公共卫生研究摘要 (2026-06-30)

共收录 52 篇研究文章

1. Analysis of the current status and influencing factors of influenza vaccination among medical staff in multiple regions of China.

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

摘要

Background: This study investigated influenza vaccination coverage and its predictors among medical staff in multiple Chinese regions to develop targeted vaccination promotion measures.Methods: A cross-sectional questionnaire survey was conducted on medical workers from Beijing, Hebei, Hunan, Shaanxi, Yunnan and other provinces. Questionnaires collected demographic information, influenza/vaccine knowledge, personal and family vaccination history, and vaccine-related health beliefs. We calculated intra-class Correlation Coefficient (ICC) to evaluate hospital clustering due to nested data, adopted binary logistic regression as primary analysis, and applied two-level multilevel logistic regression to correct biased standard errors for robustness.Results: 476 valid questionnaires were retrieved from 483 distributed ones (98.6%). ICC = 0.021 suggested negligible hospital clustering, and the overall vaccination rate was only 16.4% (78/476). Multivariate analysis identified three positive predictors: vaccine training (OR = 2.503, 95% CI 1.337-4.686), family influenza infection (OR = 2.606, 95% CI 1.338-5.076) and family vaccination (OR = 8.266, 95% CI 4.100-16.663). Perceived barriers negatively predicted uptake (OR = 0.589, 95% CI 0.452-0.767). Staff in primary hospitals had higher coverage than those in tertiary hospitals (OR = 3.640, 95% CI 1.420-9.333).Conclusion: The overall influenza vaccination rate among medical staff remains relatively low. To increase the vaccination rate, in addition to strengthening professional training on influenza vaccine-related knowledge, it is also essential to optimize vaccination accessibility and foster a positive social and occupational vaccination atmosphere. Meanwhile, based on the health belief model of influenza vaccination, targeted health education should be carried out by focusing on reducing perceived barriers and improving health beliefs, so as to effectively enhance the influenza vaccination status of medical staff.

2. Cannabis Use and Tooth Loss by Race and Sexual Orientation/Gender Identity.

期刊: AJPM focus 发表日期: 2026-Aug 链接: PubMed

摘要

Tooth loss is an indicator of oral health and may be affected by cannabis use. The authors aimed to examine whether cannabis use and frequency of past-month cannabis use (in days) were associated with tooth loss, especially among racial and/or sexual orientation/gender identity groups, in a cross-sectional, nationally representative sample of Americans. The number of missing teeth was assessed in the 2016, 2018, 2020, and 2022 Behavioral Risk Factor Surveillance System surveys. Past-month cannabis use was assessed as both a binary and continuous variable (days of cannabis use) in 2024. Backwards selection selected covariates for 2 multivariate models. Final models were stratified by race/ethnicity and sexual orientation/gender identity if the interaction with cannabis use was significant. After adjusting for covariates, current cannabis use was associated with 1.157 times higher odds of tooth loss (95% CI=1.065, 1.257), although this relationship was found to differ by racial/ethnic subgroups. Among non-Hispanic Whites, cannabis use was associated with higher odds of tooth loss (OR=1.223, 95% CI=1.119, 1.336), although no significant associations were found among other subgroups. Among those who used cannabis, each 1-day increase in the frequency of past-month cannabis use was associated with 1.009 times higher odds of tooth loss (95% CI=1.003, 1.015). Cannabis use was significantly associated with tooth loss overall and among non-Hispanic Whites specifically. Frequency of cannabis use was significantly associated with tooth loss among those using cannabis. More research may be needed to fully understand the relationship among minority subgroups.

3. Leveraging Real-World Evidence to Inform Regulatory, Clinical, and Coverage Decisions Related to Glucagon-Like Peptide-1-Based Therapies: Synopsis of a National Institute of Diabetes and Digestive and Kidney Diseases Workshop.

期刊: Annals of internal medicine 发表日期: 2026-Jun-30 链接: PubMed

摘要

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have transformed obesity and diabetes management, with rapidly expanding indications and use among U.S. adults. Despite their promise, key questions remain about optimal treatment pathways, long-term safety, effectiveness across diverse populations, adherence, and economic impact. Real-world evidence (RWE) derived from electronic health records, claims, and other data sources could address these gaps, but unique challenges complicate its use, such as inconsistent insurance coverage, high discontinuation rates, medication shortages, compounded formulations, and off-label prescribing. To explore these issues, the National Institute of Diabetes and Digestive and Kidney Diseases convened a workshop in May 2025 with experts from regulatory agencies, guideline committees, payers, and academia. Discussions focused on identifying knowledge gaps in GLP-1RA use, evaluating how RWE informs practice, assessing limitations of real-world data, and strategies to reduce bias in RWE. Presentations emphasized RWE’s potential to complement randomized trials by capturing rare adverse events, long-term outcomes, and effectiveness in routine care. However, persistent challenges include data reliability, confounding, and incomplete capture of medication use and outcomes, particularly in pediatric and underserved populations. Coverage decisions remain heterogeneous across Medicare, Medicaid, and private payers and across time, underscoring the need for rigorous cost-benefit analyses. The workshop concluded that robust RWE is essential for developing value-based coverage policies and optimizing GLP-1RA use. Continued investment in high-quality data infrastructure and analytic methods will be critical to inform regulatory, clinical, and economic decisions as utilization expands.

4. Methodological Approaches to Real-World Evidence Generation for Glucagon-like Peptide-1-Based Therapies: Synopsis of a National Institute of Diabetes and Digestive and Kidney Diseases Workshop.

期刊: Annals of internal medicine 发表日期: 2026-Jun-30 链接: PubMed

摘要

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have reshaped the clinical approach to managing obesity and type 2 diabetes. As approved indications have expanded, use of GLP-1RAs has increased rapidly in the United States. Although randomized trials demonstrate strong efficacy, many questions remain about their optimal use in clinical practice. Real-world data (RWD) from electronic health records, registries, insurance claims, and other sources offer a promising avenue to address these questions. However, concerns about data quality, selection bias, and incomplete ascertainment of medication use and outcomes pose significant challenges to the validity of the resulting evidence. In May 2025, the National Institute of Diabetes and Digestive and Kidney Diseases convened experts from regulatory agencies, payer organizations, and academia to explore these challenges. This second of 2 synopsis articles on the workshop summarizes the discussion around the strengths and limitations of various RWD sources and methodological approaches to strengthen causal inference and generalizability. Presenters highlighted pragmatic clinical trials and target trial emulation as strategies to generate stronger real-world evidence (RWE) that is relevant to both clinical practice and policy. The workshop underscored that careful attention to study design, data limitations, and analytic approach is essential to yield RWE that informs clinicians, patients, payers, and policymakers.

5. Reporting Interest-Holder Engagement in Practice Guidelines: The RIGHT-MuSE Checklist.

期刊: Annals of internal medicine 发表日期: 2026-Jun-30 链接: PubMed

摘要

As part of the development of practice guidelines, developers need to systematically engage relevant interest-holder groups. The Reporting Items for practice Guidelines in HealThcare (RIGHT) checklist for reporting practice guidelines lacks detailed guidance on how to report the engagement process. To develop a standardized checklist for reporting interest-holder engagement in practice guidelines, named the RIGHT-MuSE checklist. The development process followed the methods recommended by the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) Network, as well as lessons learned from the development of the RIGHT statement and its extensions. Key steps included developing the protocol, registering the project, establishing a working group, conducting background work, generating an initial list of items, conducting a consensus survey, holding panel discussions, and creating the final RIGHT-MuSE checklist and an accompanying explanation and elaboration document. International collaboration. 25 panelists from various guideline development interest-holder groups. Consensus agreement on checklist items. The final RIGHT-MuSE checklist consists of 11 items covering the guidance used, methods of engagement, characteristics of interest-holders, evaluation of engagement, and management of conflicts of interest. The checklist is supplemented with a glossary of key terms and detailed explanations for each item to facilitate its use. The RIGHT-MuSE checklist has not been evaluated in a broader context or widely applied in real-world guideline development processes. Guideline developers can use the RIGHT-MuSE checklist to comprehensively report on interest-holder engagement. The Vincent and Lily Woo Foundation.

6. Adverse Events After Same-Day COVID-19 and Influenza Vaccination Versus Influenza Vaccination Alone : A Target Trial Emulation.

期刊: Annals of internal medicine 发表日期: 2026-Jun-30 链接: PubMed

摘要

Safety studies of the COVID-19 vaccine have identified some adverse events. Yet newer variant-updated formulations, along with increased hybrid immunity, may change these risks. Early-era safety data may not reflect experience with updated formulations in more immune-experienced populations. To evaluate 90-day risks for adverse events after coadministration of COVID-19 and influenza vaccines compared with influenza vaccination alone, across bivalent, XBB-adapted, and KP-adapted COVID-19 vaccine periods. Target trial emulation using electronic health care data. U.S. Department of Veterans Affairs. Participants receiving both COVID-19 and seasonal influenza vaccines (n = 705 124) and those receiving only an influenza vaccine (n = 1 813 205) between 1 September 2022 and 26 August 2025. Receipt of both COVID-19 and seasonal influenza vaccines versus receipt of only an influenza vaccine. 90-day risks for 46 prespecified individual adverse events grouped into 3 composite outcomes (tier 1, serious or life-threatening; tier 2, clinically significant; tier 3, less severe or self-limiting), using weighted discrete-time survival models. For all 3 composite outcomes, risks were similar between groups: tier 1 (risk ratio [RR], 1.03 [95% CI, 0.99 to 1.09]), tier 2 (RR, 0.99 [CI, 0.96 to 1.03]), and tier 3 (RR, 0.99 [CI, 0.96 to 1.02]). Of the 46 individual adverse events, 2 tier-3 risks had nominal statistical significance: syncope (RR, 1.09 [CI, 1.02 to 1.17]) and tinnitus (RR, 0.95 [CI, 0.92 to 0.99]); no risks were statistically significant after correcting for multiple comparisons. For all risks in tier 1 or tier 2, confidence bounds included 1.0 (no effect). In period-stratified analyses, neither composite (tier) nor individual event estimates supported differences in risks between groups. Generalizability and potential unmeasured confounding. Same-day coadministration of COVID-19 and influenza vaccines was not associated with an increased risk for adverse events in 3 updated-formulation periods. These findings support the short-term safety of coadministration. U.S. Department of Veterans Affairs.

7. Performance of Lung Cancer Risk Prediction Models in Different Racial and Ethnic Groups in the United States: Results From the Lung Cancer Cohort Consortium.

