Regional variation across federal states was assessed using directly age-standardized rates. We identified 240,646 influenza/ILI hospitalizations, with the highest burden observed in the 2024-2025 season (87,745 cases; incidence: 105.0/100,000 population). Less than 5000 cases were observed in both the 2020-2021 and 2021-2022 seasons. Across all seasons, adults aged ≥ 60 years accounted for 48% of hospitalizations and 92% of 10,054 in-hospital deaths. In this age group, in-hospital mortality ranged between 5.8% and 12.3% per season. Mean hospitalization costs per case increased during the study period and were highest in older adults, reaching €5430 in 2023-2024 and €5421 in 2024-2025. Total inpatient costs of influenza/ILI were highest in 2024-2025 and estimated at €390 million. Regional hospitalization rates varied considerably, but patterns were inconsistent across seasons. Influenza/ILI causes a substantial and re-emergent inpatient burden in Germany, disproportionately affecting older adults. These findings highlight the need for sustained prevention efforts to reduce the burden of influenza/ILI in Germany. Further research is needed to understand the substantial regional disparities between federal states.

26. The factors between BMI and diabetic nephropathy and protective role of the FGF21-SIRT1 axis in diabetic nephropathy.

期刊: Molecular and cellular biochemistry 发表日期: 2026-Jun-25 链接: PubMed

摘要

Obesity and diabetic nephropathy (DN) represent escalating global health burdens. Glomerular mesangial cell (MC) injury, driven by lipotoxicity from free fatty acids like palmitic acid (PA), is central to DN pathogenesis. Fibroblast growth factor 21 (FGF21) regulates metabolism and mitigates obesity-related complications, yet its specific protective mechanisms against PA-induced MC injury remain unclear. This study employed a dual approach. Part I involved a cross-sectional survey of 1,067 type 2 diabetes mellitus (T2DM) patients to identify demographic and clinical risk factors for chronic kidney disease (CKD) using multivariate regression and latent class analysis. Part II utilized human MCs to investigate PA-induced apoptosis and endoplasmic reticulum stress (ERS), evaluating the therapeutic potential of recombinant human FGF21 (rhFGF21) and the involvement of the SIRT1 signaling pathway. A total of 1067 patients with T2DM were involved in the current study, among them, 345 patients with chronic kidney disease (CKD). The percent of females was 50.3%, and the mean age was 59 ± 11.3 years. Multivariate regression analysis showed that age, systolic blood pressure (SBP), duration of diabetes, hyperlipidemia and smoking status were associated with DN. We also performed a potential category analysis of these factors, and the results were derived into three groups. Further analysis found that there was a positive association between the stage of diabetes and the risk factors at high risk levels. We identified that PA increased the levels of pro-apoptotic markers (cleaved caspase-3 and BCL-2 associated X-protein), decreased the expression levels of the anti-apoptotic marker BCL-2, and upregulated the expression levels of the endoplasmic reticulum stress (ERS)-related proteins, glucose-regulated protein 78, activation transcription factor 4, and CHOP. However, all the effects were attenuated by rhFGF21 treatment. In addition, PA increased FGF21 and sirtuin 1 (SIRT1) expression levels, and rhFGF21 further upregulated SIRT1 expression. However, upon SIRT1 knockdown, rhFGF21 did not exert its protective effect on human MCs. Our findings demonstrate that rhFGF21 protects human MCs from PA-induced apoptosis and ERS via the FGF21-SIRT1 signaling cascade. Integrating these molecular insights with clinical risk stratification suggests that targeting the FGF21-SIRT1 pathway, alongside managing modifiable risk factors such as hypertension and hyperlipidemia, offers a promising integrated strategy for preventing and treating diabetic nephropathy.

27. Factors Associated with High Internalized Stigma Among People Living with HIV in Selected Provinces in Vietnam.

期刊: AIDS and behavior 发表日期: 2026-Jun-25 链接: PubMed

摘要

Internalized HIV-related stigma undermines mental health, quality of life, and engagement in care among people living with HIV (PLHIV), yet data from Vietnam remain limited. We analyzed data from the 2020 PLHIV Stigma Index, a cross-sectional study conducted in seven provinces. Participants were recruited primarily from public outpatient HIV treatment clinics and through limited chain referral. Internalized stigma was assessed using the 6-item Internalized AIDS-Related Stigma Scale (IARSS); scores of 5-6 were classified as high internalized stigma. Among 1,623 participants (mean age 34.6 years, 74.6% male), the IARSS showed acceptable internal consistency (Cronbach’s alpha = 0.74), and 29.4% had high internalized stigma. In the multivariable logistic regression, secondary/high school education (adjusted odds ratio [aOR]: 0.47, 95% confidence interval [CI]: 0.35-0.65), university/tertiary education (aOR: 0.34, 95% CI: 0.22-0.52), and more than 5 years since HIV diagnosis (aOR: 0.66, 95% CI: 0.49-0.89) were associated with lower odds of high internalized stigma. Higher odds were observed among participants with depression/anxiety symptoms (aOR: 2.02, 95% CI 1.56-2.62), those unaware of their partner’s HIV status (aOR: 1.79, 95% CI 1.21-2.65), and those reporting community stigma or discrimination in the prior 12 months (aOR: 1.49, 95% CI 1.06-2.09); internalized stigma also varied by province. Internalized stigma remains common among PLHIV in Vietnam and appears shaped by psychological, relational, community, and geographic factors. Integrated mental health, stigma-reduction, and context-responsive interventions may help reduce internalized stigma.

28. Integrative Bioinformatics and Experimental Validation Identify LOX as a Glycolysis-Related Biomarker in Myocardial Ischemia-Reperfusion Injury.

期刊: Cardiovascular toxicology 发表日期: 2026-Jun-25 链接: PubMed

摘要

Reprogramming of glycolytic metabolism plays a critical role in the pathogenesis of myocardial ischemia-reperfusion injury (MIRI). Although transient glycolysis activation may alleviate energy deficits, excessive glycolytic flux can worsen myocardial damage. This study aimed to identify specific biomarkers and therapeutic targets by investigating glycolysis-related genes in MIRI. We analyzed differentially expressed genes (DEGs) from GEO datasets GSE61592 and GSE160516 and constructed co-expression modules using weighted gene co-expression network analysis (WGCNA). By intersecting DEGs, WGCNA modules, and glycolysis-related genes, we identified glycolysis-related DEGs (GR-DEGs). Machine learning (support vector machine-recursive feature elimination and Random Forest) was applied to GR-DEGs; LOX emerged as the top intersecting feature (log2FC = 3. 67, adjusted P = 1. 44 × 10⁻⁵, validation set AUC = 0. 97). Diagnostic value was assessed using gene set enrichment analysis (GSEA), decision curve analysis (DCA), and nomogram modeling. Immune infiltration was evaluated using CIBERSORT. Experimental validation was conducted in a rat MIRI model and H9c2 hypoxia-reoxygenation (H/R) cells. GR-DEGs were enriched in pathways including ribose phosphate metabolism, collagen binding, and apoptosis. Machine learning identified LOX as a hub gene, significantly upregulated in both models. Functional analysis suggested LOX expression was significantly associated with extracellular matrix (ECM) receptor interaction pathways, with its upregulation coinciding with myocardial injury progression. LOX expression correlated positively with CD8⁺ T cells and activated memory CD4⁺ T cells, indicating its potential association with metabolic and immune microenvironment remodeling in MIRI. Our findings suggest that LOX may serve as a key candidate gene associated with MIRI pathogenesis in preclinical models, with a potential value for preclinical research exploration.

