公共卫生研究摘要 (2026-07-02)

共收录 60 篇研究文章

1. Maternal nutrition practices and behaviours in the context of a Cash-Plus intervention: a qualitative study in Rajasthan, India.

期刊: Global health action 发表日期: 2026-Dec 链接: PubMed

摘要

In low- and middle-income countries, breaking the intergenerational cycle of malnutrition requires the promotion of healthy nutrition practices and behaviours during pregnancy and early motherhood. This study aimed to explore nutrition practices and behaviours among pregnant women and mothers of children under 2 years who were exposed to the Cash-Plus intervention in tribal districts of Rajasthan, India. Data was collected in December 2024 through in-depth interviews with 46 women which included parity-2 pregnant women and mothers of young children (below 2 years of age), 36 husbands and 34 other family members; plus 7 focus group discussions with 23 frontline workers of four intervention districts. A framework analysis approach was used to identify emerging concepts around practices and behaviours. Participants were positive about the intervention, potentially reflecting the study design. They reported improved practices related to antenatal care, pregnancy weight monitoring and gain, dietary diversity, early and exclusive breastfeeding, and child feeding. These were influenced by the combined effect of consistent interpersonal counselling from trained frontline workers and conditional cash transfers. Counselling improved knowledge and motivation, while cash transfers enabled adoption of resource-dependent practices. Involvement of husbands and mothers-in-law supported the uptake and sustenance of practice and behaviours, alongside emerging peer and community influences. The Cash-Plus intervention supported improvements in maternal and child nutrition practices and behaviours through interacting behavioural, economic and social pathways. Findings highlight the importance of integrated, family-centred approaches that address knowledge and structural barriers, alongside ensuring inclusive intervention design in vulnerable settings. Main findings: Cash-Plus interventions influenced maternal and child nutrition behaviours through interacting pathways, including improved knowledge, financial enablement, intra-household support, and emerging normative change.Added knowledge: This study provides insight into how counselling and cash transfers operate through distinct but complementary mechanisms, with counselling initiating behaviour change and cash transfers enabling and reinforcing resource-dependent practices in vulnerable settings.Global health impact for policy and action: Findings support the design of integrated, family-centred Cash-Plus interventions that address both behavioural and structural barriers, while highlighting the need for inclusive and flexible delivery mechanisms to reach vulnerable populations.

2. The Additive Labor of Survival: A Scoping Review of Black Familial Strategization in Preparation for Police Interactions.

期刊: Family process 发表日期: 2026-Sep 链接: PubMed

摘要

Black American families are aware of the precarious nature of police interactions. Black people are disproportionately killed by the police at such levels that police violence is now categorized as a public health issue among the Black population. Black children and youth are not exempt from police violence and tend to be adultified or perceived as older than their biological age. In recognition of police violence, Black families engage in a context-specific socialization process, commonly referred to as “the Talk” to adequately prepare their children for potential police interactions. To explore this socialization process, we conducted a scoping review summarizing the existing literature to provide further insight into the content of this process, with a key focus on identifying the strategies that Black parents in the United States employ to insulate their children from harm. The review utilizes Arksey and O’Malley’s framework for scoping studies. We searched five databases using a literature-informed search strategy, which resulted in the identification of 7736 records, of which 20 articles met the inclusion criteria. Findings of this review show that strategies used by Black parents emerged in four types: regulatory, consciousness raising, system-engaged, and beyond our control. Parental strategies focused on behavioral regulation, racial consciousness education, engagement and collaboration with systems, and reliance on faith and other-worldly protection. Implications for policy and practice call for the acknowledgment of additive labor performed by Black families, and the necessary provision of support and services that address the harm caused by discriminatory policing.

3. Seasonal Restructuring of Microbial Communities and Resistomes in the Shitalakshya River, Bangladesh Revealed by Shotgun Metagenomics.