期刊: Annals of internal medicine 发表日期: 2026-Jun-30 链接: PubMed

摘要

Racial and ethnic disparities are a concern in lung cancer screening. To investigate the performance of risk prediction models to define screening eligibility across 4 U.S. racial and ethnic groups. Cohort study. United States, Lung Cancer Cohort Consortium. 641 830 participants aged 50 to 80 years with a smoking history from 12 U.S. cohorts, including 6390 Asian, 9781 Hispanic, 39 872 non-Hispanic Black, and 585 787 non-Hispanic White participants. Calibration and discrimination were quantified for 16 lung cancer prediction models. Then, screening-related metrics were calculated after applying model thresholds to select the same number of eligible participants as the 2021 criteria from the U.S. Preventive Services Task Force (USPSTF-2021). These included eligibility, sensitivity, and efficiency measured as estimated number needed to screen (NNS; the ratio between participants and lung cancer cases) for each strategy or prediction model in each racial and ethnic group. General patterns across the 16 models included substantial underestimation of lung cancer risk in non-Hispanic Black participants (expected-observed ratio < 0.75 for 11 of 16 models), lower discrimination in Asian participants than all other groups (13 of 16 models), and lower discrimination in non-Hispanic Black than non-Hispanic White participants (15 of 16 models). When a same-sized screening-eligible population as USPSTF-2021 (38.0%) was enforced, all risk-based strategies achieved better average estimated screening efficiency and reduced racial and ethnic differences in efficiency compared with USPSTF-2021. The Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial Model 2012 (PLCOm2012) and Life Years gained From Screening-Computed Tomography model (LYFS-CT) performed best (mean estimated NNS, 36.5 [SD, 8.8] and 40.1 [SD, 8.2], respectively). However, no strategy could simultaneously optimize eligibility, sensitivity, and efficiency while also reducing racial and ethnic differences. Smaller sample for Asian and Hispanic participants. To optimize efficiency and minimize its variation across racial and ethnic groups, risk-based strategies were superior to USPSTF criteria. Further optimization of prediction models for the diverse U.S. population is needed. U.S. National Cancer Institute, Lung Cancer Research Foundation, and Cancer Research UK.

8. Cervical cancer burden and elimination readiness in the US-affiliated Pacific Islands: A structured narrative review.

期刊: Cancer epidemiology 发表日期: 2026-Jun-29 链接: PubMed

摘要

The US-Affiliated Pacific Islands (USAPI) experience a high burden of cervical cancer, but progress toward achieving cervical cancer elimination targets is difficult to assess due to limited and fragmented data on HPV vaccination, cervical cancer screening and cancer treatment access. This narrative review aims to synthesise evidence of disease burden, risk factors, and interventions to inform region-specific strategies. We conducted a structured narrative review of published literature (MEDLINE, Embase, Global Health), cancer registry data, surveillance reports, and health system registries for six USAPI jurisdictions from 1990 to 2025. We collated information on HPV, cervical precancers and cancers, and related risk factors. Information on HPV vaccination, cervical cancer screening, and treatment, obtained from jurisdictional health system registries and reports, was used to assess the region’s trajectory towards the elimination targets. Cervical cancer incidence among women aged ≥ 20 years during 2007-2022 in the USAPI (age-standardized rate:17.2/100,000;95%CI:15.6-18.8) exceeded that of the US (10.8/100,000;95%CI:10.7-10.8), with large variation across jurisdictions, from 8.4/100,000 in American Samoa to 68.9/100,000 in Republic of the Marshall Islands (RMI). Approximately 75% of cases were diagnosed at Stage III + . HPV vaccination was introduced between 2007-2016, with coverages ranging from 44.2% in Federated States of Micronesia (FSM) to 92.7% in Commonwealth of the Northern Mariana Islands (CNMI). Four jurisdictions have implemented cytology-based screening, whereas RMI/FSM primarily rely on visual inspection with acetic acid. Screening coverage varies from 14.2% (CNMI, 2019) to 67.8% (Guam, 2020). Cancer treatment capacity is limited, with most jurisdictions lacking radiotherapy and relying on off-island referrals for advanced cases. USAPI cervical cancer burden is substantially higher than the US, compounded by late-stage diagnoses and limited treatment capacity. Although vaccination coverage has improved, major gaps remain in screening, follow-up, and access to care. Strengthening health systems through scalable, resource-appropriate strategies will accelerate progress toward elimination.

9. The association between diabetes mellitus and the risk of anal cancer: Results from a large nationwide cohort study in Taiwan.

期刊: Cancer epidemiology 发表日期: 2026-Jun-29 链接: PubMed

摘要

Few studies have investigated the association between diabetes mellitus and risk of anal cancer and the results to date have been inconsistent. We analysed the relation between a history of diabetes and diabetic retinopathy and risk of anal cancer in a nationwide cohort in Taiwan. Data from a retrospective cohort study of 5.9 million Taiwanese men and women aged 18-90 years were used for the analysis. Multivariable proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between diabetes diagnosis and diabetic retinopathy and risk of anal cancer. During a mean of 7.8 years follow-up, 2315 anal cancer cases occurred. The HRs (95% CIs) of anal cancer among persons with compared to those without a history of diabetes mellitus was 1.04 (0.95-1.13), and for persons with diabetic retinopathy vs. no diabetic retinopathy was 1.52 (1.20-1.92) and proliferative diabetic retinopathy vs. no proliferative diabetic retinopathy was 1.78 (1.27-2.50), respectively. This large-scale cohort study provides evidence of no clear association between diabetes mellitus and anal cancer risk overall, however, there was indication of increased risk among persons with diabetic retinopathy and proliferative diabetic retinopathy. Additional large-scale cohort studies with more comprehensive risk factor data are needed to further clarify these findings.

10. Weight loss and gut microbial changes associated with semaglutide among people living with schizophrenia receiving clozapine or olanzapine: An open-label 24-week semaglutide intervention and 76-week trial.

期刊: Schizophrenia research 发表日期: 2026-Jun-29 链接: PubMed

摘要

In individuals with schizophrenia receiving either clozapine or olanzapine, this study examined changes in 1) body weight and other cardiometabolic measures and microbiota biodiversity and composition between commencement and completion of 24-week semaglutide intervention; 2) body weight between commencement and 76-week follow-up. 24-week intervention (16-weeks full-dose (1.0 mg/week) after 8-weeks’ titration) of open-label nurse-administered semaglutide in a public mental health setting, with one-year post-intervention follow-up (76-week trial-completion). people with schizophrenia without diabetes receiving clozapine or olanzapine with BMI > 27 kg/m2. %body weight change at 24-weeks, and 76-weeks. Secondary endpoints: %change in waist circumference, HbA1c at 24-weeks and 76-weeks, body composition at 24-weeks. Gut microbiota changes were compared at baseline, 10-weeks and 24-weeks intervention completion. Mean age: 41.5 years (range 18-61), 65.4% female. Intervention completed by 65.4% (n = 17/26). 24-week intervention: intention-to-treat body weight reduction: -9.8% (95% CI: [-12.7%, -6.8%], p < 0.001) or - 10.1 kg (95% CI [-13.6, -6.6]); waist circumference reduction: -7.3% (95% CI: [-10.1%, -4.4%], p < 0.001); HbA1c non-significant reduction: -5.3% (95% CI [-10.4%, 0.1%], p = 0.055). Microbial alpha diversity decreased as time on semaglutide increased, with enrichment of Parasutterella excrementihominis. Trial completion: 88.2% (n = 15/17). Average body weight change baseline-76-weeks: -5.1% (95% CI: [-8.3%, -1.9%], p = 0.001) or - 5.3 kg (95% CI: [-8.9, -1.7]). Semaglutide was associated with significant weight loss in overweight/obese people with schizophrenia. These benefits attenuated following semaglutide discontinuation. Gut microbial compositional differences consistent with improvement in health outcomes may occur in semaglutide-treated people living with schizophrenia.

11. Individual and Social Factors Associated with Naswar Consumption Among Adults in Bandar Abbas, Southern Iran.

期刊: Substance use & misuse 发表日期: 2026-Jun-29 链接: PubMed

摘要

Naswar, a form of smokeless tobacco, has become an important public health concern in southern Iran due to its increasing use and associated health risks. Despite its growing social acceptance, limited evidence is available regarding the combined influence of individual, cognitive, and social factors on Naswar consumption. This study aimed to investigate the individual and social determinants of Naswar use among residents of Bandar Abbas, southern Iran. This cross-sectional study was conducted from June to September 2024 among 399 individuals aged 15 years and older recruited from urban healthcare centers in Bandar Abbas. Data were collected through face-to-face interviews using a validated questionnaire assessing demographic characteristics, knowledge, attitudes, social norms, behavioral intention, and Naswar use. Descriptive statistics, univariate analyses, and multivariable logistic regression were performed to identify factors associated with current Naswar consumption. The prevalence of Naswar use was 6% in the study population. Univariate analyses indicated that male gender, lower educational level, and lower socioeconomic status were associated with higher odds of use. Greater knowledge of Naswar harms, more negative attitudes toward use, and stronger anti-use social norms were associated with lower odds of consumption. In the multivariable model, higher knowledge and stronger anti-use social norms remained significant protective factors, whereas stronger behavioral intention toward Naswar use was identified as a significant risk factor. Naswar use in Bandar Abbas is influenced more by psychosocial factors than demographic characteristics alone. Prevention strategies should strengthen health knowledge, reinforce anti-use social norms, and target behavioral intentions through culturally appropriate interventions.

12. Outpatient Point-of-Care Cardiopulmonary Exercise Testing in Chronic Thromboembolic Pulmonary Disease: A Single-Center Experience.

期刊: JACC. Advances 发表日期: 2026-Jun-29 链接: PubMed

摘要

Pulmonary vascular obstruction causes dyspnea in chronic thromboembolic pulmonary disease (CTEPD) and chronic thromboembolic pulmonary hypertension (CTEPH). Conventional assessments, like 6-minute walk test (6MWT) and World Health Organization (WHO) functional class (WHO-FC), poorly discriminate the mechanism of dyspnea. Cardiopulmonary exercise testing (CPET) offers direct evaluation of ventilatory efficiency and gas-exchange abnormalities. The purpose of this study was to evaluate the impact of balloon pulmonary angioplasty (BPA) and pulmonary thromboendarterectomy (PTE) on CPET-derived gas-exchange parameters. In this prospective study, patients with CTEPD or CTEPH evaluated by a multidisciplinary team underwent outpatient point-of-care CPET (SHAPE-HF system) before and after BPA/PTE. The primary endpoint was change in ventilatory efficiency, assessed by the VE/VCO2 (minute ventilation/carbon dioxide production) slope. Secondary endpoints included changes in WHO-FC and 6MWT. Sixty patients were evaluated; 8 served as controls, and 52 underwent revascularization (20 PTE and 32 BPA). The VE/VCO2 slope improved from 43 to 31 (P < 0.001) after BPA and from 42 to 32 (P = 0.02) after PTE. WHO-FC improved from class III to I in both groups (P < 0.001). The mean 6MWT increased 38 m (381 ± 146 vs 419 ± 151 m; P = 0.03) in the BPA and PTE group (349 ± 162 vs 358 ± 140 m; P = 0.7). VE/VCO2 and Shape-HF Severity Score positively correlated (P < 0.001), but not with 6MWT (P = 0.83). Before and after revascularization, the Shape-HF score improved in the BPA (2.4 vs 1.5; P < 0.001) and the PTE (2.3 vs 1.6; P = 0.01) groups. Survival at 1-year follow-up was a 100%. Point-of-care CPET provides objective assessment of gas-exchange improvements after pulmonary revascularization in mild-to-moderate CTEPH/CTEPD.