29. Adherence to the Mediterranean diet and risk of pancreatic cancer: an analysis of 2.3 million participants in the Pooling Project of Prospective Studies of Diet and Cancer (DCPP).

期刊: European journal of epidemiology 发表日期: 2026-Jun-25 链接: PubMed

摘要

Pancreatic cancer incidence is rising, yet few modifiable risk factors have been identified. The Mediterranean diet, which lowers inflammation and improves healthy weight maintenance and insulin control, may lower pancreatic cancer risk, yet the evidence for this association is inconsistent. To investigate the association, we conducted a pooled analysis of 2,315,406 individuals from 23 prospective cohorts in the Pooling Project of Prospective Studies of Diet and Cancer (DCPP), of whom 10,748 developed incident pancreatic cancer over a mean follow-up duration ranging from 8.1 to 23.3 years across studies. Adherence to the Mediterranean diet was assessed using the alternative Mediterranean diet score (aMED) and a modified score excluding alcohol (maMED). Study- and sex-specific hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards models and then pooled using random effect models. No statistically significant association was found between aMED or maMED and pancreatic cancer or pancreatic ductal adenocarcinoma (PDAC) risk. For aMED, the pooled pancreatic cancer HR was 0.96 (95% CI: 0.90-1.02) comparing the fourth to the first quartile, 0.94 (0.88-1.00) comparing high (6-9) versus low (0-3) scores, and 0.98 (0.96-1.00) per 2-unit increment in the score. Overall, there was no evidence of heterogeneity in these associations by sex, attained age, race, BMI, physical activity, or follow-up time; a positive association between maMED and pancreatic cancer risk was observed in past smokers (HR = 1.04, 95% CI 1.00-1.09) but not in never or current smokers (Pinteraction=0.04). In conclusion, there was little evidence of an association between a Mediterranean diet score and pancreatic cancer risk in this large international pooled analysis.

30. Validation of the regular physical exercise adherence scale (REPEAS) in Brazilian older adults.

期刊: Aging clinical and experimental research 发表日期: 2026-Jun-25 链接: PubMed

摘要

The objective of this cross-sectional observational study was to validate a scale that highlights the personal and environmental barriers that hinder adherence to regular physical exercise in older adults. Individuals aged 60 years or over, sedentary and/or ex-practitioners, regular practitioners of physical exercise, with Brazilian Portuguese as their mother tongue. In addition to the Regular Physical Exercise Adherence Scale (REPEAS), the following instruments were applied: sociodemographic data sheet and Baecke Habitual Physical Activity Questionnaire. The measurement properties tested were: structural validity, construct validity, reliability, consistency internal and ceiling and floor effects. This research involved 200 older adults’ participants, predominantly women. The confirmatory factor analysis supported the two-domain, 12-item structure of the REPEAS, demonstrating good model fit with the following indices: chi-square/degrees of freedom = 1.60, comparative fit index = 0.965, Tucker-Lewis index = 0.957, root mean square error of approximation = 0.078, and standardized root mean square residual = 0.078. Construct validity was evidenced by a statistically significant difference (p < 0.05) in the personal factors domain between groups. Additionally, the domains of the REPEAS showed appropriate correlations with the items in the factor analysis. Reliability was acceptable, with composite reliability ≥ 0.84 and intraclass correlation coefficient ≥ 0.89. This scale presented adequate measurement properties when tested on Brazilian older adults to assess environmental and personal barriers to regular physical exercise. However, as this was a study conducted with a convenience sample, generalization of the findings should be made with caution. Despite this, the REPEAS can serve as a practical tool for health professionals and researchers to identify modifiable barriers and guide strategies to promote physical activity among older adults. Not applicable.

31. Unraveling clade-specific differences in Candida auris: evolution, adaptation, and pathogenicity.

期刊: European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology 发表日期: 2026-Jun-25 链接: PubMed

摘要

Since its 2009 emergence, Candida auris (now also known as Candidozyma auris) has evolved from a rare isolate into a global “critical priority” pathogen. This rapid expansion is defined by its unique population structure consisting of six distinct genomic clades with starkly different evolutionary trajectories, phenotypic traits, and clinical risks. We conducted a systematic synthesis of literature from PubMed, Scopus, and Google Scholar (2009-2026), focusing on comparative genomics, clade-specific virulence, and diagnostic accuracy. A total of 64 studies were analyzed to identify patterns in clade divergence and antifungal resistance. Our analysis reveals that C. auris is not a monolithic threat but a complex of diverse lineages with specialized adaptations. Clade I (South Asian) and Clade IV (South American) represent the highest clinical risk due to hyper-virulence and high rates of multi-drug resistant (MDR) strains. In contrast, Clade II (East Asian) was initially associated with localized ear infections; recent genomic data show an expanding pathogenic profile with emerging bloodstream infections. Our review also identifies Clade V (Iranian) as a genetically distinct group and highlights the recent identification of Clade VI (Indomalayan) as a distinct lineage, suggesting a long-standing environmental reservoir. Furthermore, we identify critical “blind spots” in automated diagnostic platforms (VITEK® 2, BD Phoenix) where phenotypic variations in Clades II and III lead to frequent misidentification as Candida haemulonii or Candida famata. This review proposes a “clade-aware” framework for public health. While frontline antifungal treatment remains standardized regardless of lineage, we argue that effective long-term management and outbreak containment require integrating genomic surveillance with clade-specific infection control. By identifying high-biofilm clades (Clade I) or hyper-virulent lineages (Clade IV), public health systems can implement more targeted containment strategies, moving toward a precision-based approach to managing this fungal pathogen.

32. Microalgae-Mediated Synthesis of Gold Nanoparticles from Indonesian Chlorella vulgaris InaCC M205 with Potential Anticancer Properties for Biomedical Application.

期刊: Cell biochemistry and biophysics 发表日期: 2026-Jun-25 链接: PubMed

摘要

Sustainable nanomaterial synthesis has emerged as a critical strategy to reduce the environmental burden associated with conventional chemical synthesis method. Microalgae-derived biomolecules offer a promising platform for the green production of metal nanoparticles due to their rich bioactive compounds capable of acting as natural reducing and stabilizing agents. Here, we report the eco-friendly synthesis of gold nanoparticles (AuNPs) using extract of Indonesian microalga Chlorella vulgaris extract. To optimize the synthesis process, the effects of precursor-to-extract ratio, temperature, and incubation time were evaluated. Optimal synthesis of C5-AuNPs was obtained at 37 °C for 20 h with precursor to extract ratio of 6:4, resulting in moderately stable C5-AuNPs characterized by a surface plasmon resonance (SPR) peak at 541 nm. Furthermore, Fourier-transmission infra-red (FT-IR) analysis revealed the involvement of functional groups of C. vulgaris extract in the interaction with Au+ during the production of C5-AuNPs. Transmission electron microscopy (TEM) demonstrated the formation of uniformly spherical nanoparticles with an average diameter of approximately 8.8 nm. Biological evaluation showed that the synthesized C5-AuNPs exerted pronounced dose-dependent cytotoxicity against MCF-7 breast cancer cells with an IC50 threshold of 21.17 ppm, while no toxicity appears in normal HEK293 cells. Mechanistically, the C5-AuNPs induced early apoptosis and inhibit cell-cycle progression at the stage of G0/G1. Collectively, these findings demonstrate that C. vulgaris-mediated AuNPs represent a promising preliminary in vitro findings for cancer therapy candidate.