期刊: MicrobiologyOpen 发表日期: 2026-Aug 链接: PubMed

摘要

Urban rivers supplying drinking water face mounting pollution and AMR threats. We combined shotgun metagenomics with physicochemical analysis to investigate microbial community and resistome dynamics in Bangladesh’s Shitalakshya River, a drinking water source under increasing pollution pressure, during early and peak dry seasons. Peak dry season water quality deteriorated markedly, characterized by hypoxia and elevated nutrient and organic carbon levels, which drove pronounced restructuring of the river microbiome. A distinct shift occurred from Myroides dominance toward a more diverse assemblage enriched in pollution-tolerant and opportunistic genera, notably Comamonas, Brevundimonas, Tissierella, and Aeromonas. Metagenomic profiling revealed a diverse resistome encompassing antibiotic, metal, and biocide resistance genes. Although overall antibiotic resistance gene abundance declined slightly, metal resistance genes increased more than twofold, with strong enrichment of mercury resistance determinants such as merA. Concurrent increases in multidrug efflux pump genes suggested potential co-selection driven by metal and chemical stressors. These findings indicate that dry-season pollutant concentration reshapes both microbial communities and resistance profiles through non-antibiotic selective pressures. Despite limited sampling, this study provides a baseline metagenomic snapshot of antimicrobial resistance dynamics in a climate-stressed urban river system, offering vital insights for pollution abatement and the safeguarding of drinking water safety.

4. Spatiotemporal Associations Between Cortical Microinfarcts and Cortical Superficial Siderosis in Cerebral Amyloid Angiopathy.

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

摘要

Cerebral amyloid angiopathy (CAA) is a small vessel disease characterized by hemorrhagic and nonhemorrhagic brain injuries. While cortical cerebral microinfarcts (CMI) have been associated with cortical superficial siderosis (cSS), the mechanisms linking these lesions remain unknown. This study aims to determine the spatiotemporal relationship between cortical CMI and cSS in CAA, with the hypothesis that cSS can promote local ischemic injury. Patients with probable CAA (Boston Criteria v2.0) without previous symptomatic intracerebral hemorrhage or CAA-related inflammation were recruited from a prospective memory clinic-based cohort at Massachusetts General Hospital. CAA-related radiologic manifestations-including cortical CMI and cSS-were quantified at baseline and at the 24-month follow-up on 3-Tesla MRI. Multivariable logistic regression and generalized linear models were applied to assess associations between baseline radiologic features and radiologic progression. We also compared the local density of cortical CMIs in regions with and without overlaid cSS. Among 74 patients with probable CAA (age: 73.0 [67.9-78.2] years; 38% female), 26 (35%) had cortical CMIs (n = 135, 39% underlying cSS). Compared with CMI-negative CAA, those with CMI had a higher cSS prevalence (73% vs 40%; p = 0.006), cSS volume (1.3 [0.1-8.3] vs 0 [0-0.5] mL; p < 0.001), and lobar lacunes count (50% vs 19%; p = 0.005). At baseline, cortical CMI count demonstrated a nonlinear association with cSS volume (Exp(B) = 1.12 [95% CI 1.07-1.18]; p < 0.001) and with lobar lacunes count (Exp(B) = 1.65 [95% CI 1.52-1.80]; p < 0.001). The CMI density was markedly higher in cSS-covered vs non-cSS regions (median: 20.84 [0.00-56.95] vs 0.49 [0.11-0.89]n° cortical CMI/1,000 cm2; p = 0.010). Follow-up scans (n = 36) revealed 23 incident cortical CMIs (43% underlying cSS). Baseline cSS volume was independently associated with incident CMI (OR:1.41 [95% CI 1.02-1.95]; p = 0.036), whereas baseline CMI burden was not associated with cSS progression. Our findings demonstrate a close interplay between cortical CMI and cSS, with the spatiotemporal relationship supporting the hypothesis that convexity subarachnoid hemorrhage, and potentially resultant cSS, may trigger local ischemic injury. Given the sample size of the longitudinal cohort, we consider these data hypothesis-generating. Further studies should confirm this association and identify the driving pathophysiology, which may represent a new therapeutic target for preventing cSS-associated cortical injury.

5. Cerebral Artery Pulsatility, Premorbid Blood Pressure, and Small Vessel Disease on Brain Imaging: A Population-Based Study.