13. Converting negative symptom dimension scores across SANS and PANSS.

期刊: Schizophrenia research 发表日期: 2026-Jun-29 链接: PubMed

摘要

Several factor-analytic studies of the Scale for the Assessment of Negative Symptoms (SANS) and Positive and Negative Syndrome Scale (PANSS) have identified two dimensions. These dimensions reflect expressive (EXP) and experiential or Motivation and Pleasure (MAP) negative symptoms. However, the extent to which these factor solutions yield similar dimension scores across the two scales remains unclear. This study compared equipercentile linking and linear regression data harmonization methods for cross-scale EXP and MAP conversions and evaluated their accuracy and reliability. While conversions between methods were similar, regression provided a slight edge over equipercentile linking in most comparisons. Most conversions had moderate or better reliability (ICC > 0.6, p < 0.01). EXP conversions generally had higher ICCs than MAP, with EXP >60% and MAP <60% posterior probability of exceeding ICCs>0.75. Some factor score conversions yielded higher reliability than others. However, when considering both EXP and MAP together, Ahmed’s factor scores for SANS and Jang’s or Khan’s for PANSS performed the best. This study is the first to compare equipercentile linking and regression frameworks for scale harmonization as well as to examine the conversion reliability and accuracy for the EXP and MAP dimensions across SANS and PANSS. It is also the first to employ a Bayesian approach, which provides additional information through probability distributions for choosing the most favorable conversion. The conversion formulae from this study and their reported metrics lay the groundwork for analyses of the EXP and MAP even when assessed with different clinical scales.

14. Repetitive Transcranial Magnetic Stimulation as a Cognitive Rehabilitation Approach for Veterans With Parkinson Disease and Mild Cognitive Impairment: Protocol for a Randomized Sham-Controlled Trial.

期刊: JMIR research protocols 发表日期: 2026-Jun-29 链接: PubMed

摘要

Parkinson disease (PD) is characterized by motor symptoms as well as progressive cognitive decline leading to long-term functional impairment and diminished quality of life. Mild cognitive impairment in PD (PD-MCI) is a risk factor for developing PD-related dementia. PD-MCI provides a window to assess interventions that can improve cognition. Repetitive transcranial magnetic stimulation (rTMS) shows promise as an effective treatment to improve cognitive performance. This study aims to test the safety and feasibility of a 10-session, high-frequency rTMS protocol applied to the left dorsolateral prefrontal cortex and the rTMS efficacy in improving cognitive test performance among veterans with PD-MCI. This is a double-blind randomized controlled trial. We will enroll US military veterans with PD-MCI. Participants will be randomized to either active or sham rTMS treatment groups, each with 10 treatment sessions (2 sessions/day). Treatment need not be consecutive; rather, they can be spread across approximately 10 days (eg, Monday, Wednesday, Thursday, Monday, Tuesday, and Wednesday). Participants randomized to active rTMS will receive stimulation applied to the left dorsolateral prefrontal cortex at 110% the resting motor threshold, a 15-Hz rate, 5 seconds per train of pulses, a 10-second intertrial interval, and 40 trains of pulses per session. Each patient will receive approximately 3000 pulses per session. Sham stimulation will be administered at the same parameters as real rTMS; however, no magnetic field will be produced on the placebo side of the active or placebo coil. This protocol was approved by the Edward Hines Jr Veterans Administration Hospital and Jesse Brown Department of Veterans Affairs Medical Center institutional review boards. This study includes a Food and Drug Administration investigational device exemption (G190076). Safety will be assessed using the number of research-related adverse events experienced by the active rTMS group compared to the sham rTMS group. Feasibility will be assessed using protocol completion rates. To examine preliminary effects of rTMS, participants will complete a standardized neurocognitive battery assessment at baseline, end point, and 1-month follow-up. The primary study outcome is the change in score from baseline to end point on the National Institutes of Health-sponsored Executive Abilities: Measures and Instruments for Neurobehavioral Evaluation and Research Executive Composite score. This project was funded in June 2019, with additional funding secured in April 2024. As of April 2025, a total of 18 veterans with PD-MCI have completed the randomized controlled trial phase. Data collection is ongoing and will be completed by March 2027. We expect the results of this study to be available by March 2028. The knowledge gained on the safety, feasibility, and efficacy of rTMS will set the stage for future research optimizing therapeutic gains for existing cognitive rehabilitation treatments or developing new and adjunct treatments for PD-MCI. ClinicalTrials.gov NCT03836950; https://clinicaltrials.gov/study/NCT03836950. DERR1-10.2196/77241.

15. Associations of Solid Fuel Use and Circadian Rhythm Syndrome With Physical Function and Muscle Strength in Middle-Aged and Older Adults: Nationwide Cohort Study in China.

期刊: JMIR aging 发表日期: 2026-Jun-29 链接: PubMed

摘要

The relationships among circadian rhythm syndrome, physical function, and muscle strength remain unclear. This study aimed to demonstrate the separate and combined deleterious effects of solid fuel use and circadian rhythm syndrome on physical function and muscle strength. We used data from the China Health and Retirement Longitudinal Study cohort. The study population consisted of participants who underwent comprehensive assessments of metabolism, circadian rhythm, indoor air pollution, physical function, and muscle strength at the initial evaluation. Muscle strength was assessed using repeated grip strength measurements, and physical function was assessed using a composite score of muscle strength, physical performance, and balance. Circadian rhythm syndrome was derived from the 5 diagnostic components of metabolic syndrome combined with sleep duration and depression. Logistic regression and linear mixed models were used to assess the relationships among solid fuel use, circadian rhythm syndrome, physical function, and muscle strength. Furthermore, we analyzed the mediating role of circadian rhythm syndrome and its combined effect with solid fuel use on physical function and muscle strength. A total of 7934 participants were included in the study, most of whom used solid fuels. Solid fuel use was positively associated with circadian rhythm syndrome (odds ratio [OR] 1.078, 95% CI 1.031-1.125; P<.05). Circadian rhythm syndrome was found to be a significant risk factor for impairment of physical function (β=-0.475; P<.05) and muscle strength (β=-0.304; P<.05). Participants who used solid fuels and had circadian rhythm syndrome needed to pay more attention to changes in physical function (β=-0.698; P<.05) and muscle strength (β=-0.332; P<.05). A significant interaction was observed between solid fuel use and circadian rhythm syndrome on physical function (Pinteraction=.03) and muscle strength (Pinteraction=.02). Circadian rhythm syndrome partially mediated the association between solid fuel use and physical function, accounting for 2.51% of the total effect. Circadian rhythm syndrome exacerbates the adverse effects of solid fuel use on physical function and muscle strength. Fuel cleanliness and regular work and rest habits are crucial for the health of middle-aged and older adults.

16. Cost-Effectiveness Analysis of Age-Specific N-Terminal Pro-B-Type Natriuretic Peptide Thresholds for Heart Failure Diagnosis in China: Protocol for a Markov Model-Based Study.

期刊: JMIR research protocols 发表日期: 2026-Jun-29 链接: PubMed

摘要

Heart failure (HF) imposes a substantial clinical and economic burden in China. Although N-terminal pro-B-type natriuretic peptide (NT-proBNP) is widely used in the diagnostic pathway for HF, conventional thresholds are largely derived from Western populations and may not be fully applicable to Chinese adults. This study aims to evaluate the cost-effectiveness of an exploratory age-specific NT-proBNP threshold strategy compared with a conventional universal threshold strategy for HF diagnosis in China. We developed a hybrid decision-analytic model linking an initial diagnostic decision tree to long-term Markov state-transition pathways. The target population comprised adults aged ≥45 years with symptoms suggestive of HF who underwent further clinical diagnostic evaluation. The China Health and Retirement Longitudinal Study was used to inform the baseline demographic and comorbidity structure. Two diagnostic strategies were compared: (1) an exploratory age-specific NT-proBNP strategy using thresholds of 100 ng/L for individuals aged <65 years and 248 ng/L for those aged ≥65 years and (2) a conventional threshold strategy using 125 ng/L as the comparator cutoff. The analysis was conducted from the perspective of the Chinese health care system. Primary outcomes included direct medical costs, quality-adjusted life-years, and incremental cost-effectiveness ratios. The base-case analysis used a 10-year time horizon, with annual discounting of 5% for both costs and health outcomes. Parameter uncertainty will be assessed using deterministic sensitivity analysis, probabilistic sensitivity analysis with 5000 Monte Carlo simulations, and scenario analyses. This study was funded in January 2025. Model construction has been completed, and parameter collection, calibration, and validation are ongoing. The final cost-effectiveness analysis is expected to be completed after project-specific Chinese data become available. Planned outputs include total costs, quality-adjusted life-years, incremental cost-effectiveness ratios, diagnostic classification outcomes, and cost-effectiveness acceptability results. This protocol will assess whether age-specific NT-proBNP thresholds provide economic or clinical advantages over a conventional universal threshold strategy in the Chinese health care setting. The findings are intended to inform future diagnostic policy while explicitly acknowledging uncertainty surrounding the exploratory age-specific thresholds and other structural assumptions. PRR1-10.2196/95071.

17. A Futures Framework for Clinical AI Governance: Anticipating Emerging Risks, Shifting Roles, and Regulatory Challenges.

期刊: Journal of medical Internet research 发表日期: 2026-Jun-29 链接: PubMed

摘要

This viewpoint develops the futures framework for clinical artificial intelligence governance (FF-CAIG), a conceptual and anticipatory framework for organizing emerging governance challenges in clinical artificial intelligence (AI). Although life cycle-oriented oversight is increasingly reflected in clinical AI regulation and institutional governance, existing approaches remain more developed for near-term validation, current-state assurance, and retrospective risk detection than for longer-horizon sociotechnical change. This gap is increasingly relevant, as AI systems become more complex, adaptive, and autonomous, and as they become more deeply embedded in care relationships and accountability structures. FF-CAIG is grounded in 3 futures methodologies: the 3 horizons model, scenario planning, and causal layered analysis. It is operationalized through an emerging clinical AI risk taxonomy that links these methods to governance domains. Its practical outputs include horizon classification, risk-domain mapping, scenario stress-testing findings, accountability-chain mapping, and horizon-scaled minimum governance actions for deployment or continued use. Applied across near-term, transitional, and longer-term horizons, the framework proposes cross-horizon priorities, including stronger predeployment equity evaluation, clearer life cycle accountability, clinician AI oversight competencies, and safeguards for increasingly autonomous or AI-mediated care systems. We illustrate FF-CAIG through 3 representative clinical AI deployment patterns and discuss its limitations, including differential compliance burdens, risks of overdocumentation, variable feasibility across jurisdictions, and the need for empirical validation. FF-CAIG is intended not as a prescriptive policy instrument or validated assessment tool, but as a structured analytic approach for regulators, health system leaders, developers, and researchers seeking prospective and systems-oriented approaches to clinical AI governance.

18. Demographic disparities in health-related social needs among caregivers of stroke survivors: an exploratory cross-sectional study.

期刊: Disability and rehabilitation 发表日期: 2026-Jun-29 链接: PubMed

摘要

To investigate the prevalence and demographic disparities of health-related social needs (HRSNs) across 12 domains among caregivers of stroke survivors, with attention to race/ethnicity and care partnership context. Cross-sectional survey examining disparities and correlates of total HRSN burden. Sample consisted of eighty-one US caregivers (69% female; 56% Black or African American between November 2024 and June 2025. Instruments included a demographic questionnaire and CMS Accountable Health Communities HRSN screening tool assessing 12 domains, scored dichotomously, and summed into total HRSNs. Caregivers reported an average of 6.5 unmet social needs (95% CI [5.69, 7.25]). Racial and ethnic minority (REM) caregivers experienced significantly higher total HRSNs than non-REM caregivers (mean 7.81 vs. 3.56; mean difference 4.25, 95% CI [3.05, 5.46]). Regression analysis showed that stroke survivor race, caregiver age (<41), and marital status accounted for 61% of variance in total HRSNs. Caregivers of stroke survivors face extensive and inequitable social needs, particularly among those caring for REM stroke survivors, younger caregivers, and married partners. Addressing these disparities requires integrating caregiver-focused, equity-oriented social needs screening into stroke care models. Rehabilitation teams should systematically screen both stroke survivors and their caregivers for health-related social needs (HRSNs).Racial and ethnic disparities in HRSNs were pronounced and multidimensional, with racial and ethnic minority caregivers experiencing higher unmet needs across nearly all domains.High HRSN burden was strongly patterned by sociodemographic factors, demonstrating the need for rehabilitation systems to include structured pathways for connecting caregivers with financial assistance, transportation programs, food access services, and home modification support.Policy and program development within rehabilitation systems should acknowledge caregivers as essential members of the rehabilitation team whose social context shapes the survivor’s long-term outcomes.