33. Wqsreg: a Stata command for weighted quantile sum regression.

期刊: European journal of epidemiology 发表日期: 2026-Jun-25 链接: PubMed

摘要

Weighted Quantile Sum (WQS) regression is a statistical method for quantifying the association between multiple possibly correlated predictors and a health outcome, estimating both the joint effect of the predictors as well as their individual contributions to the total effect. WQS has become one of the most popular and widely used approaches for investigating complex mixtures in environmental epidemiology, yet its implementation has been largely restricted to R users. In this paper we present wqsreg, the first Stata command for WQS regression, implemented for continuous, binary and count outcomes. We describe command’s architecture and present an application of the command on exposome data exploring the association between 38 exposures and a continuous outcome. Wqsreg provides a user-friendly command for WQS regression that integrates several flexible components of the framework such as bootstrap, training/validation splitting, and repeated holdout procedures. Wqsreg returns regression estimates as well as graphical displays of the individual weights. It requires Stata version 11 or higher and is freely available on GitHub [ https://github.com/PonzanoMarta/wqsreg ]. Given the increasing importance of appropriately exploring complex multidimensional exposures, this contribution will further promote the use of appropriate statistical methods in epidemiological settings with multiple correlated predictors.

34. Naturally occurring asbestos and its possible environmental and health implications in the Basilicata region (Southern Italy).

期刊: Environmental geochemistry and health 发表日期: 2026-Jun-25 链接: PubMed

摘要

Asbestos that occurs in the environment and has not been extracted for commercial purposes is commonly referred to as Naturally Occurring Asbestos (NOA). Research has shown a higher-than-expected incidence of mesothelioma in populations residing near NOA sites across California, Greece, Turkey, Cyprus, Corsica, and New Caledonia. In Italy, in the area around Pollino Massif (Basilicata region), a total of 124 mesothelioma cases were documented among population living in the villages of Castelluccio Superiore and Inferiore, Lauria, Latronico, Episcopia, San Severino Lucano, and Francavilla in Sinni. In this work for the first time, we report the morphological and chemical structural characterization of asbestos tremolite samples from the NOA outcrops in the Pollino area (Basilicata region). The detailed sample characterization has been attained by using a multi-analytical approach (EMP, SEM-EDS, TEM-EDS, Mössabuer, X-ray powder diffraction, and thermal analysis). Morphological investigation highlighted that a significant fraction of each sample (ca. 50%) consists of long fibres (> 5 µm) having width below 0.25 µm, considered the most carcinogenic fibres. Additionally, all asbestos samples showed the presence of Fe at the octahedral sites of the tremolite structure. This is relevant from the toxicological point of view because the presence of Fe in the fibre structure is a critical factor in asbestos pathogenicity. Obtained results provide a solid foundation for better understanding the potential health risks associated with asbestos tremolite in the Pollino Massif area. They also highlight the importance of constant monitoring and risk assessment to protect local communities from asbestos exposure.

35. Post-diagnosis physical activity in relation to mortality among prostate cancer survivors: a systematic review and meta-analysis.

期刊: Cancer causes & control : CCC 发表日期: 2026-Jun-25 链接: PubMed

摘要

Physical activity after cancer diagnosis may reduce mortality. However, systematic evidence for this association for men living with prostate cancer remains limited. We searched PubMed, Embase, and CINAHL data bases from start to June 2025. Random-effects meta-analyses estimated summary hazard ratios (HRs) and 95% confidence intervals (CI) for all-cause mortality and prostate-cancer-specific mortality to assess the association between post-diagnosis physical activity, measured in metabolic equivalents of task-hours per week (MET-hr/week), and mortality among prostate cancer survivors. We included ten studies with more than 50,144 participants (one study did not report the number of prostate cancer cases included in the meta-analysis) and 28,044 deaths. Higher levels of post-diagnosis physical activity (≥ 7.5 MET-hr/week) were associated with lower all-cause mortality (HR = 0.69; 95% CI: 0.62-0.77), compared to lower levels (< 7.5 MET-hr/week). Meta-analysis of five studies showed an inverse association between post-diagnosis physical activity and prostate cancer-specific mortality (HR = 0.77; 95% CI: 0.66-0.89). Meta-analysis of four studies showed that moderate-to-vigorous physical activity was inversely associated with mortality (HR = 0.62; 95% CI: 0.51-0.74). Higher post-diagnosis physical activity, including activity at higher intensities, was associated with lower all-cause and prostate cancer-specific mortality among men living with prostate cancer. Our findings suggest that physical activity may complement cancer care for prostate cancer patients.

36. Melanophore physiology and adrenergic receptor signaling in zebrafish (Danio rerio).

期刊: Fish physiology and biochemistry 发表日期: 2026-Jun-25 链接: PubMed

摘要

Zebrafish (Danio rerio) is used as a model to study adrenergic signaling and pigment cell development because their genetic structure matches human genetics and enables advanced scientific research methods. Researchers use zebrafish to conduct their studies in three different research areas which include cellular signaling studies and toxicology research and pharmacology investigations and translational scientific work. Hormonal processes through alpha-MSH MCH and melatonin interact with each other to regulate pigment distribution. The GPCR-mediated pathways initiate melanosome aggregation and dispersion processes through catecholamine binding which leads to cyclic AMP (cAMP) and calcium (Ca2+) pathway activation. The adrenergic signaling system adjusts to different environmental factors and endocrine disruptors which then creates changes to both pigmentation and behavioral patterns. The review examines how adrenergic receptor signaling works in the body and demonstrates its role in controlling melanophore functions. This review underscores the importance of adrenergic signaling in zebrafish as a model system that bridges fundamental cellular biology with translational applications in human health, drug development, and environmental toxicology, offering valuable perspectives for future interdisciplinary research.

37. Predictors of Perceived Sports Performance in Female Athletes: The Role of Pelvic Floor Dysfunction and Sleep Quality.

期刊: International urogynecology journal 发表日期: 2026-Jun-25 链接: PubMed

摘要

This study aimed to examine the relationships between perceived sports performance (PSP) and pelvic floor dysfunction (PFD) and sleep quality, and to identify whether PFD and sleep quality serve as independent predictors of PSP. A total of 95 female athletes from various competition levels (46.3% amateur, 46.3% professional, and 7.4% elite) (mean age 21.18 ± 4.51 years) were included in the study. Athletes’ PSP, PFD, and sleep quality were assessed using the Perceived Performance in Sports Scale (PPSS), Pelvic Floor Distress Inventory-20 (PFDI-20) with its subscales [Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6), Colorectal-Anal Distress Inventory-8 (CRADI-8), and Urinary Distress Inventory-6 (UDI-6)], and Single-Item Sleep Quality Scale (SISQS), respectively. Pearson correlation analysis was used to examine relationships between PPSS, PFDI-20, and SISQS, while multiple linear regression determined the predictive power of independent variables on PSP. The PPSS total score correlated with PFDI-20 total (r = -0.239, p = 0.019) and POPDI-6 (r = -0.384, p < 0.001), while with SISQS scores (r = 0.212, p = 0.039). Psychological perception score correlated with POPDI-6 (r = -0.399, p < 0.001), PFDI-20 total (r = -0.353, p < 0.001), CRADI-8 (r = -0.205, p = 0.047), UDI-6 (r = -0.233, p = 0.023), and SISQS scores (r = 0.261, p = 0.011). Physical and tactical perception scores were linked to POPDI-6 score (r = -0.334, p = 0.001; r = -0.326, p = 0.001, respectively); tactical perception was also related to SISQS score (r = 0.242, p = 0.018). Environmental perception correlated with PFDI-20 total (r = -0.196, p = 0.046) and POPDI-6 scores (r = -0.299, p = 0.003). Significant regression models explained 7.3-17.5% of the variance, identifying POPDI-6 as the sole consistent independent predictor for overall PSP (β = -0.446, p = 0.003) and all subdimensions (p < 0.05), whereas SISQS did not emerge as a significant independent contributor in the regression models (p > 0.05). Within the limits of the examined variables, pelvic organ prolapse symptoms emerged as a significant independent predictor for specific PSP domains, though the absolute explained variance remained modest (7.3-17.5%), while sleep quality was not a significant independent predictor. Rather than practice-ready guidelines, these cross-sectional findings suggest that future prospective and interventional research is warranted to explore whether integrating pelvic health screenings into training routines can meaningfully support athletes’ PSP, while carefully considering that the feasibility, confidentiality, and healthcare support for such screenings may vary across different sport participation and competition levels.