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

摘要

Increased pulsatility of cerebral blood flow is proposed as a potential cause of cerebral small vessel disease (SVD), but the apparent association could be confounded by shared vascular risk factors, especially current and past blood pressure (BP). Most previous studies were small, usually in selected populations, and most did not adjust fully for confounders, particularly heart rate, pulse pressure, and premorbid BP. Therefore, we aimed to determine if cerebral pulsatility is independently associated with SVD on brain imaging. Patients with TIA or minor ischemic stroke (NIH Stroke Scale ≤3) ascertained from 2011 to 2018 in a prospective population-based cohort study in Oxfordshire, the United Kingdom, were included. Cerebral pulsatility was measured with pulsatility index at the middle cerebral artery (MCA-PI) by transcranial Doppler ultrasound, and the burden of SVD was assessed using standard rating scales on MRI. We determined the associations of MCA-PI and SVD (total SVD score) adjusting for age, sex, vascular risk factors, heart rate, baseline BP (systolic, diastolic, and pulse pressure), and multiple premorbid BP readings up to 20 years before the event. We also performed mediation analysis to assess the contribution of MCA-PI on the causal pathway between BP and SVD. Among 1,035 consecutive patients with measurements of both MCA-PI and SVD burden on MRI (mean age 66 years; 52.1% men), higher MCA-PI was associated with the total SVD score on MRI (top vs bottom quartile odds ratio [OR] 9.00, 95% CI 6.32-12.84). The association was attenuated after adjustment, but it remained significant (fully adjusted for systolic and diastolic BP OR 2.67, 1.55-4.60; for PP OR 1.88, 1.12-3.14). The results were consistent for individual markers of SVD (p-het = 0.77). In mediation analysis, 25.0% of the total association between premorbid systolic BP and SVD severity was due to MCA-PI. In this cross-sectional analysis, cerebral pulsatility was positively associated with the increasing burden of cerebral SVD on brain MRI independent of age, sex, vascular risk factors, heart rate, baseline and premorbid BP in patients with TIA or minor ischemic stroke, and also explained a significant proportion of the association between BP and cerebral SVD on brain MRI. Prospective cohort studies and clinical trials targeting cerebral pulsatility are underway, which will help to further establish the role of cerebral pulsatility in SVD.

6. Familial Aggregation of Parkinson Disease and Essential Tremor in Early and Late Onset Parkinson Disease Cohorts.

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

摘要

Early-onset Parkinson disease (EOPD) is associated with stronger genetic contributions than late-onset Parkinson disease (LOPD). However, the complex interplay between genetic susceptibility, family history, and environmental factors remains incompletely understood. This study assesses familial aggregation of PD and essential tremor (ET) among relatives of patients with EOPD and compares it with patients with LOPD. Patients with EOPD evaluated at the Mayo Clinic were identified, whereas patients with LOPD were identified through the Rochester Epidemiology Project record-linkage system. All cases with symptom onset between 1991 and 2020 were included. A total of 732 cases with EOPD and 469 with LOPD were included. EOPD patients were significantly more likely to have a positive family history of PD in parents (proportion ratio [PR] = 1.67, p = 0.049), second-degree relatives (PR = 2.54, p < 0.001), and all family members (PR = 1.63, p < 0.001). Similarly, they had higher frequency of family history of ET (PR = 1.47, p = 0.029). By contrast, patients with EOPD were less likely to have siblings with PD (PR = 0.38, p = 0.009). The higher prevalence of PD and ET family history in the EOPD cohort supports a stronger genetic contribution and may reflect enrichment for high-penetrance monoallelic variants. Conversely, the higher frequency of affected siblings in the LOPD cohort suggests a polygenic inheritance pattern with greater environmental contribution.

7. Working With Risk: Improving Collection of Industry and Occupation Data During Public Health Surveillance Case Follow-Up in Wisconsin.

期刊: Journal of public health management and practice : JPHMP 发表日期: 2026-Jul-03 链接: PubMed

摘要

Surveillance of occupational health conditions has historically lagged behind other types of public health surveillance. Improving the capture of industry and occupation variables in surveillance case follow-up interviews is one avenue for improving occupational health surveillance. Five approaches were implemented to maintain and improve capture of industry and occupation data during case follow-up in Wisconsin. This project involved efforts at the state, local, and Tribal health department level. Counts and completion percentages were assessed for working-age case-patients with reportable conditions in Wisconsin from 2022 through 2024. The completion of industry and occupation fields increased across the 3 years under study, particularly in those conditions with lower initial completion. This project was successful in improving the capture of industry and occupation data for potentially work-related infectious diseases and, generally, for occupational surveillance in the state of Wisconsin.