19. Operationalizing Digital Health Equity in Artificial Intelligence-Enabled Patient Decision Aids for Older Adults: Mixed Methods Study.

期刊: Journal of medical Internet research 发表日期: 2026-Jun-29 链接: PubMed

摘要

Artificial intelligence-enabled patient decision aids (AI-PDAs) hold promise for supporting older adults with chronic diseases in accessing personalized health information, clarifying preferences, and engaging in shared decision-making. Achieving equity in their design requires attention to the complex health care and digital contexts in which these tools are used. While the Digital Health Equity Framework (DHEF) provides a conceptual foundation, practical strategies for its application remain limited. This study aimed to identify equity-related determinants and generate actionable design strategies for applying the DHEF to AI-PDAs for older adults. A mixed methods study was conducted. Semistructured interviews were conducted with older adults living with hypertension and/or diabetes, health care providers, and medical students to explore equity determinants relevant to AI-PDAs. In parallel, a review of reviews synthesized existing evidence on approaches to addressing these determinants. Interview findings and review findings were integrated through an iterative mapping process conducted by the research team and refined through multidisciplinary expert consultation involving medicine, public health, social services, and computer science. A total of 33 stakeholders were interviewed, including 15 older adults, 8 health care providers, and 10 medical students. Thirteen reviews were included in the umbrella review. The integrated synthesis identified equity determinants spanning individual, interpersonal, community, and societal levels across both the health care and digital environments, together with cross-level concerns related to algorithmic fairness. These findings informed 5 recommendations for equitable AI-PDA development: (1) co-design with end users to address their needs, (2) embrace relationship-centered design, (3) leverage community resources to improve support, (4) promote accessible and equitable artificial intelligence (AI) governance in society, and (5) enhance equitable AI through algorithmic fairness. Together, these recommendations provide practical guidance for design, pilot testing, implementation, and evaluation. By integrating stakeholder perspectives with synthesized review evidence, this study extends the DHEF from a primarily conceptual framework toward a more practice-oriented approach for AI-PDAs for older adults with chronic disease. Health care settings serve as a mediating sociotechnical context where AI tools may either support or constrain equitable care participation. The findings underscore the need for interdisciplinary collaboration to align technological innovation with equity-oriented design. Future work should focus on co-designed prototypes, real-world testing, and measurable equity outcomes.

20. Therapy for Stage IV Non-Small Cell Lung Cancer With Driver Alterations: ASCO Living Guideline, Version 2026.3.2.

期刊: Journal of clinical oncology : official journal of the American Society of Clinical Oncology 发表日期: 2026-Jun-29 链接: PubMed

摘要

Living guidelines are developed for selected topic areas with rapidly evolving evidence that drives frequent change in recommended clinical practice. Living guidelines are updated on a regular schedule by a standing expert panel that systematically reviews the health literature on a continuous basis, as described in the ASCO Guidelines Methodology Manual. ASCO Living Guidelines follow the ASCO Conflict of Interest Policy Implementation for Clinical Practice Guidelines. Living Guidelines and updates are not intended to substitute for independent professional judgment of the treating clinician and do not account for individual variation among patients. See appendix for disclaimers and other important information (Appendix I and Appendix II). Updates are published regularly and can be found on the ASCO Publications website.

21. Should Adherence to Medical Recommendations Be a Requirement for Kidney Transplant Candidacy?

期刊: The American journal of bioethics : AJOB 发表日期: 2026-Jun-29 链接: PubMed

摘要

To be considered a candidate for transplant, patients with advanced kidney disease must demonstrate their ability to adhere to medical recommendations. An adherence criterion is intended to ensure effective use of deceased donor kidneys by selecting candidates who are able to engage in complicated post-transplant clinical care. However, evidence that pre-transplant assessment of adherence predicts meaningful post-transplant outcomes is equivocal. Further, this criterion risks exacerbating existing inequities in access to transplant and rigid definitions of what constitutes adherent behavior may impede opportunities to tailor treatment plans to individual preferences and circumstances. It is also unclear that an adherence criterion supports ethical standards for a fair process of resource allocation including transparency, relevance to affected groups, regulation, and opportunity for revision. We offer several strategies to revise the current approach to evaluating transplant candidates for adherence to better align with ethical principles guiding allocation of a scarce societal resource.

22. Meteorological and Environmental Factors Associated With Sudden Cardiac Arrest During Marathons in Japan.

期刊: JACC. Advances 发表日期: 2026-Jun-29 链接: PubMed

摘要

Sudden cardiac arrest (SCA) during marathons is a rare but life-threatening event. Although underlying cardiovascular conditions have been implicated in race-related SCA, the contribution of environmental factors, including meteorological conditions and ambient air pollution, remains incompletely understood. The objective of the study was to examine the associations of meteorological conditions and ambient air pollutants with SCA during marathon races. We conducted a nationwide race-level study in Japan using data from 4.53 million runners participating in Japan Association of Athletics Federations-certified full marathons between April 2011 and March 2020. Race-level SCA counts were linked to meteorological variables at race start, including ambient temperature, humidity, solar radiation, wind speed, precipitation, and air pressure, and to ambient air pollutants including fine particulate matter, suspended particulate matter, photochemical oxidants, sulfur dioxide, nitrogen dioxide, and carbon monoxide. Associations were examined using Poisson regression models with adjustment for race characteristics and participant composition. Among 4.53 million runners, 75 cases of SCA were identified. Ambient temperature at race start was inversely associated with SCA risk (adjusted incidence rate ratio per 1 °C increase: 0.94; 95% CI: 0.90-0.99), corresponding to a higher risk at lower temperatures. No statistically significant associations were observed between ambient air pollutants and SCA risk. In Japanese marathon races held predominantly in autumn and winter, lower ambient temperature at race start was associated with a higher risk of SCA, whereas no significant association was observed for ambient air pollutants.

23. Framework for Health-Promoting Environments for Office Workers: Photovoice Study.

期刊: JMIR formative research 发表日期: 2026-Jun-29 链接: PubMed

摘要

Office work is increasingly carried out outside conventional office settings, particularly during and after the COVID-19 pandemic. This highlights the need to understand the complexity of aspects that may influence health across different office work environments. This study aimed to (1) identify aspects that office workers perceive as supporting or hindering their health during office work, and (2) formulate novel questions about office work for quantitative studies. In February 2021, we conducted a digitally distributed photovoice study in Sweden, in which a convenience sample of 17 office workers from 5 companies took photos and provided written comments on what they perceived as supporting or hindering their health in places where they performed office work. For objective 1, we carried out both qualitative formal analysis and analysis without a theoretical frame, as well as quantified the content of the photos and comments. The identified aspects and their interactions were summarized in a visual framework. For objective 2, findings from the photovoice study were used to adapt selected items from the 2019 Swedish Work Environment Survey, capturing office work performed across multiple settings. Of a total of 63 photos, 70% (44/63) were taken at home, 24% (15/63) in an office, and 6% (4/63) outdoors. The comments on photos taken in conventional office settings largely highlighted health-promoting aspects, while the interpretations of home office photos showed greater variability regarding their impact on health. We identified 9 aspects and categorized them into two groups: (1) environmental perspective, including space, ergonomic, technical, and aesthetic-sensuous aspects and (2) behavioral perspective, including flexibility, focus, breaks-recovery, physical activity, and eating habits. Whether the aspects supported or hindered health depended on the environment where office work was performed and the employees’ living conditions. Our visual framework illustrates how these two perspectives interact with each other, bridged by space and flexibility. The study also resulted in a battery of multiple-choice questions about work in offices, at home, in public places, and outdoors that can be used in future research to better capture variation in modern work arrangements. This study extends the notion that office environments play a central role in supporting employee health by suggesting that this also applies to home offices. The results emphasize the need for tailored health-promoting interventions that account for the diverse environments in which office work is performed and for individual needs. The developed visual framework for analyzing health-promoting work environments for office workers and the battery of survey questions can contribute to future research and the advancement of sustainable, health-promoting office environments.

24. Digital Conversation Companions.

期刊: The Gerontologist 发表日期: 2026-Jun-29 链接: PubMed

摘要

Advances in voice recognition and artificial intelligence (AI) could soon yield digital conversation companions-software that combines conversational AI with health monitoring and promotion. We describe how this technology, once developed and deployed, could transform the way older adults age and receive care. By obviating the need to read or type, the software could be used by individuals with reduced dexterity, vision, or literacy. Repeated conversations could facilitate the consistent longitudinal tracking of mental acuity and sentiment. Over time, the conversations could be tailored to strengthen cognitive reserve, physical resilience, and social lives. By continuously recording and relaying changes in cognitive function, digital conversation companions could offer older adults unprecedented visibility into their own aging trajectories. Drawing on three well-known conceptualizations of aging, we explore how older adults might respond to this new dimension, a process we term “reflected aging”. Digital conversation companions could support caregivers by monitoring care recipients’ mental health, explaining treatment options, and automating documentation. They also might engender an atmosphere of constant surveillance and discount caregiver expertise and judgment. As digital conversation companions could lead to anthropomorphism, delusion, or social withdrawal in users of any age, these risks should be monitored closely in vulnerable older adults.

25. Potential of Bacillus amyloliquefaciens XSZ-1 as a bio-inoculant for enhancing cotton productivity and health in saline-alkali cotton field soil.

期刊: World journal of microbiology & biotechnology 发表日期: 2026-Jun-29 链接: PubMed

摘要

Soil salinization and fungal diseases severely constrain cotton production in Xinjiang, necessitating the development of sustainable and regionally adapted biocontrol strategies. This study aimed to evaluate the plant growth-promoting and biocontrol potential of Bacillus amyloliquefaciens XSZ-1, a bacterial strain isolated from continuous cotton field soil in Xinjiang. The strain XSZ-1 demonstrated pronounced tolerance to saline-alkaline stress, sustaining growth at NaCl concentrations up to 60.00 g/L and pH values ranging from 7.0 to 9.0. XSZ-1 exhibited multiple plant growth-promoting traits, including solubilization of both organic and inorganic phosphorus and IAA production (12.38 µg/mL). Antagonistic assays revealed broad-spectrum antimicrobial activity against all tested phytopathogens. Inoculation with XSZ-1 significantly enhanced cotton plant height (12.67%), root length (11.44%), and dry matter accumulation (up to 122.05% increase in root dry weight) compared to the uninoculated control. Bacillus amyloliquefaciens XSZ-1 is a promising multi-functional bacterium with both plant growth-promoting and biocontrol capabilities, well-suited for integration into cotton production systems in saline-alkaline regions. These findings provide a foundation for further field validation and mechanistic studies to support sustainable agriculture in Xinjiang.