38. A triple-emission ratiometric fluorescence and multi-color sensing platform for the detection of 6PPD-Q based on aggregation-induced emission.

期刊: Mikrochimica acta 发表日期: 2026-Jun-25 链接: PubMed

摘要

For the first time, silicon quantum dots (Si-QDs), rhodamine 6G (R6G) and Au nanoclusters (Au NCs) were self-assembled through electrostatic adsorption to form the triple-emission ratiometric fluorescence probe Si-QDs@R6G@Au NCs for the detection of N-(1,3-dimethylbutyl)-N’-phenyl-p-phenylenediamine-quinone (6PPD-Q). Based on the dynamic variation patterns of these three fluorescence channels, the fluorescence intensity ratio (I550 + I650)/I435 demonstrated a highly linear relationship with 6PPD-Q concentration with the detection limit of 0.1 ng·mL- 1. Moreover, under 365 nm UV excitation, the fluorescence color of the probes altered significantly from initial orange to rose-red, then purple, and finally blue. Furthermore, a portable handheld sensing platform coupled with a smartphone was developed. Meanwhile, the YOLOv8 was significantly introduced to enhance the detection accuracy for fluorescence images. In general, this sensing system achieves high-throughput, rapid-response, and real-time monitoring of 6PPD-Q, which offers a practical and significant tool for ensuring food safety and public health.

39. Efficacy of Mechanical Insufflation-Exsufflation Devices as Analyzed in Lung Models: Systematic Review and Network Meta-Analysis of Peak Expiratory Flow Data.

期刊: Respiratory care 发表日期: 2026-Jun-25 链接: PubMed

摘要

Mechanical insufflation-exsufflation (MI-E) devices support airway clearance by generating positive and negative pressure cycles that simulate a cough. Bench studies using lung models provide a controlled environment to investigate device performance and optimize settings; however, the lack of methodological standardization limits reproducibility and clinical translation. A systematic review and network meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in PROSPERO (International Prospective Register of Systematic Reviews) (CRD42023486537). Experimental studies using adult mechanical lung models were identified from MEDLINE, Embase, and Web of Science (search updated November 2024). Two reviewers independently extracted data and assessed methodological quality using a customized risk-of-bias tool specifically developed for bench studies of respiratory devices. The primary outcome was peak expiratory flow (PEF); secondary outcomes included insufflation and exsufflation parameters. Random-effects meta-analyses were performed. Eleven studies (2002-2024) met the inclusion criteria, encompassing 6 MI-E devices and a range of simulated lung mechanics. The most frequently used settings were +40/-40 cm H2O with 3-s insufflation, 1-s exsufflation, and 1-s pause. Higher pressure pairs (+50/-50 cm H2O) produced significantly greater PEF compared with lower pressures, particularly in obstructive models (mean difference = 134 L/min, 95% CI 2-267). Methodological quality varied widely, with limited information on calibration, sensor characteristics, and study reproducibility. Higher pressure differentials generally enhance PEF, but optimal MI-E settings are not universal. MI-E performance depends on pressure settings and simulated respiratory mechanics. Clinically, these findings support individualized adjustment of MI-E parameters based on patient-specific characteristics. The lack of methodological standardization and calibration reporting limits comparability. A structured protocol for MI-E bench studies is proposed to enhance reproducibility, transparency, and translational relevance.

40. Posttrauma Benzodiazepine Use and Subsequent PTSD: A Population-Wide Analysis Following Extreme Traumatic Exposure.

期刊: The Journal of clinical psychiatry 发表日期: 2026-Jun-22 链接: PubMed

摘要

Objective: To examine whether benzodiazepine use within 30 days after mass trauma increases posttraumatic stress disorder (PTSD) risk and whether timing or persistence of use modifies this association. Methods: This retrospective cohort study leveraged 3 advantages: large-scale clinical dataset (∼4 million individuals), unprecedented collective exposure to trauma, and novel methodological approach addressing severity bias. Using data from Clalit Health Services (covering ∼54% of the population), we identified 15,570 benzodiazepine-naïve adults who received a new benzodiazepine prescription within 30 days of index date (October 7, 2023). Medication exposure was defined by prescription redemption (none, early ≤7 days, late 8-30 days) and by persistence based on refill behavior. Incident PTSD diagnoses (ICD-10 F43.1) were identified over 12 months. Cox proportional hazards models estimated hazard ratios (HRs), adjusting for demographic characteristics and psychiatric history. Results: Overall PTSD incidence was 5.0% (773/15,570). Twelve-month risk was 5.2% for nonpurchasers, 4.7% for early purchasers, and 5.0% for late purchasers. Fully adjusted models showed no increased risk with early (HR=0.98, 95% CI=0.80-1.20) or late (HR=1.11, 95% CI=0.94-1.31) purchase. Persistent users had elevated risk (HR=1.60, 95% CI=1.14-2.25 and HR=2.07, 95% CI=1.60-2.68), whereas discontinued users did not. Among Gaza border residents (n=238), both early (HR=0.52, 95% CI=0.31-0.88) and late (HR=0.62, 95% CI=0.38-0.98) purchasers had lower PTSD risk than nonpurchasers. Conclusions: In this naturalistic setting of mass trauma, short-term benzodiazepine use during 30 days postexposure was not associated with increased 12 month PTSD risk. Among highly trauma-exposed individuals, it was linked to reduced risk at 12 months. These findings challenge current caution against early benzodiazepine use in the immediate aftermath of trauma.

41. Multidimensional Predictors of Ranking-Based Competitive Success in National-Level Junior Tennis Players: Evidence for the Dominant Role of Physical Performance.

期刊: Sports (Basel, Switzerland) 发表日期: 2026-Jun-22 链接: PubMed

摘要

The aim of this study was to examine the relative contribution of physical performance, executive functions, and competitive anxiety to competitive success in junior tennis players. A total of 39 national-level junior athletes (20 males, 19 females) participated in the study. Physical performance was assessed using a standardized test battery including a 20 m sprint, standing long jump, agility test, and shuttle run. Executive functions were measured using the Adult Executive Functioning Inventory (ADEXI), while competitive anxiety was assessed with the Competitive State Anxiety Inventory-2 (CSAI-2). Competitive success was operationalized using ranking points. Hierarchical multiple regression analysis was conducted using log-transformed ranking points as the dependent variable. Age and sex explained 71.3% of the variance in LogRanking (R2 = 0.713, p < 0.001). The addition of physical performance variables provided a modest, non-significant increase in explained variance (ΔR2 = 0.068, p = 0.064). Executive functions (ΔR2 = 0.006, p = 0.645) and competitive anxiety (ΔR2 = 0.008, p = 0.801) did not provide additional explanatory power. In the final model, age and standing long jump were significant predictors of LogRanking. These findings suggest that ranking-based competitive success in junior tennis is strongly influenced by age-related and competition-exposure factors. Physical performance showed a limited additional contribution, while executive functions and competitive anxiety did not explain further variance in this sample.