8. Association Between Cigarette Smoking and Sleep Outcomes Among Long-Haul Truck Drivers: A Secondary Data Analysis.

期刊: Journal of occupational and environmental medicine 发表日期: 2026-Jul-02 链接: PubMed

摘要

To describe smoking prevalence among long-haul truck drivers (LHTDs) and assess differences in sleep quality, quantity, and propensity between smokers and non-smokers. Sleep quality was measured using the Pittsburgh Sleep Quality Index, and sleep propensity using the Epworth Sleepiness Scale. Data were analyzed in RStudio using descriptive statistics, Shapiro-Wilk, Levene’s Test, Mann-Whitney U Tests, and Cohen’s D. Among 96 LHTDs surveyed, 63 were non-smokers, and 33 were smokers. Smokers reported significantly higher daytime sleepiness scores (p =.038, d = 0.2), while differences in sleep quality and sleep propensity duration were not statistically significant. Individuals who smoke experienced poorer sleep quality and greater daytime sleepiness. These findings underscore the need for larger studies and targeted interventions to address smoking-related sleep issues in LHTDs.

9. Work Exposome estimation through Job Exposure Matrices - JEMs?

期刊: Journal of occupational and environmental medicine 发表日期: 2026-Jul-02 链接: PubMed

摘要

10. Using Ripple Effects Mapping to translate an innovative service model for children with disabilities in Lusaka, Zambia.

期刊: Public health 发表日期: 2026-Jul-01 链接: PubMed

摘要

Describe the use and output from Ripple Effects Mapping, a participatory process to evaluate the impact of a program to decrease stigma toward children with disabilities (CWD) living with families in low-income compounds in Zambia. Participatory, group-based process that occurs at one time with retrospective reflection. In Dec. 2024, health facility staff, community partner staff, community outreach workers, women with CWD, and a pastor participated in Ripple Effects Mapping in Lusaka, Zambia. Participants interviewed each other using four open-ended questions, such as “Share a story or highlight a success that you had based on your involvement with Kusamala+. What did this lead to? How did it happen?” Real-time mind mapping was done while participants shared their interviews and additional written notes were added. Inductive analysis created preliminary themes that were validated by the participants. Using the Social Model of Disability and deductive analysis, the mind-maps were quantified across domains. Briefly, 50% of the participant responses indicated improved access to education, 30% of the responses were related to decreased social isolation, 48% of responses indicated more services were available, and 19% indicated that there were improved policies and practices at the institutional level. The Ripple Effects Mind Map and the application to the Social Model of Disability revealed strong positive impacts due to Kusamala+. Kusamala + had substantial positive impacts in the community and for families. Ripple Effects Mapping is an effective and adaptable tool to evaluate program impacts.

11. Phenotyping population-level chronic condition prevalence: The importance of forcing factors from the ecological framework.

期刊: Public health 发表日期: 2026-Jul-01 链接: PubMed

摘要

The primary health challenges currently facing the United States (U.S.) and many other countries around the world are largely due to patients with chronic conditions, which act either independently or synergistically. The current study assesses the ability of the Ecological Framework of Population Health to predict U.S. county-level prevalences of eight common chronic conditions. Analytic analysis of population-level surveillance data METHODS: This study utilizes several U.S. county-level datasets representing over 30 predictive variables of the ecological framework, a model that includes measures of culture, politics, policy, socioeconomics, lifestyle behaviors, and both chronic condition risk factors and diagnoses. A non-linear artificial intelligence statistical approach was used to assess the ability of these variables (i.e., features) to predict the prevalence of eight leading chronic conditions at the U.S. county-level. Artificial intelligence models demonstrated good to excellent performances in the independent test set (0.73 < R2 < 0.96) in predicting U.S. county-level prevalence of chronic conditions. Findings indicate that upstream domains (culture, politics, policy and environment) explain substantial variance in the prevalence of chronic conditions before downstream domains (behavior and risk) are introduced. Despite a significant amount of attention given to the health challenges associated with chronic conditions, little progress has been made in reversing trends. The findings presented here propose a new approach to this complex issue that focuses on the forcing factors that lie upstream from health behaviors to improve downstream health outcomes.

12. Multifactorial predictive model for nurses' intention to correct online health misinformation: A machine-learning and SHAP analysis.