26. A blind spot of human T cell immunology: epitope specificity in secondary lymphoid organs.

期刊: Current opinion in immunology 发表日期: 2026-Jun-29 链接: PubMed

摘要

The fate of T cells is determined through the expression of a unique T cell receptor (TCR). TCR epitope specificity drives spatial localization, phenotypic and metabolic plasticity, effector function, as well as the evolution of complex repertoires of T cell clones. However, human immunology is often restricted to the peripheral blood compartment and neglects ‘professional’ lymphoid organs. Furthermore, despite the generation of single-cell ‘atlases’, our knowledge of the epitopes that are recognized by human T cells is largely limited to only a handful of antigenic specificities from conventionally studied viruses. So far, this has prevented a holistic understanding of T cell clonotypes that link location-dependent cellular qualities to specific antigen exposures or disease entities. Novel methodologies for high-throughput annotation of T cell epitope specificity and high-resolution mapping of histological context bear the potential to enhance our understanding of basic human T cell biology, to provide a large-scale data resource for the connected field of computational T cell biology, and to facilitate the development of novel or improved vaccines and other immunotherapies.

27. Targeting the fusion machinery of Peste des petits ruminants virus: design and in vitro characterization of an HRC-derived antiviral peptide.

期刊: Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie 发表日期: 2026-Jun-29 链接: PubMed

摘要

Peste des petits ruminants virus (PPRV) is a highly contagious morbillivirus causing severe disease in small ruminants, with major implications for global food security and ongoing eradication efforts. Despite the availability of effective vaccines, the absence of antiviral therapeutics represents a critical gap in outbreak control. Here, we describe the design and in vitro characterization of a synthetic peptide derived from the heptad repeat C (HRC) region of the PPRV fusion (F) protein as a novel viral entry inhibitor. The HRC peptide potently inhibited PPRV F/H-mediated membrane fusion in a dose-dependent manner, with IC₅₀ values of 11.80 μM and 18.11 μM for SLAM/CD150- and nectin-4-dependent entry, respectively. Consistently, the peptide blocked viral entry in a vesicular stomatitis virus (VSV)-based pseudovirus system (IC₅₀ = 14.5 μM). Antiviral activity was further confirmed using a replicative morbillivirus model (canine distemper virus), where significant inhibition of infection was observed in both co-treatment and virus pre-treatment conditions. Notably, the combination with a fusion inhibitory compound (FIP) resulted in synergistic antiviral activity (FICI = 0.44), highlighting the potential of dual-targeting strategies. Biophysical analyses revealed a strong α-helical propensity in membrane-mimetic environments and high stability in human serum. Molecular docking and dynamics simulations indicated that the HRC peptide stabilizes the F protein by bridging critical domains through a persistent hydrogen-bond network, thereby preventing the conformational rearrangements required for membrane fusion. Collectively, these findings provide the first evidence that HRC-derived peptides can effectively inhibit PPRV entry and support their development as antiviral agents to complement current eradication strategies.

28. Evaluation of a Digital Intervention for Monitoring and Improving Medication Adherence Among Real-World e-Consumers of HIV Preexposure Prophylaxis in China: Protocol for a Randomized Controlled Trial.

期刊: JMIR research protocols 发表日期: 2026-Jun-29 链接: PubMed

摘要

Preexposure prophylaxis (PrEP) is a key biomedical HIV prevention strategy that relies heavily on adherence for optimal effectiveness. In China, most PrEP users purchase their medication online, making it challenging to monitor and support adherence effectively. This protocol aims to describe a digital intervention developed to monitor and improve the medication adherence of real-world e-consumers of PrEP and an evaluation plan assessing its acceptability, feasibility, and effectiveness. The Real-Time Monitoring and Precision Intervention for HIV PrEP Adherence (REMOTE) trial is a parallel-group, open-label, online-delivered, active-controlled, and stratified randomized controlled trial conducted among 430 e-consumers of PrEP (320 event-driven regimen users and 110 daily regimen users) in China. People who have purchased PrEP online, have taken PrEP in the previous 3 months, and plan to continue for the next 6 months will be stratified by regimen type and randomized into control and intervention groups at a 1:1 ratio. A WeChat-based digital platform will deliver the REMOTE intervention. The monitoring module follows ecological momentary assessment principles. The intervention design is guided by the stages of change theory, tailoring strategies to different nonadherence risks based on monitoring results. Intervention components include low-risk (health education and an artificial intelligence chatbot), medium-risk (peer forum and admonitory education), and high-risk (customized reminders and physician counseling) strategies. The control group will use a simplified platform with only real-time monitoring. The primary outcome is the proportion of participants achieving optimal adherence for 6 months, assessed via real-time monitoring and validated via surveys at baseline and the 1-, 3-, and 6-month follow-ups. Secondary outcomes include PrEP adherence knowledge, self-efficacy, risk perception, adherence barriers, stigma, and social support, measured via surveys. Intention-to-treat analysis will be conducted. Funding for the study was approved in March 2024. Ethics approval for the study was granted in July 2024. The pilot trial was completed in November 2025. Baseline data collection commenced in January 2026. By February 5, 2026, recruitment and baseline data collection were completed, with 448 participants enrolled. The data have not been viewed by the research team. The intervention is currently ongoing, and the study is expected to conclude in August 2026. Results are anticipated to be published in early 2027. The REMOTE trial pioneers a real-time monitoring and precision intervention for e-consumers of PrEP. Leveraging technology and ecological momentary assessment, it delivers a personalized, real-time intervention that is crucial for adherence. The findings could significantly impact future HIV prevention strategies. Chinese Clinical Trial Registry ChiCTR2400088278; https://www.chictr.org.cn/showproj.html?proj=236414. DERR1-10.2196/92750.

29. Assessment of Immunization Status Following Non-HSCT Chemotherapy-treated Pediatric Leukemia Survivors.

期刊: Journal of pediatric hematology/oncology 发表日期: 2026-Jun-29 链接: PubMed

摘要

Chemotherapy for pediatric leukemia induces profound immunosuppression, resulting in waning protection against vaccine-preventable diseases. Despite high survival rates, standardized revaccination protocols for non-transplant survivors remain controversial. We aimed to assess the serologic immunity to measles, mumps, rubella, and varicella among pediatric leukemia survivors and to identify clinical and treatment-related determinants of immune persistence. In this retrospective cohort study, 192 pediatric leukemia survivors treated with non-HSCT chemotherapy at Phoenix Children’s Hospital (2021 to 2023) underwent serologic testing for measles, mumps, rubella, and varicella IgG antibodies. Demographic, clinical, and immunization data were retrieved from institutional and state registries. Associations between patient characteristics and serologic immunity were analyzed using logistic regression. At a mean of 6.51 years following chemotherapy completion, the overall seropositivity rates were 37.0% for measles, 40.6% for mumps, 70.8% for rubella, and 24.5% for varicella. Survivors who received post-chemotherapy vaccination demonstrated significantly higher seropositivity for rubella (81.9% vs. 64.1%, P=0.004) and varicella (35.6% vs. 16.3%, P=0.005), with higher but non-significant seropositivity for measles and mumps. Low-risk B-cell acute lymphoblastic leukemia (ALL) patients exhibited higher immunity compared with high-risk patients, with significant differences observed for mumps (53.6% vs. 24.6%, P=0.0009) and rubella (81.2% vs. 66.7%, P=0.039). Moreover, a shorter interval from therapy completion was associated with improved rubella immunity (adjusted OR=0.753; 95% CI: 0.66-0.86). Post-chemotherapy revaccination was independently associated with increased odds of rubella (adjusted OR=4.89; 95% CI: 1.762-13.572) and varicella (adjusted OR=2.65; 95% CI: 1.124-6.26) immunity. Substantial attenuation of vaccine-derived immunity persists years after chemotherapy completion in pediatric leukemia survivors. Both treatment intensity and absence of post-chemotherapy revaccination contribute to impaired long-term humoral immunity. These findings support routine revaccinations for all non-transplant pediatric leukemia survivors and underscore the need for risk-adapted, individualized survivorship immunization strategies.

30. Subacute Exposure to Macrocyclic Lactone Insecticides Induces Parkinson's Disease-like Motor Deficits and Neuropathology in Mice.

期刊: Environmental science & technology 发表日期: 2026-Jun-29 链接: PubMed

摘要

Evidence links multiple environmental contaminants to an increased risk of Parkinson’s disease (PD), yet the identification of PD-relevant pesticides, particularly their combined effects, remains largely unexplored. Herein, we found that subacute exposure to the macrocyclic lactone abamectin or emamectin benzoate via ingestion induced PD-like motor dysfunction and dopaminergic neurodegeneration in mice. These adverse effects were associated with excessive α-synuclein aggregation, dopamine depletion, dopaminergic neuron loss, mitochondrial degeneration, mitochondrial membrane depolarization, and inflammatory responses in the substantia nigra/striatum, and this pathological profile resembled that induced by the known PD toxicant rotenone. We therefore used SH-SY5Y cells to further examine the combined effect of their coexposures and observed potential synergistic/additive effects in vitro. Integrated Biomarker Responses version 2 (IBRv2) analysis identified mitochondrial dysfunction as a key event underlying combined cytotoxicity. Multiomics analyses of differentially abundant metabolites and proteins suggested that the combined cytotoxicity is associated with mitochondrial Ca2+ overload, extracellular matrix-receptor interactions, ferroptosis, reactive oxygen species accumulation, and mitogen-activated protein kinase (MAPK) signaling, which may collectively contribute to oxidative stress and mitochondrial metabolic dysfunction. These findings offer updated insights into pesticide risks and guidance for pesticide reasonable application.

31. Impact of social determinants of health on perimenopause symptom burden: insights from the Flo app.

期刊: Climacteric : the journal of the International Menopause Society 发表日期: 2026-Jun-29 链接: PubMed

摘要

Perimenopause is the time leading up to and including the first 12 months after the final menstrual period. This study examined how social determinants of health (SDOH) including race/ethnicity, income, education and healthcare access influence perimenopause symptom burden. A cross-sectional survey was distributed to English, Spanish, Portuguese and French-speaking Flo app users aged 35 years and above. Participants completed the validated Menopause Rating Scale (MRS) and provided data on key SDOH. Associations between SDOH and total MRS and domain scores (psychological, somatic, urogenital) were evaluated using multivariable linear regression. A total of 12,382 women completed the survey. All examined SDOH were significantly associated with total and domain MRS scores (p < 0.001). Healthcare access had the strongest association, followed by income sufficiency and education level. Asian, Black and Hispanic/Latino race/ethnicities were significantly associated with MRS scores (p < 0.001) compared with White race/ethnicity. In a subset of 2618 women who reported being in perimenopause, SDOH remained significantly associated with MRS scores, with income sufficiency showing the strongest association (p < 0.001). SDOH, particularly healthcare access and income, are strongly associated with perimenopause symptom burden. Addressing health inequities is essential to improve perimenopause care and reduce symptom burden. Social determinants of health are factors including social, cultural and environmental exposures that can affect a person’s health and quality of life. The aim of this study was to study the relationship between perimenopause symptoms and household income, education level, healthcare access and race/ethnicity in a large group of Flo app users aged 35 years and over from around the world. The results show that all of the social determinants of health assessed in the research were linked with perimenopause symptoms. Among all study participants, healthcare access problems had the strongest links with experiencing a higher burden of perimenopause symptoms, followed by insufficient household income and lower education level. When looking specifically at the data from participants who identified as being in perimenopause, insufficient household income had the strongest links with symptoms, followed by healthcare access problems and lower education level. Hispanic/Latino, Black and Asian race/ethnicities also had significant links with symptoms compared with White race/ethnicity. To improve care and reduce the burden of symptoms that those going through perimenopause experience, it is important to address these health inequities.