42. Imported Tungiasis in Greece: Secondary Household Transmission and Transient Mixed Liver Enzyme Elevation.

期刊: Tropical medicine and infectious disease 发表日期: 2026-Jun-21 链接: PubMed

摘要

Tungiasis is a cutaneous ectoparasitosis caused by the penetration of gravid female Tunga penetrans fleas into the epidermis. Although endemic in tropical and subtropical regions, it remains rare in Europe, where most cases are travel-associated and secondary household transmission is seldom documented. This study describes imported tungiasis in Greece and investigates possible secondary household transmission in a non-endemic setting. Seven Greek men residing in Attica developed tungiasis following occupational exposure in Tanzania, together with one secondary case in a non-travelling household contact who had never travelled outside Greece. Diagnosis was based on clinical and dermoscopic findings and confirmed by amplification and sequencing of the mitochondrial cytochrome oxidase I (COI) gene. Household investigations were also performed. Eight male patients presented with painful plantar and/or subungual nodular lesions. Sequence analysis of COI demonstrated 657/662 bp (99%) identity with the Tunga penetrans reference sequence, and identical sequences were identified in all samples. A representative sequence was deposited in GenBank (accession no. PZ336383). All patients exhibited mild-to-moderate elevations of hepatocellular and cholestatic liver enzymes, which resolved within two weeks following treatment. One probable secondary household case was identified, and no infestation was detected among additional cohabitants or companion animals. This report documents imported tungiasis with probable secondary household transmission in Greece and highlights the importance of clinical awareness and environmental assessment in non-endemic settings.

43. Sustainable Athletes' Career Pathways and Mental Health Support: An Integrative Umbrella Review.

期刊: Sports (Basel, Switzerland) 发表日期: 2026-Jun-19 链接: PubMed

摘要

The present integrative umbrella review aims to provide a comprehensive overview of the evidence and practices related to mental health and career transitions in elite sport toward the implementation of service provision through digital interventions. Following PRIO guidelines, an extensive search across five databases (2015-2025) identified 52 eligible manuscripts (e.g., conceptual, review, and position studies). Data extraction focused on mental health, dual-career pathways, career transition challenges and needs, and identity-related issues among high-performance athletes. The findings revealed a strong consensus that athlete well-being is shaped by the dynamic interaction of mental health symptoms, sport-specific stressors, identity processes, and structural conditions across the athletic lifespan. Mental health vulnerabilities (e.g., anxiety, depression, disordered eating, and distress) were consistently reported, particularly during injury, deselection, and retirement. Dual-career engagement, diversified identities, and proactive career planning emerged as key protective factors, while stigma, limited literacy, and uneven access to psychological services remained persistent barriers. Five main thematic areas (Matrix 1) operationalized in ten higher-order intervention domains (e.g., Matrix 2, screening, monitoring, literacy, and others) and 14 potential online implementation strategies (Matrix 3) were identified. However, the evidence highlights fragmented implementation and a lack of scalable, cross-national tools to support athletes during and beyond their competitive careers. Therefore, a harmonized, evidence-based, multidimensional framework for the development and implementation of digital support resources has been proposed. This integrative review underscores the need for integrated, culturally sensitive, and digitally enabled support systems to promote sustainable transitions and long-term athlete well-being.

44. Dangerous Measures: A Case Report and Review of Motoro Ray Envenomation.

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

摘要

Aquatic envenomations may cause severe tissue injury, neurologic morbidity, and even mortality among those whose leisure and/or occupational activities expose them to marine and freshwater animals. The Motoro ray, or Potamotrygon motoro (also known as an ocellate river stingray) is endemic to freshwater tributaries throughout Brazil, and is a frequent source of severe envenoming of local fisherman and those residing near waterways. Local wound management including immersion in warm water, wound cleaning and debridement, as well as antibiotics are mainstays of treatment, as are local anesthetics (e.g., nerve blocks) and systemic opioid analgesics; however, high-quality evidence supporting such interventions is lacking. We present a case of a Canadian who was envenomed by his pet Motoro ray, and describe his clinical presentation and evolution of symptoms over the subsequent months. With the ever-increasing trade of exotic wildlife, clinicians, public health authorities, and those within the broader wildlife regulatory ecosystem should be attuned for unanticipated adverse consequences, such as those described herein. We further situate this case within the existing published literature around this particular species of ray, which is not typically considered an ornamental fish.

45. Reducing Anaesthesia's Carbon Footprint: A Survey of Awareness and Attitudes.

期刊: Irish medical journal 发表日期: 2026-Jun-18 链接: PubMed

摘要

This study aimed to explore Irish anaesthesiologists’ attitudes toward environmentally sustainable anaesthesia, including perceptions of safety, efficacy, and policy influences on anaesthetic choice. A cross-sectional online survey was distributed to anaesthesiologists across Ireland between March and June 2025. The questionnaire assessed demographic factors, preferences for intravenous versus inhalational anaesthesia, environmental awareness, and institutional support. Descriptive and comparative statistical analyses were performed. A total of 98 responses were received. Patient factors and ease of administration were the primary determinants of anaesthetic choice, while cost was less influential. Environmental considerations were common, with 71 (72%) reporting they consider environmental impact when selecting an anaesthetic technique. Most respondents (n=86, 88%) were willing to modify their practice to reduce environmental harm, yet 55 (56%) felt their institution did not provide adequate environmental education or guidance. Irish anaesthesiologists demonstrate strong awareness and willingness to engage in sustainable practice, but institutional training and policy support remain limited. Targeted education and system-level initiatives may enhance environmentally responsible anaesthetic care.

46. Comparative Analysis of Structurally Diverse PFAS-Induced Injury in Vascular Endothelial Cells and Characterization of Necroptosis-Related Cell Death Signaling.

期刊: Toxics 发表日期: 2026-Jun-11 链接: PubMed

摘要

Perfluoroalkyl and polyfluoroalkyl substances (PFAS) are persistent environmental contaminants associated with cardiovascular diseases; however, the mechanisms underlying PFAS-induced vascular endothelial injury remain incompletely understood. In this study, we systematically evaluated the effects of 15 PFAS on endothelial morphology and cell viability with different carbon-chain lengths and functional groups in cultured bovine aortic endothelial cells. Morphological observations and MTT assays revealed that perfluorononanoic acid, perfluorodecanoic acid (PFDA), and perfluorooctane sulfonate (PFOS) markedly reduced cell viability, with estimated concentrations producing a 50% reduction in viability of 60.9, 34.7, and 87.3 µM, respectively, whereas the other tested PFAS did not reduce viability by 50% at concentrations up to 100 µM in bovine aortic endothelial cells. Among the perfluoroalkyl carboxylic acids, the reduction in cell viability increased with increasing carbon-chain length. Among perfluoroalkyl sulfonates, PFOS caused the greatest reduction in cell viability, whereas perfluorodecanesulfonate did not induce clear endothelial damage. Comparative analyses across multiple cell types showed that PFDA reduced cell viability broadly across all cell types examined, whereas PFOS caused a greater reduction in cell viability in bovine-derived cell types examined than in human- or porcine-derived cell types examined. Since PFDA and PFOS were the most cytotoxic compounds among perfluoroalkyl carboxylic acids and perfluoroalkyl sulfonates, respectively, in bovine aortic endothelial cells, they were selected to compare cell death signaling. In both PFOS- and PFDA-treated cells, the selected apoptosis- and pyroptosis-related markers were not altered under the tested conditions. PFDA was associated with increases in phosphorylated RIP3 and phosphorylated MLKL, whereas PFOS increased MLKL expression without detectable RIP3 activation. Inhibition experiments further suggested that necroptosis-related signaling contributes, in part, to PFOS- and PFDA-induced endothelial injury in vascular endothelial cells. These findings suggest that PFAS-induced vascular endothelial injury depends on molecular structure and cell type, and may involve distinct necroptosis-related signaling patterns. However, it should be noted that the PFAS concentrations used in this study were higher than those typically detected in environmental and human exposure settings.