期刊: Public health 发表日期: 2026-Jul-01 链接: PubMed

摘要

To develop and interpret a predictive model that detects key factors associated with nurses’ intention to rectify online health misinformation, and to offer an evidence foundation for targeted interventions that strengthen frontline responses to misinformation. A nationwide cross-sectional survey that incorporated machine-learning modelling and explainable artificial intelligence. Convenience sampling was used to conduct this cross-sectional online survey among registered nurses employed in Chinese healthcare facilities between May and June 2025. A dichotomous item was used to measure the intention to rectify online health misinformation. Thirty-nine predictors were collected, including sociodemographic traits, psychological constructs, health information attitudes, eHealth literacy, and work environment factors. Stratified data splitting, the Synthetic Minority Over-sampling Technique, and grid-search-based hyperparameter tuning were used to train seven machine-learning algorithms (i.e., logistic regression, random forest, AdaBoost, CatBoost, ExtraTrees, XGBoost, and LightGBM). Accuracy, recall, precision, F1 score, and the area under the receiver operating characteristic curve (AUC) were used to assess the model’s discrimination ability. The best-performing model was interpreted with SHapley Additive exPlanations (SHAP). Structural equation modelling (SEM) was subsequently conducted to test theoretically hypothesized relationships among the key predictors identified by SHAP, providing theory-driven validation of the findings. Data analyses from 1120 nurses suggested that 80.2% of them intended to actively rectify online health misinformation. On the test set, the ExtraTrees model performed the best (AUC = 0.919; accuracy = 0.827). The model demonstrated a balance between sensitivity (recall = 0.827) and precision (0.791), indicating reasonable performance despite class imbalance. SHAP analysis identified perception of information-related harm, working in general wards, education level, perceived information trustworthiness, years of clinical experience, and eHealth literacy skills as the most influential predictors. These variables clustered into three overarching domains, namely risk perception, professional competence, and clinical practice context. Higher values of these features were consistently associated with positive SHAP values, indicating an increased likelihood of correction intention. Notably, perception of information harm exhibited a clear monotonic positive relationship with the outcome. Visual inspection of SHAP dependence plots suggested that interaction effects among key predictors were limited, with most variables demonstrating consistent monotonic relationships with the outcome. Structural equation modelling further supported these findings, showing that capability factors (eHealth literacy) exerted a strong positive effect on psychological factors (risk perception and information attitudes) (β = 0.761, p < 0.001), a direct effect on intention (β = 0.336, p < 0.001), and an indirect effect mediated by psychological factors (β = 0.124, 95% CI [0.065, 0.188]), accounting for 27.0% of the total effect. The model explained 22.4% of the variance in intention (R2 = 0.224) with acceptable fit (SRMR = 0.056). This study provides novel machine-learning-based and explainable evidence on the determinants of nurses’ intention to correct online health misinformation, offering a comprehensive framework that integrates predictive modelling and theory-driven analysis. The ability of nurses to recognise harm caused by misinformation, critically appraise data, and mobilise digital health competencies within supportive practice settings influences their intention to rectify online health information. Enhancing eHealth literacy and risk communication skills may increase frontline capacity to reduce the negative effects of misinformation on public health, particularly in high-interaction ward settings.

13. Baicalein mitigates anti-tuberculosis-induced liver injury via inhibition of lipid peroxidation mediated by ferritinophagy and ferroptosis: Involvement of Yap 1/NCOA4 signaling.

期刊: Biochimica et biophysica acta. Molecular basis of disease 发表日期: 2026-Jul-01 链接: PubMed

摘要

Anti-tuberculosis drug-induced liver injury (ATB-DILI) is a leading cause of impaired anti-TB treatment efficacy in patients with tuberculosis. Baicalein (Bai), a dietary flavonoid from the root of Scutellaria baicalensis, exhibits diverse therapeutic effects across a broad spectrum of diseases. This study aimed to investigate the protective effects of Bai against ATB-DILI and to elucidate the role of ferritinophagy, using an integrated approach combining network pharmacology, animal models, and cellular assays. Bai treatment ameliorated ATB-DILI and hepatocyte injury in vivo and in vitro, respectively. Reactive oxygen species production, lipid accumulation, and cellular ferroptosis caused by anti-TB drugs were ameliorated following Bai treatment both in vivo and in vitro. Furthermore, Bai treatment alleviated excessive ferritinophagy induced by anti-TB drugs by modulating the nuclear receptor coactivator 4 (NCOA4)/ferritin heavy chain 1 (FTH1) signaling pathway. Notably, knockdown of YES-associated protein 1 (YAP1) abrogated the protective effects of Bai treatment, preventing it from alleviating the anti-TB drug-induced increase in NCOA4 expression, decrease in FTH1 expression, iron overload, and subsequent ferroptosis and lipid peroxidation in rat liver and hepatocytes. This study suggested that Bai treatment attenuates anti-TB drug-induced hepatocyte injury via inhibition of ferritinophagy activation-induced ferroptosis, which is regulated through the YAP1/NCOA4/FTH1 signaling pathway. These findings establish a novel therapeutic target for Bai in the treatment of ATB-DILI and provide a rational basis for its clinical application.