32. Experiences of Persons With Disabilities Regarding Home Adaptation and Assistive Products in a Rural Community of Northern Thailand: Qualitative Study.

期刊: Asian/Pacific Island nursing journal 发表日期: 2026-Jun-29 链接: PubMed

摘要

Chiang Mai Province, located in northern Thailand, is a well-known tourist destination. Its rural areas are characterized by mountainous and valley landscapes, where residents primarily engage in agricultural activities and maintain traditional ways of life rooted in Northern Thai culture. However, persons with disabilities in rural areas of Chiang Mai face significant challenges in enhancing their quality of life and well-being. Home adaptations and assistive products are essential for these individuals, as they facilitate daily activities and improve overall living conditions. To address the needs of persons with disabilities in these communities effectively, it is crucial to gather insights and perspectives that reflect their everyday experiences. This study aimed to explore the experiences of persons with disabilities, focusing on the needs and obstacles they encounter in accessing home adaptation and using assistive products. A qualitative approach was used for this study. Individual interviews were conducted with 11 persons with disabilities residing in rural communities of the Doilor Subdistrict in Chiang Mai, Thailand. The data were analyzed using thematic analysis. Five themes emerged: (1) financial and personal burdens of home adaptations, (2) living with safety risks in the home environment, (3) the need for assistive products aligned with individual health conditions and contexts, (4) challenges in accessing mobility support and essential services, and (5) emotional impact and sociocultural support. The findings indicate that persons with disabilities in rural northern Thailand encounter multifaceted barriers to enhancing their mobility and adapting to their home environments. More effort is needed to enhance home modification support, integrate assistive products, and provide transportation accessibility that promotes community inclusion for persons with disabilities. This study highlights the influence of organizational priorities on community practice and the need for person-centered practice to ensure that modifications lead to meaningful outcomes valued by persons with disabilities in the future.

33. Inhalation exposure and health effects of copper particles in the context of occupational exposure limit derivation.

期刊: Critical reviews in toxicology 发表日期: 2026-Jun-29 链接: PubMed

摘要

Copper is a naturally occurring element found in the Earth’s crust, soil, water, and air. However, human activities such as smelting, refining, and producing copper-containing products pose a likelihood of occupational inhalation exposure. While copper is an essential element vital to human health, it is also a redox-active metal; thus, exposure beyond tolerable ranges could elicit a toxicological response. Previous occupational exposure limits (OELs) for copper and its compounds have been proposed, but most are based on limited datasets. More recent data available on the health effects of copper inhalation in exposed workforces, the characterization of copper forms in smelters during inhalation exposure, and inhalation effects in rodents have prompted a reevaluation of copper’s inhalation toxicity in the context of deriving an up-to-date and more robust OEL. This review examines the toxicological impact of copper inhalation, from its toxicological mode of action to respiratory effects in animal models and humans, in the context of adversity, and identifies relevant points of departure (PoDs) for establishing an OEL. Coupled with data on the rapid clearance of copper from the lung, this information was used in a dosimetric model to quantitatively translate the PoD from the in vivo test model to a human equivalent concentration (HEC) for copper. To address areas of uncertainty and variability, the scientific rationale for chemical-specific versus default assessment factors is discussed.

34. Activatable fluorescent probe for auxiliary diagnosis of atherosclerosis: from foam cells to clinical samples.

期刊: Spectrochimica acta. Part A, Molecular and biomolecular spectroscopy 发表日期: 2026-Jun-27 链接: PubMed

摘要

Cardiovascular diseases remain a leading cause of morbidity and mortality worldwide, with atherosclerosis playing a central role in their pathogenesis. A fluorescent probe activatable by leucine aminopeptidase was synthesized and designated as LAP probe. This probe was constructed using a hemicyanine scaffold conjugated with an LAP-recognizing peptide via a condensation reaction. Upon LAP activation, a bathochromic shift in absorption and a marked turn-on fluorescence response in the near-infrared region were observed, with a strong linear correlation established between fluorescence intensity and LAP concentration. The probe successfully distinguished foam cells from normal macrophages and enabled in vivo imaging of atherosclerotic plaques in high-fat diet-fed ApoE-/- mice. Serum LAP activity was found to be significantly elevated in atherosclerotic mice and in patients with arterial stenosis, particularly in those with severe stenosis exceeding 60%, as confirmed by receiver operating characteristic curve analysis. The probe exhibited low toxicity with no observable organ damage. These findings demonstrated that LAP probe holds promise for the auxiliary diagnosis and risk stratification of atherosclerosis.

35. Evaluation of the remineralisation potential of a novel peptide GA-C16G2 on artificial root dentine lesions.

期刊: Journal of the mechanical behavior of biomedical materials 发表日期: 2026-Jun-27 链接: PubMed

摘要

In this study, artificial root dentine lesions were treated with a novel peptide, GA-C16G2, to evaluate its remineralisation potential under in vitro conditions. Human root dentine specimens were demineralised for 4 days and subjected to a 7-day pH-cycling regimen with daily application of GA-C16G2 (500 μM), C16G2 (500 μM), gallic acid (GA; 500 μM), or distilled water (DW). Mineral density, mechanical properties, morphology, and chemical composition were determined using micro-computed tomography, nanoindentation, scanning electron microscopy, energy dispersive spectroscopy, and Fourier transform infrared spectroscopy analyses, respectively. GA-C16G2 and GA treatments resulted in significantly higher mineral density (1.69 ± 0.05 g/cm3 and 1.69 ± 0.02 g/cm3) than C16G2 (1.58 ± 0.06 g/cm3) and DW (1.63 ± 0.04 g/cm3) (p < 0.05), corresponding to mineral gains of 17.8% and 16.5%, respectively. Similarly, GA-C16G2 (hardness: 0.33 ± 0.08 GPa; elastic modulus: 7.63 ± 1.93 GPa) and GA (hardness: 0.32 ± 0.06 GPa; elastic modulus: 6.91 ± 1.45 GPa) demonstrated significantly greater recovery of mechanical properties than C16G2 and DW (p < 0.05). Root dentine appeared to show fewer exposed collagen fibrils, higher calcium and phosphate contents, and stronger phosphate bands in groups GA-C16G2 and GA, compared to those in groups C16G2 and DW. GA-C16G2 demonstrated the potential to promote mineral recovery and mechanical reinforcement of artificial root dentine lesions. Further studies incorporating established remineralising reference standards and biofilm-based models are required to determine its relative therapeutic performance and clinical relevance.

36. Chronogeroprotection: Circadian Action Bundles for Healthy Aging.

期刊: Aging and disease 发表日期: 2026-Jun-26 链接: PubMed

摘要

Aging is a multidimensional biological process characterized by a progressive decline in physiological resilience to stressors, shaped by molecular dysregulation and cumulative behavioral and environmental challenges, and accompanied by an increased risk of disease. Despite advances in geroscience, biological time remains underused in prevention, clinical care, and public-health strategy. Here we propose chronogeroprotection as a novel circadian-informed perspective on the preservation of physiological resilience across the life span. We synthesize evidence showing that circadian regulation coordinates near-24-hour rhythms in metabolism, immune function, DNA repair, and sleep-wake regulation, thereby influencing vulnerability to age-related diseases. We then translate these insights into a prevention-oriented model for healthy aging. We suggest that chronogeroprotective action bundles, which consist of interventions, properly synchronized to light exposure, sleep, meal timing, physical activity, pharmacology, diagnostics, and patient care workflows according to biological time, will help bridge the hallmarks of aging and healthcare system redesign. Through integration of circadian principles into diagnostic procedures, electronic health records, clinical workflows, educational programs, research networks, and public-health policy, biological time can become a tangible preventive and therapeutic factor relevant for healthy aging consistent with the WHO Decade of Healthy Ageing priorities.

37. Pelvic venous disorders and orthostatic intolerance: A systematic review of diagnostic associations and treatment outcomes.

期刊: Autonomic neuroscience : basic & clinical 发表日期: 2026-Jun-18 链接: PubMed

摘要

Pelvic venous disorders (PeVD) are recognised causes of chronic pelvic pain; emerging evidence suggests that venous outflow obstruction or reflux can also provoke orthostatic intolerance (OI) by infra-diaphragmatic pooling and reduced preload. Diagnostic and therapeutic frameworks for this overlap remain poorly defined. We systematically searched PubMed, Ovid MEDLINE, Scopus, and Cochrane to 20 May 2025. Two reviewers extracted data; risk of bias used design-specific validated tools. Sixteen studies met criteria (4 case reports, 7 case series, 2 single-arm cohorts, 2 case-control, 1 cross-sectional), comprising 964 participants (93% female; age 7-67 years). Case-control data suggested left common iliac or left renal-vein compression is more prevalent in patients with postural tachycardia syndrome than in controls. Paediatric series linked left renal-vein entrapment with orthostatic symptoms and proteinuria. Imaging confirmation used duplex ultrasound, CT, CT-venography, intravascular ultrasound, and dynamic MRA with 4D-flow. Eleven studies reported interventions (iliac stenting, ovarian/internal-iliac embolization, superficial venous ablation, renal-vein transposition or robotic auto-transplantation). Orthostatic symptoms generally improved; cohorts using the Orthostatic Hypotension Questionnaire showed ∼50% mean reduction, and several stented patients no longer met POTS criteria. Follow-up was typically ≤12 months. Overall risk of bias was high for single-arm cohorts and moderate for case-control studies. Available evidence supports a biologically plausible link between pelvic venous obstruction and OI suggests PeVD-directed procedures can ameliorate OI in selected patients. Prospective, multicentre studies with standardized imaging thresholds, objective autonomic endpoints, and longer follow-up are needed to define patient selection and comparative effectiveness.

38. Microplastics in the air and potential health risks - a narrative review.

期刊: Swiss medical weekly 发表日期: 2026-Jun-17 链接: PubMed

摘要

Microplastics, defined as plastic particles smaller than 5 mm and larger than 1 micrometer, along with nanoplastics (in the 1-1000 nm range), are ubiquitous environmental contaminants originating from both primary production and secondary fragmentation. Little is known about exposure to microplastics in ambient air and their health effects. This review summarises current knowledge regarding microplastics in ambient air and their potential health effects. To capture the limited available evidence on airborne microplastics exposure and human health, a search strategy using five complementary approaches was designed and implemented across multiple databases and timeframes through September 2024. In Switzerland and globally, major sources of airborne microplastics include tyre wear, textile fibres, and the degradation of plastics from various sectors. Exposure measurements reveal that microplastics are present in both indoor and outdoor air, with indoor exposure generally exceeding outdoor exposure. Exposure in cities is higher than in rural areas, thus depending on proximity to human activity. Based on calculations derived from various studies, an adult might inhale from 1,200 microplastic particles per year in remote locations to over 1.5 million particles per year in highly polluted urban areas. Human biomonitoring confirms the presence of microplastics across multiple tissues and bodily fluids, including the lungs, blood, placenta, breast milk, faeces, and, more recently, brain tissue, with evidence suggesting that microplastics can cross biological barriers, including the blood-brain barrier. While epidemiological studies specifically addressing airborne microplastic exposure are lacking, occupational health studies from textile and rubber industries report respiratory symptoms, impaired lung function, and an increased risk of respiratory diseases. Studies examining non-exhaust traffic emissions (as proxies for tyre wear particles) suggest associations with respiratory effects, increased mortality risk, cardiovascular impacts, and potential links to cancer and neurodevelopmental disorders. However, both approaches to understanding and deriving health effects from airborne microplastics have limitations. Additional research challenges include non-standardised measurement methods, a limited understanding of biokinetics, and difficulty differentiating microplastic effects from general particulate matter exposure. Despite these limitations, microplastics likely contribute to health effects similar to those of particulate matter pollution, with potential additional concerns related to their specific composition and chemical additives. The proportion of microplastics in ambient particulate matter may increase with decreasing exhaust emissions and increasing use of plastic products, emphasising the need for interdisciplinary research on exposure assessment and health implications.