47. Unveiling Hidden Aconitum Alkaloids in a Poisoning-Implicated Tincture by Untargeted Screening and Molecular Networking.

期刊: Toxins 发表日期: 2026-Jun-05 链接: PubMed

摘要

Aconitum poisoning is a major public health concern in East Asia, and remains difficult to diagnose when the causative toxins are not covered by routine targeted assays. In a poisoning incident that occurred in 2018, 15 individuals were affected, including five fatalities, after accidentally consuming a medicinal tincture during a shared meal. The comprehensive alkaloid profile of the tincture implicated in the poisoning was achieved through the integration of targeted analysis, molecular networking, and untargeted screening based on ultra-high performance liquid chromatography coupled to time-of-flight mass spectrometry, aiming to clarify the causative agents. Targeted quantitative analysis detected nine alkaloids derived from Aconitum plants, confirming the presence of Aconitum ingredients in the medicinal tincture. However, these alkaloids were either present at low concentrations or exhibited low toxicity, and thus were not the principal causative agents of this poisoning incident. Molecular networking revealed additional hidden diester-diterpenoid alkaloids (DDAs) and monoester-diterpenoid alkaloids (MDAs) that were undetected by targeted analysis. Untargeted screening identified 58 Aconitum alkaloids, including 15 DDAs, 17 MDAs, 17 amino-diterpenoid alkaloids (ADAs), 2 C20-diterpenoid alkaloids, and seven unclassified alkaloids. The three most abundant alkaloids were structurally identified as pseudoaconitine, 8-deacetylpseudoaconitine, and 3’-methoxyacoforestinine, and were identified as the main causative agents of this poisoning. To our knowledge, this is the first detection of these alkaloids in Aconitum poisoning in China. These findings demonstrate that integrated targeted and untargeted toxicological analysis can identify undocumented toxins in poisoning events of unknown origin and clarify the chemical etiology of unusual Aconitum poisoning.

48. Physical Activity During Official Match Play in Female Masters Basketball Players: An Accelerometry-Based Study.

期刊: Sports (Basel, Switzerland) 发表日期: 2026-Jun-05 链接: PubMed

摘要

Insufficient physical activity remains a major public health concern among adult women, highlighting the need to identify structured activity contexts that can contribute meaningfully to recommended weekly physical activity levels. Official masters basketball may represent one such context; however, the amount of physical activity accumulated during female masters basketball match play remains insufficiently quantified. This study quantified the physical activity profile of official tournament match play among female masters basketball athletes and described the associated external physical demands. This observational study included 52 female master basketball athletes aged 37-63 years who competed in a three-day national masters tournament. Match demands were monitored using tri-axial microsensors. Physical activity was classified from processed raw tri-axial acceleration data into intensity zones, and differences in time spent across zones were examined using one-way repeated-measures ANOVA. External load during active play was quantified using total distance, distance across speed zones, accumulated acceleration load (AAL), mechanical load (ML), jump load (JL), and Physio Load. Significant differences were observed across physical-activity intensity zones, with more time accumulated in light physical activity (LPA) and vigorous physical activity (VPA) than in moderate physical activity (MPA), whereas MPA accounted for the least time overall [F (1.98, 101.16) = 47.57, p < 0.001, ηp2 = 0.48]. Descriptively, moderate-to-vigorous physical activity (MVPA) amounted to 42.78 min, calculated as the sum of MPA (9.41 ± 3.82 min) and VPA (33.37 ± 14.49 min). During active play, athletes covered 59.19 ± 17.26 m·min-1, with most distance accumulated in the low- and medium-speed zones and limited very-high-speed running; AAL, ML, and JL averaged 8.32 ± 2.31 AU·min-1, 22.35 ± 5.53 AU·min-1, and 31.26 ± 28.35 J·min-1, respectively. Official female masters basketball appears to provide a meaningful intermittent physical-activity stimulus within a single monitored match exposure and may contribute substantially to weekly aerobic physical-activity accumulation in adult women.

49. Reducing Antibiotic Dependence in Poultry: The Potential of Phytochemicals as Antibiotic Alternatives Against Bacterial Foodborne Pathogens.

期刊: Tropical medicine and infectious disease 发表日期: 2026-Jun-04 链接: PubMed

摘要

Antimicrobial resistance (AMR) is one of the most serious threats to global public health, driven in part by extensive antibiotic use in food-producing animals. The poultry industry, a major contributor to the global animal protein supply, has depended on antibiotics for growth promotion and disease control, thereby contributing to the emergence and dissemination of AMR zoonotic bacteria. This review synthesizes current evidence on the potential of phytochemicals (PCs), plant-derived bioactive compounds, as sustainable non-antibiotic alternatives for controlling bacterial foodborne pathogens in poultry. Relevant literature including in vitro and in vivo studies assessing PCs against major poultry-associated zoonotic bacteria, including Salmonella enterica, Campylobacter spp., Clostridium perfringens, Listeria monocytogenes, and pathogenic Escherichia coli, is examined. Evidence indicates that PCs exert antimicrobial and anti-virulence effects through mechanisms like bacterial membrane disruption, inhibition of quorum sensing and virulence gene expression, modulation of gut microbiota, and enhancement of host immune responses. In vivo studies demonstrate reductions in pathogen colonization and improvements in gut health and performance metrics in poultry. Despite these promising findings, challenges remain in bioavailability, dose optimization, standardization, and regulatory approval. Overall, PCs represent a promising component of integrated antimicrobial stewardship strategies in poultry production, with significant implications for mitigating zoonotic AMR transmission.

50. How Frailty Is Considered, Measured and Managed in Clinical Practice, Quality Improvement and Research in Australia: Insights From a National Survey.

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

摘要

This study investigated the extent to which frailty is currently considered, measured and managed in clinical practice, quality improvement and research in Australia. A cross-sectional electronic survey was developed and promoted to clinicians, health service managers and researchers involved in the provision or study of health care for older people across Australia (August 2024 to March 2025). Of the 155 responses analysed, 88% (n = 136) were from clinicians. Over half of the respondents, 57% (n = 55/97) reported that frailty screening occurred regularly in their health service. Screening was performed by clinicians with allied health, nursing and medical backgrounds, with the Clinical Frailty Scale (CFS) the tool reported most commonly (61%). Free text responses indicated that although frailty screening often informed individual clinical care, system-level models of care to manage people who were screened as frail were rare. Respondents viewed management of frailty as the most important research area (management 41%, prevention 34%, screening 25%). Free text responses on priority research questions highlighted knowledge and implementation gaps in all domains. Of those who responded to the question on research (n = 154), 75% indicated that there was no ongoing research on frailty in their health service and 43% indicated willingness to be involved in frailty research. Frailty screening in practice was reported by over half of the respondents, with opportunities identified to implement models of care for patients with frailty. There is an appetite for further research on frailty in health services across Australia, with management of frailty a priority.

51. Making Policy When the Perfect Is Impossible.

期刊: JAMA health forum 发表日期: 2026-Jun-01 链接: PubMed

摘要

This JAMA Forum discusses ethical and economic aspects of allocating resources in the context of cuts made to Medicaid under the Budget Reconciliation Act of 2025.

52. Sex-Based Disparities in Health Care Access and Utilization Among Patients With Atrial Fibrillation.

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

摘要

Females with atrial fibrillation (AF) experience a higher risk of stroke, myocardial infarction, and mortality than males with AF. Theories suggest that sex-based differences in hormonal, structural, and electrophysiologic factors are associated with this imbalance; we hypothesized that sex-based differences in health care access and utilization (HCAU) are also underlying factors. To determine whether sex-based disparities in HCAU barriers exist among individuals with AF. This cross-sectional study used data on patients with AF in the All of Us Research Program Registered Tier dataset (version 8), which contains integrated data from the electronic health record and various health surveys between August 8, 2016, and October 1, 2023. Inclusion criteria were age 18 years or older, a SNOMED (Systematized Nomenclature of Medicine) diagnosis of AF, and completion of the Health Care Access and Utilization Survey. Exclusion criteria included lack of binary sex information. Data were extracted and analyzed between November 2025 and April 2026. Association between sex at birth and participant responses to 20 HCAU outcomes. Multivariable logistic regression and marginal standardization were used to calculate unadjusted and adjusted odds ratios, adjusted predicted probabilities (APPs), and adjusted risk differences (ARDs). Multiplicity was addressed using the Holm-Bonferroni method. The 12 428 eligible participants had a median (IQR) age of 70 (63-75) years and included 6877 males (55.3%). Compared with males with AF, females with AF had significantly higher APPs of reporting HCAU barriers to 14 of 20 outcomes after adjusting for baseline differences in sociodemographic and clinical characteristics. The largest differences were observed in cost-related medication access and adherence behaviors and nervousness about seeing a health care practitioner. Females compared with males were more likely to report asking for a lower-cost medication (APP, 25.12% [95% CI, 23.92%-26.32%] vs 20.84% [95% CI, 19.82%-21.86%]; ARD, 4.28 [95% CI, 2.65-5.90] percentage points), being unable to afford prescription medications (APP, 12.77% [95% CI, 11.93%-13.61%] vs 9.20% [95% CI, 8.47%-9.93%]; ARD, 3.57 [95% CI, 2.42-4.72] percentage points), delaying prescription fills (APP, 11.20% [95% CI, 10.38%-12.01%] vs 7.81% [95% CI, 7.12%-8.50%]; ARD, 3.39 [95% CI, 2.29-4.48] percentage points), and being nervous about seeing a health care practitioner (APP, 9.35% [95% CI, 8.57%-10.14%] vs 6.18% [95% CI, 5.56%-6.80%]; ARD, 3.17 [95% CI, 2.14-4.21] percentage points). In this cross-sectional study, females with AF reported a greater burden of HCAU barriers than males with AF. This finding may explain some of the observed differences in AF outcomes between sexes.

53. Severity of Chronic Kidney Disease and Outcomes After Admission to the Intensive Care Unit.

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

摘要

Individuals with chronic kidney disease (CKD) are disproportionately admitted to the intensive care unit (ICU); however, the association between CKD severity and outcomes after ICU admission remains uncertain. To evaluate the association between CKD severity and health outcomes after ICU admission. This population-based cohort study was conducted from November 1, 2008, to February 28, 2021. Participants included 531 090 consecutive adult (≥18 years) residents of Ontario, Canada, admitted to an ICU during the study period who had a baseline outpatient serum creatinine measurement within 7 to 365 days prior to admission. Statistical analyses were conducted from July 23, 2025, to April 16, 2026. CKD severity was classified according to the baseline outpatient estimated glomerular filtration rate (eGFR) Kidney Disease Improving Global Outcomes criteria. Mortality (ICU, hospital, and 90-day mortality) and kidney replacement therapy (KRT) requirement in the ICU and dependence at 90 days. The study included 531 090 adults (mean [SD] age, 67 [15] years; 57% men) admitted to the ICU. One in 4 individuals had preexisting CKD: stage 3a CKD, eGFR 45 to 59 mL/min/1.73 m2 (12% of adults); stage 3b CKD, eGFR 30 to 44 mL/min/1.73 m2 (7% of adults); stage 4 CKD, eGFR 15 to 29 mL/min/1.73 m2 (3% of adults); non-dialysis-dependent stage 5 CKD, eGFR less than 15 mL/min/1.73 m2 (1% of adults); and undergoing maintenance dialysis (2% of adults). Compared with individuals without CKD, the severity of the disease among individuals with CKD was progressively associated with increased mortality risk up to non-dialysis-dependent stage 5 CKD. However, the risk of mortality was lower for individuals receiving maintenance dialysis (odds ratio [OR], 1.92 [95% CI, 1.82-2.04]) compared with those with non-dialysis-dependent stage 5 CKD (OR, 2.32 [95% CI, 2.14-2.52]). Risk for KRT initiation in the ICU increased with CKD severity relative to individuals without CKD: stage 3a (adjusted OR [AOR], 1.79 [95% CI, 1.68-1.90]), stage 3b (AOR, 3.02 [95% CI, 2.83-3.22]), stage 4 (AOR, 6.71 [95% CI, 6.23-7.22]), and non-dialysis-dependent stage 5 (AOR, 32.00 [95% CI, 29.07-35.22]). Among those who initiated KRT in the ICU and survived to 90 days, KRT dependence at day 90 increased progressively by CKD stage: no CKD, 7.2%; stage 3a, 14.2%; stage 3b, 22.5%; stage 4, 50.3%; and previously non-dialysis-dependent stage 5, 83.8%. In this cohort study of consecutive adults admitted to the ICU, the presence and severity of CKD were associated with adverse health outcomes. These findings can inform risk prognostication, discussions about goals of care, resource allocation, and health policy initiatives for this large portion of the ICU population.

54. Diet Quality and Dementia Risk in Older Adults With Alzheimer Pathology.

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

摘要

Higher diet quality has been linked to reduced dementia incidence, but whether it buffers dementia onset in individuals with Alzheimer disease (AD) pathology or broader neurobiological risk is unclear. To explore the association of diet quality with dementia risk across biomarker levels of AD pathology (phosphorylated tau at threonine 217 [p-tau217]) and broader neurodegenerative and glial processes (neurofilament light chain [NFL], glial fibrillary acidic protein [GFAP]). This cohort study analyzed data from adults without dementia aged 60 years or older from the population-based Swedish National Study on Aging and Care in Kungsholmen, which enrolled participants between March 2001 and August 2004 and examined them up to 6 times until February 2016 to November 2019. Adherence to 3 dietary patterns was examined: the Alternate Mediterranean Diet (AMED), Alternative Healthy Eating Index (AHEI), and reversed Empirical Dietary Inflammatory Index (rEDII). Data were analyzed between September 2024 and August 2025 and reanalyzed in March and April 2026. Baseline serum p-tau217, NFL, and GFAP concentrations and repeated adherence over 6 years to the AMED, AHEI, and rEDII dietary patterns. The primary outcome was all-cause dementia identified by clinical diagnosis, medical records, and death certificates. The secondary outcome was AD-related dementia. Dementia risk was analyzed using adjusted Cox regression models. Ten-year dementia probabilities and restricted mean time lost due to dementia were also estimated. A total of 1865 participants were included (mean [SD] age at baseline, 70.5 [9.3] years; 1125 female [60.3%]). Over a mean follow-up of 8.4 years (range, <0.1 to 15.9 years), 240 participants developed dementia. Higher adherence to healthier dietary patterns was associated with lower dementia risk in participants with elevated AD and neurobiological risk biomarkers. For rEDII, each 1-z-score increase in adherence was associated with lower dementia risk among those with elevated p-tau217, NFL, and GFAP levels, with hazard ratios of 0.71 (95% CI, 0.58-0.88), 0.79 (95% CI, 0.66-0.95), and 0.73 (95% CI, 0.60-0.89), respectively. Associations of AMED and AHEI with lower dementia risk were generally found only among participants with lower biomarker levels. Similar findings were observed for AD-related dementia. This cohort study of older adults found that adherence to a dietary pattern with lower inflammatory potential was associated with lower dementia risk among individuals with AD pathology and broader neurobiological risk. These findings reinforce the importance of targeted dietary dementia prevention strategies not only for the general population but also for individuals already at elevated risk.