39. A Video Protocol of a Randomized Controlled Clinical Trial - Electrochemotherapy of Cutaneous Metastases with Reduced Dose Bleomycin (BLESS Trial).

期刊: Journal of visualized experiments : JoVE 发表日期: 2026-Jun-09 链接: PubMed

摘要

Cutaneous metastases in patients with incurable cancer represent a significant problem as they often cause pain, discomfort, and emotional distress that affect everyday life. Finding treatment options that are both effective and gentle is essential. ECT offers one such possibility. Here, short, high-voltage electrical pulses are applied directly to the tumor, briefly opening tumor cells, allowing chemotherapy to enter more effectively and kill cancer cells. Traditionally, patients receive 15.000 IU/m2 of bleomycin intravenously, but emerging evidence suggests that a lower dose may be just as effective while causing fewer side effects. This protocol describes an ongoing double-blinded, randomized clinical trial that tests whether ECT with half the standard bleomycin dose is non-inferior to the conventional regimen for tumor control in patients with cutaneous metastases. The article outlines randomization and blinding procedures, pretreatment evaluation, bleomycin preparation and administration, electrode placement, pulse delivery, and response evaluation using the modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria. In addition to clinical response at three months, the protocol includes pharmacokinetic blood sampling and qualitative interviews with the patients to enable a comprehensive evaluation of treatment impact. Baseline tumor characteristics from the first 15 enrolled patients and an example of how mRECIST is applied are presented. Critical steps to ensure methodological rigor are discussed, including standardized tumor measurements, consistent electrode positioning, and predefined management of confluent or poorly demarcated tumors. By visually outlining the procedural workflow and key methodological considerations, this article provides a reproducible framework for dose optimization in ECT. It supports future implementation of reduced-dose regimens in clinical oncology practice.

40. Physical Activity and Perceived Barriers In Individuals With Spinal Cord Injury In Saudi Arabia: A Cross-Sectional Study.

期刊: Journal of visualized experiments : JoVE 发表日期: 2026-Jun-09 链接: PubMed

摘要

Spinal cord injury (SCI) impairs physical function and quality of life (QoL), and physical activity is important for health maintenance; however, participation may be influenced by multiple barriers. This cross-sectional study (May-September 2024) recruited 50 individuals with SCI in Saudi Arabia using convenience sampling via outpatient clinics and online distribution. Data were collected through structured interviews or self-administered surveys using identical questionnaires, including demographics, lesion characteristics, physical activity levels using the Arabic Physical Activity Scale for Individuals with Physical Disabilities (PASIPD-AR), awareness of physical activity recommendations, and perceived barriers and facilitators. Descriptive analyses were performed. The PASIPD score was 12.94 (4.48-26.86) MET-hr/day (median [IQR]) and 17.25 ± 15.35 MET-hr/day (mean ± SD). Awareness of recommendations was reported by 32% of participants, while 10% and 4% correctly identified aerobic and strength recommendations, respectively. The most frequently reported barrier was lack of suitable facilities (42%), and the most commonly reported facilitator was maintaining a healthy body (74%). Individuals with SCI in Saudi Arabia reported lower PASIPD scores compared with previous studies and limited awareness of recommendations, alongside commonly reported environmental and informational barriers.

41. Relationships between bilateral tapping skills and brain gray matter volumes: a voxel-based morphometry study.

期刊: Cerebral cortex (New York, N.Y. : 1991) 发表日期: 2026-Jun-02 链接: PubMed

摘要

Brain activity associated with bilateral hand movements has been reported to involve multiple regions. However, the association between gray matter (GM) volume in these regions and bilateral hand movement remains unclear. Therefore, this study aimed to elucidate the association between tapping skills using both hands and GM volume. This study included 61 healthy adults. Each participant’s Magnetic Resonance Imaging scans and bilateral motor task performance were evaluated. The motor task was a finger-tapping task, and the movement conditions were set as in-phase and antiphase. The participants were instructed to open and close their thumb and index finger as quickly and widely as possible, either simultaneously (in-phase condition) or alternately (antiphase condition) on both sides. Using voxel-based morphometry, we measured brain GM volume associated with the performance in the bilateral finger-tapping task. The results indicated a significant negative correlation between the similarity index of bilateral movement under the antiphase condition and GM volume around the left cingulate motor cortex. This result suggests that participants who were able to smoothly move both hands under the antiphase condition had greater GM volume in the left cingulate motor cortex. This GM volume may serve as a neurophysiological indicator of bilateral hand movement.

42. Incidence and outcome of paediatric cardioembolic stroke: a nationwide population-based study.

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

摘要

Cardiac disease is a leading cause of arterial ischaemic stroke (AIS) in children, yet data on paediatric cardioembolic stroke remain limited. This study investigated the incidence rate, underlying cardiac diseases and outcome of paediatric cardioembolic stroke in Denmark. In a nationwide registry, we identified all children with a stroke or stroke-related diagnosis (2013-2020). Arterial ischaemic stroke events were confirmed by medical record review and classified using the Childhood AIS Standardized Classification and Diagnostic Evaluation (CASCADE) criteria as definite cardioembolic, probable cardioembolic or non-cardioembolic. Neuroimaging and neurological outcomes were extracted from medical records. Follow-up time was 2 years. Cardioembolic stroke was identified in 31 (24.6%) of 126 children with AIS, corresponding to an incidence rate of 0.28 (95% CI, 0.20-0.40) per 100,000 person-years. Congenital heart diseases were the most common underlying conditions (n = 26, 83.9%). Among children undergoing angiography, LVOs were present in 41.2% of the cardioembolic group and in 18.5% of the non-cardioembolic group (P-value .060). The frequency of neurological impairments was similar between cardioembolic and non-cardioembolic AIS (48.4% vs 43.6%, P = .681). When limiting analysis to definite cardioembolic stroke, neurological impairment was more common in the cardioembolic than the non-cardioembolic group (73.3% vs 43.6%, P = .050), though this association was non-significant after adjusting for stroke severity. Cardioembolic stroke accounted for nearly one-quarter of paediatric AIS events. While clinical outcomes were similar between cardioembolic and non-cardioembolic AIS, definite cardioembolic stroke was associated with a higher risk of incomplete neurological recovery, highlighting the need for improved preventive strategies.

43. Multilevel onsite training and mentorship model to accelerate early childhood cancer diagnosis in Northwest Ethiopia: A quasi-experimental mixed method study.

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

摘要

Childhood cancer survival in low-income countries remains below 20%, with late recognition and delayed referral commonly reported. In Northwest Ethiopia, care providers often lack the knowledge, skills, and support systems for recognizing early warning signs of pediatric malignancies. Community caregivers often present only after symptoms become advanced. The University of Gondar Comprehensive Specialized Hospital piloted a quality improvement initiative aimed at achieving earlier diagnoses. This study reports whether a multilevel onsite training and mentorship model could improve early recognition, referral practices, and timely diagnosis of childhood cancer in Northwest Ethiopia. From January 2024 through September 2024, a quasi-experimental pre-post, mixed-methods study design was employed across three tiers of care: primary (e.g., health centers), secondary (general hospitals), and tertiary (specialized hospitals). Eighteen primary-level and 29 secondary-level clinicians completed intensive, on-site training (Ten and Seven days, respectively), while one thousand twenty health extension workers received pictorial outreach modules. A 6-month mentorship program combined monthly onsite visits with remote supervision. Mentees included general practitioners, nurses, health officers, and health extension workers mentored by a multidisciplinary team that included, for example, pediatric haemato-oncologists. Knowledge, attitude, and practice surveys and clinical chart reviews were conducted at baseline and 6 months post-implementation to evaluate patient-journey intervals. These quantitative assessments were integrated with qualitative interviews and focus groups grounded in the consolidated framework for implementation research. The intervention utilized specific curricula focusing on clinical recognition, referral protocols, and documentation. In this study, the participants had a 100% response rate. Median knowledge scores at primary and secondary levels rose from 54.6 (95% CI: 36.4, 63.6) to 90.90 (95% CI: 81.8, 100.0) and from 36.36 (95% CI: 27.3, 45.5) to 90.91 (95% CI: 61.4, 93.7), respectively. Median practice proficiency increased 87.5 (95% CI: 78.7, 100) to 100.00 (95% CI: 100.0, 100.0) at primary level and 68.75 (95% CI: 50.0, 87.5) to 93.8 (95% CI: 86.7, 100.0) at secondary level. The median interval from symptom onset to first health contact fell by 9.3% (from 27.0 days (95% CI: 16.0, 33.3) to 24.5 days (95% CI: 15.0, 32.0)), and the time from first contact to confirmed diagnosis decreased by 54.2%. Treatment initiation interval increased by 11.9%, reflecting ongoing infrastructural constraints. Qualitative findings underscored the roles of supportive leadership, diagnostic supply limitations, cultural beliefs, and referral coordination in shaping outcomes. This quasi-experimental pre-post design without a control group limits strong causal inference, especially in the presence of potential confounders like parallel public-health initiatives and seasonal variations in care-seeking. A context-tailored, multilevel training and mentorship model was associated with improved provider capacity and reduced diagnostic delays in Northwest Ethiopia. While the initiative demonstrated high fidelity and adaptability in conflict-affected settings, achieving timely treatment requires further investment in diagnostic infrastructure. These tools and protocols are well-positioned for national scale-up and integration into routine continuing medical education.

44. Life's Essential 8 in Pregnancy and Time to Incident Cardiometabolic Disease Over 7 Years Follow-Up.

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

摘要

Assessment of cardiovascular health (CVH) during pregnancy may unmask latent metabolic vulnerability and indicate long-term disease risk. However, the prognostic value of the American Heart Association’s Life’s Essential 8 (LE8) framework during pregnancy remains uncertain. To evaluate CVH during pregnancy using a modified LE8 (mLE8) score in association with time to incident cardiometabolic disease. This cohort study used electronic medical record (EMR) surveillance for 7 years post partum (August 2018 to March 2026) and included singleton pregnancies in individuals aged 18 to 44 years without preexisting diabetes or cardiovascular disease (CVD) from a large academic medical system in South Carolina. Data were analyzed from December 2024 to April 2026. A 7-component mLE8 score assessed during pregnancy, incorporating hypertensive disorders of pregnancy (HDP), 50 g glucose tolerance test results, early pregnancy body mass index, smoking status, sleep adequacy, diet quality, and physical activity. Scores ranged from 0 to 100, with higher scores indicating more favorable CVH. Postdelivery incident cardiometabolic conditions captured through EMRs and classified as chronic hypertensive conditions, chronic metabolic conditions (eg, dyslipidemia, impaired glucose regulation), and CVD (eg, cardiac arrest, cardiomyopathy). Adjusted accelerated time-to-failure models estimated mLE8 associations with incident conditions. Time to incident diagnosis was measured in days from delivery. Among 1225 pregnancies (mean [SD] age, 25.0 [5.3] years), 499 incident cardiometabolic events occurred over a median (IQR) follow-up of 6.2 (2.8) years. Each 10-point higher mLE8 score was associated with a longer time to incident diagnosis of chronic hypertensive conditions (time ratio [TR], 1.26; 95% CI, 1.11-1.42) and chronic metabolic conditions (TR, 1.20; 95% CI, 1.11-1.29). Healthier HDP (1.06 [1.03-1.10]), glucose (1.15 [1.10-1.21]), body mass index (1.07 [1.04-1.11]), and sleep (1.05 [1.00-1.09]) scores were associated with longer time to diagnosis of chronic metabolic conditions. Associations were generally similar after excluding individuals with gestational diabetes or HDP. In this cohort study of 1225 pregnancies, better CVH during pregnancy was associated with a longer time to incident postdelivery diagnosis of cardiometabolic conditions. Pregnancy-based CVH assessment may help identify individuals with elevated and emerging cardiometabolic risk who could benefit from early, targeted intervention and enhanced longitudinal surveillance.

45. Screening for Barrett's esophagus and esophageal adenocarcinoma: recent advances and next steps.

期刊: Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus 发表日期: 2026-May-12 链接: PubMed

摘要

The incidence of esophageal adenocarcinoma (EAC) has continued to increase, with a poor 5-year survival rate of ~20%. Barrett’s esophagus is the only recognized precursor to EAC, so public health strategies focus on identifying and screening high-risk populations. Currently, the standard screening method is sedated esophagogastroduodenoscopy. However, this approach has challenges, including its invasive nature, need for sedation, higher cost, procedure-related risks, sampling error, and poor suitability for population-wide screening. As a result, alternative screening techniques such as transnasal endoscopy and less invasive options including non-endoscopic cell collection devices with biomarker assays have been explored. In this review, we summarize current approaches for identifying at-risk populations and screening methods and provide insights into technologies that could complement screening strategies in the future.

46. Diagnostic performance of postoperative endoscopy versus water-soluble esophagram in detecting anastomotic leak after esophagectomy.

期刊: Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus 发表日期: 2026-May-12 链接: PubMed

摘要

Water-soluble esophagram and endoscopy are commonly used to detect anastomotic leak after esophagectomy. However, the comparative performance of these two modalities in detecting leaks has not been well established. We retrospectively reviewed all patients who underwent esophagectomy for cancer between January 2021 and December 2022 from a prospectively maintained database. Occurrence, management and consequences of leaks were examined. The primary outcome was to compare the diagnostic performance of esophagram and endoscopy in detecting anastomotic leak. Therefore, a total of 846 patients were identified. The overall incidence of anastomotic leak was 10.4%. Patients with leaks had older age and more retrosternal routes for reconstruction. Of them, 466 patients underwent endoscopy and 217 underwent esophagram. After matching, 434 patients, 217 per group were analyzed. The sensitivity and negative predictive value of endoscopy were 79.2% and 97.5%, whereas those of esophagram were only 37.9% and 91.3%, respectively (P = 0.003; P = 0.007). In the subset of patients with cervical anastomosis, endoscopy also demonstrated superior sensitivity (78.3% vs 36.0%, P = 0.004) and negative predictive value (97.4% vs 90.8%, P = 0.007). Esophagram showed false-negative results in 18 patients, while only 5 leaks were missed by initial endoscopy. Regarding the management of false negatives, esophagram group showed non-significant trends toward longer hospital stay and more interventions, including stenting (11.1% vs 0%) and clipping (5.6% vs 0%) (both P > 0.05). In conclusion, endoscopy showed higher sensitivity and negative predictive value than esophagram in detecting anastomotic leak after esophagectomy in this study. However, a large-scale, randomized study is warranted to validate these results.

47. Continuous multi-omics pathway enrichment analysis resolves hidden functional heterogeneity.

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

摘要

Pathway enrichment analysis is essential for extracting biological insights from complex omics datasets, yet existing methods suffer from critical limitations: excessive false discoveries, arbitrary significance thresholds, poor handling of multi-omics data, and inability to model gene dependencies. We present JOANA (Joint continuous multi-Omics enrichment ANAlysis), a novel Bayesian framework for pathway analysis with three key contributions. First, JOANA enables high specificity through continuous probabilistic modeling of significance scores using Beta mixture distributions, eliminating arbitrary thresholds while maintaining sensitivity. Second, JOANA’s multi-omics integration via Bayesian networks inherently accounts for missing values and reveals pathways invisible to single-layer analyses. Finally, we demonstrate high versatility across diverse experimental paradigms-from proteomics and transcriptomics to single-cell transcriptomics, mutation analysis, and transcriptomics-epigenomics data. In systematic comparisons on synthetic data as well as diverse real-world multi-modal datasets, JOANA achieves up to $\sim $20-fold reduction in reported pathways compared with existing methods while maintaining sensitivity for true biological signals. We implement JOANA in an open-source Python package, joanapy.

48. Simulating a potential mpox outbreak: Implications for control in non-endemic settings.

期刊: PLOS global public health 发表日期: 2026 链接: PubMed

摘要

We construct a model for mpox outbreaks in low and middle-income countries where the disease is non-endemic, using India as an example. We simulate potential outbreak scenarios using BharatSim, a flexible agent-based simulation framework. The spread of mpox is modelled as being driven primarily through sexual contacts within a subnetwork of men who have sex with men (MSM), embedded within a larger network representing their household and workplace contacts. Our model allows for disease spread through this expanded network, including the possibility of heterosexual transmission. We quantify the outbreak size, the dynamics of infection within and outside the MSM subnetwork, and the implications of vaccination and prophylactic measures for curtailing disease spread. These results should inform planning and policy measures for mpox control in generic LMIC settings.

49. Lived experience of depression in women living with Human Immunodeficiency Virus in Gondar City health facilities, Northwest, Ethiopia: A phenomenological study.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Many women living with HIV (WLHIV) in worldwide experience mental health conditions, particularly depression, which can negatively affect their overall wellbeing. Their lived experiences play a crucial WLHIV has been explored in various global context, there is limited research focusing on the specific women’s lived experience of depression in Ethiopia. Understanding these experience is essential to inform the development of culturally appropriate and targeted mental health interventions and support system. A qualitative phenomenological design was employed to explore women’s lived experience of depression in Ethiopia. Criterion-based sampling was used, and recruitment continued until data saturation was achieved. Data were collected through in-depth face to face interviews with 16 participants attending health facilities. An inductive approach was used for analysis, with code derived from the data using Ritchie and Spencer’s analytical framework. Subsequently, Interpretive Phenomenological Analysis was applied to identify key themes and subthemes. Data analysis was supported by MAXQDA (version 22) software. This study identified key themes on women’s lived experience of depression, including symptoms, meaning, perceived causes, perpetuating and relieving factors, treatment perceptions, coping strategies, and challenges. Depression affected emotional, physical and social well-being, and was shaped by factors such as HIV status, stigma, financial hardship, and lack of support. Women used diverse coping strategies, including spiritual practices, social support, and daily routines. Some preferred spiritual healing over professional care. Depression also negatively affected memory, motivation, self-care, and ART adherence, contributing to isolation, unemployment, and decline health. Depression among WLHIV shaped by intersecting social, economic, and health related challenge. Addressing this requires the Ministry of Health to implement integrated, culturally sensitive mental health interventions and strengthen mental health awareness, combining psychosocial support, spiritual care, and improved access to professional services.

50. Employment status, occupational profile, and common mental disorders among workers in urban informal settlements in Brazil.

期刊: PLOS global public health 发表日期: 2026 链接: PubMed

摘要

Urban informal settlements (referred to as favelas in Brazil), reflect longstanding socioeconomic and racial inequalities and are home to a workforce frequently exposed to precarious employment conditions. This study describes the socio-occupational characteristic and estimates the prevalence of common mental disorders (CMDs) among workers residing in five urban informal communities in Salvador, Bahia, Brazil. A cross-sectional epidemiological study (n = 587) was conducted with formal and informal workers aged 18-70 years. The outcome was measured using the Self-Reporting Questionnaire-SRQ-20, and associations were evaluated using Poisson Regression, with analysis stratified by employment type. Data analysis was performed using R 3.6.0 + software. The overall prevalence of CMD was 14.0%, increasing to 22.7% among informal workers. In the adjusted analysis of the overall sample, informal employment and persistent fear of job loss were associated with a higher prevalence of mental health problems, whereas the 40-49 age groups showed a lower prevalence of CMD compared with younger workers. In stratified analyses, female sex and job insecurity were associated with CMD among formal workers, while lower monthly income (<$181) was associated with CMD among informal workers. This pioneering study highlights the role of precarious employment conditions in the social determination of mental health distress among residents of urban informal communities.

51. The effect of khat consumption on work performance in small businesses in the city-center market, Hargeisa, Somaliland.

期刊: PeerJ 发表日期: 2026 链接: PubMed

摘要

Khat use is an increasing public health concern in Somaliland, linked to various mental, physical, social, and psychological problems. This study examined the effect of khat consumption on work performance among small business employees in the City-Center Market, Hargeisa, Somaliland. A quantitative cross-sectional design was employed, with purposive sampling of 150 male respondents. Data were collected through a structured Likert-scale questionnaire measuring khat consumption patterns and work performance. Reliability was confirmed using Cronbach’s alpha, and multiple linear regression analysis was applied to assess the predictive effect of khat consumption on work performance. Demographic and occupational variables (education level, marital status, employment type, type of khat commonly chewed, and age categories) were included as controls. Regression analysis showed khat consumption was significantly associated with work performance (B = 0.774, β = 0.879, t = 15.062, p < 0.001). Higher levels of khat use were associated with lower work performance, while other variables including education level (p = 0.281), marital status (p = 0.548), employment type (p = 0.902), type of khat (p = 0.700), and age (p = 0.429) showed no statistically significant effects. The study suggests that khat consumption may negatively influence employee productivity, while demographic and occupational factors appear to have limited influence. These findings highlight the importance of workplace awareness and policy measures aimed at reducing the potential adverse impact of khat use on work performance.

52. A Redescription and Characterization of the Transcriptome of the Sea Anemone Edwardsia elegans (Verrill).

期刊: The Biological bulletin 发表日期: 2025-Aug 链接: PubMed

摘要

AbstractEdwardsia elegans Verrill, 1869 is the most commonly encountered and discussed species of Edwardsia from North America. Although it is familiar and commonly cited in field guides, its anatomy, cnidom, life history, and molecular resources have been only partially described. We provide a full account of E. elegans, along with an annotated transcriptome, and differentiate it from other species of Edwardsia from the western North Atlantic. We also describe the juvenile morphology and natural history of E. elegans, based on in situ observations in Maine and ex situ observations of captive specimens maintained in an aquarium. Edwardsia elegans is distinguished from all other edwardsiids from North America in having 16 tentacles arrayed in two cycles of eight, nemathybomes forming distinct aggregations in the middle of each mesenterial compartment, and a bulbous physa. Adults burrow using their physa and tend to aggregate into clusters in the field and the lab. Analysis of the transcriptome reveals differences in content of genes related to cellular stress with a broadly studied edwardsiid species, Nematostella vectensis. This updated account and the availability of reference sequence data for E. elegans will be useful for future research with this species and comparative work across edwardsiid anemones and the Cnidaria.