55. Needs and Perspectives on Upper Limb Prostheses Among Children and Adolescents With Upper Limb Differences.

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

摘要

In low- and middle-income countries (LMICs), limited access to adequate prosthetic care hinders the psycho-socio-motor development and educational progress of children and adolescents with upper limb differences. The suitability of current pediatric prosthetic solutions and the needs and expectations of children and adolescents with upper limb differences regarding upper limb prostheses (ULPs) remain understudied in LMICs. To examine and characterize the needs, expectations, and perceptions of Nigerian children and adolescents with upper limb differences regarding ULPs, assessing contextualized specifications for prosthetic development. This qualitative study was conducted from July 20 to July 23, 2024, in Lagos, Nigeria, among 25 children and adolescents with upper limb differences purposively selected from The IREDE Foundation prosthetic care program; recipients were aged 5 through 20 years who possessed at least 1 ULP. This study involved semistructured interviews and focus groups of Nigerian children and adolescents with upper limb differences. Transcripts were analyzed using thematic analysis between August 2024 and May 2025. The needs and perceptions of children and adolescents with upper limb differences regarding ULPs. A total of 25 children and adolescents with upper limb differences (mean [SD] age, 13.5 [4.2] years; 15 male [60%]) enrolled in the study; 14 were interviewed, and 11 engaged in focus groups. The predominant cause of upper limb differences was traumatic amputations (16 [64%]), and the predominant level of upper limb differences was transhumeral (16 [64%]). Seven themes were identified from the interviews and focus groups. First, the children and adolescents with upper limb differences described the technical specifications of an ideal ULP by (1) highlighting the functionalities and task performance it should enable; (2) expressing their need for an active ULP and the characteristics of effective terminal devices; (3) specifying user-defined requirements for quality of prostheses components; (4) describing factors contributing to comfortable wear and use; and (5) explaining the necessity for anthropomorphism (shape and color) of ULP designs. Second, the psychosocial consequences of the conditions of the children and adolescents with upper limb differences and ULP use emerged: adverse repercussions (6) on self-concept and (7) in interactions with their social network, which were major factors in ULP acceptance. Overall, children and adolescents with upper limb differences expressed the need for an active, anthropomorphic, sturdy ULP, enabling them to actively engage with their peers. In this qualitative study, children and adolescents with upper limb differences expressed perceptions regarding their current ULP and described the requirements of prosthetic devices meeting the psychosocial and occupational needs within their socialcultural environment. Future studies could incorporate these findings into the development of environment-specific pediatric ULPs.

56. Early Identification of DLD in Paediatric Practice: A Pilot Validation of the CLAP Screening Tool in Italian Outpatient Settings.

期刊: International journal of language & communication disorders 发表日期: 2026 链接: PubMed

摘要

Language development in early childhood varies considerably, making early detection of Developmental Language Disorders (DLDs) challenging despite their high prevalence and long-term effects on learning and mental health. In Italy, no culturally adapted, easy-to-use screening tools are currently available in primary care. To address this gap, a screening tool was developed to support the early identification of children aged 24-72 months at risk of DLD and other clinically relevant language difficulties. To evaluate the psychometric properties and accuracy of the Comunicazione e Linguaggio in Ambulatorio Pediatrico (CLAP), a brief age-specific screening tool designed for use in Italian paediatric outpatient settings. In this pilot validation study, children were recruited by primary care paediatricians during routine well-child visits and stratified into four age groups: 24-30, 36-42, 48-54, and 60-72 months. After administration of the CLAP screening tool, each child underwent a blinded speech-language pathologist (SLP) assessment. Psychometric evaluation included internal consistency, item-total correlations, confirmatory factor analysis, and item response theory indices (discrimination and difficulty). Diagnostic accuracy was assessed using ROC curves, area under the curve (AUC), sensitivity, specificity, and optimal cut-offs. Analyses were conducted separately for each age group. Fifty children were enrolled in each age group; overall, 24% of the sample fell into the pathological subgroup after the blinded SLP assessment. Internal consistency was acceptable in the 24-30-month (KR-20 = 0.695) and 36-42-month (KR-20 = 0.777) groups, but lower in older children. Factor analyses supported a mainly unidimensional structure in the younger groups. Item response theory showed good discrimination and informativeness for several items. ROC analyses indicated excellent diagnostic accuracy in the 24-30-month group (AUC = 0.93; sensitivity = 92%; specificity = 87%), fair accuracy in the 36-42- and 48-54-month groups (AUC = 0.75 and 0.74), and poor performance in the 60-72-month group (AUC = 0.46). The CLAP demonstrates promising psychometric properties and good-to-fair accuracy as a brief screening tool for identifying children aged 24-54 months at risk of clinically relevant language difficulties, including those who may need further assessment for DLD. Its age-specific design, quick administration, and non-invasive nature support its potential integration into routine primary care. For older children, an age-specific revision or an alternative tool might be required. A larger validation study is currently in progress. What is already known on this subject Developmental Language Disorder (DLD) is common in early childhood; however, early identification remains difficult due to variable developmental pathways and the absence of validated screening tools in primary care. Currently, no brief, culturally adapted instrument is available for routine use in Italian paediatric settings. What does this study add to existing knowledge This study demonstrates that the CLAP tool has promising psychometric properties, with good accuracy in the youngest age group and fair accuracy up to 54 months for identifying children at risk of clinically relevant language difficulties, including those who may later meet criteria for DLD. It provides the first evidence supporting an age-specific, feasible screening option that can be integrated into Italian primary care, while also identifying areas requiring revision for older pre-schoolers. What are the potential or actual clinical implications of this work? CLAP can assist paediatricians in the early detection of clinically relevant language difficulties in children during routine well-child visits. Its adoption could help standardize early language screening in Italy, leading to earlier referral for further diagnostic assessment and appropriate speech-language evaluation.

57. Integrating platform usage into the comprehensive model of information seeking: Health information seeking on WeChat among Chinese young adults.

期刊: Health informatics journal 发表日期: 2026 链接: PubMed

摘要

BackgroundWeChat has become a central platform for health information seeking in China, particularly among young adults. Understanding the mechanisms underlying this behavior is crucial for improving digital health literacy and designing effective interventions.ObjectiveThis study applies the Comprehensive Model of Information Seeking (CMIS) to examine how WeChat use shapes users’ perceptions of health information characteristics and utility, influencing health information-seeking behaviors among Chinese young adults.MethodsData were obtained from a cross-sectional online survey of 890 WeChat users aged 18-35 conducted in May 2024. Structural equation modeling (SEM) and the PROCESS macro were applied to test the hypothesized associations and mediating mechanisms involving perceived characteristics and utility.ResultsWeChat use, salience, and beliefs predicted perceived utility. Perceived characteristics and utility were positively associated with health information-seeking behaviors and mediated the relationship with WeChat use both in parallel and sequentially.ConclusionIntegrating platform-specific use into CMIS can promote health information seeking and inform digital health communication.