14. Simultaneous determination of 22 carbamate pesticides and their metabolites in biological samples using ultrasound-assisted dispersive liquid-liquid microextraction combined with LC-MS/MS: application to forensic cases.

期刊: Analytical methods : advancing methods and applications 发表日期: 2026-Jul-01 链接: PubMed

摘要

Carbamate pesticides are extensively employed in agricultural and public health, but their toxicity results from the inhibition of acetylcholinesterase, which can lead to poisoning in both humans and animals. In this study, a simple and rapid ultrasound-assisted dispersive liquid-liquid microextraction (UA-DLLME) method coupled with liquid chromatography-tandem mass spectrometry (LC-MS/MS) was developed and validated for the simultaneous determination of 22 carbamate pesticides and their metabolites in biological samples. The method exhibited excellent sensitivity, with limits of quantification (LOQ) determined to be 1.00 ng mL-1, and showed good linearity (R2 > 0.99) over the concentration range of 1.00-1000.00 ng mL-1. Precision and accuracy met international bioanalytical guidelines, as indicated by intra- and inter-day relative standard deviation (RSD) below 15% and recoveries within acceptable limits. The method was successfully applied to authentic forensic cases involving human and animal poisonings, confirming its suitability for determining carbamate pesticides and their metabolites in complex matrices such as blood, liver, and urine. This robust and efficient analytical approach is well suited for applications in forensic investigations and clinical toxicology.

15. Identifiable Copula-Double-Cox Models: A Fully Parametric Framework for Dependent Right-Censored Survival Data.

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

摘要

Dependent censoring, common in medical studies with informative dropout, invalidates standard Cox regression by violating the independent censoring assumption. While copula-based methods offer flexible dependence modeling, their parametric extensions face identifiability barriers. We address this problem through a novel fully identifiable parametric model that synergizes double-Cox marginal structures with copula dependence, which is called the copula-double-Cox model. Using Weibull or generalized exponential (GenExp) distributions, the double-Cox model links both scale and shape parameters to covariates via Cox-type regressions. This structure accommodates non-proportional hazards while containing the standard Cox model as a special case. We establish identifiability under dependent censoring and derive consistent estimators for baseline parameters, regression coefficients, and copula association. Simulations confirm robustness to association structure misspecification and over-parameterization. Estimation accuracy is supported by asymptotic theory and standard error evaluation via the observed information matrix. Finally, we illustrate the proposed approach through a real-world application to a dataset on monoclonal gammopathy of undetermined significance (MGUS), highlighting its practical relevance. The results show that our method provides an interpretable characterization of covariate effects on both failure time and censoring time through its double-Cox structure. An open-source R implementation of the copula-double-Cox model is provided on GitHub.

16. Efficacy of Low-Dose Naltrexone in Women With Fibromyalgia Syndrome: A 12-Month Randomised, Double-Blind, Placebo-Controlled Single-Centre Clinical Trial (INNOVA Study).

期刊: European journal of pain (London, England) 发表日期: 2026-Jul 链接: PubMed

摘要

Low-dose naltrexone (LDN) has been used off-label for fibromyalgia syndrome (FMS) for over a decade, supported by small crossover trials. The INNOVA study evaluated the safety and efficacy of LDN 4.5 mg versus placebo on pain intensity over 12 months in women with FMS. In total, 98 women with FMS were randomised to LDN 4.5 mg/day (n = 48) or placebo (n = 50). The primary outcome was change in pain intensity (NRS 0-10) from baseline to 3 months in the intention-to-treat population. Secondary outcomes included functional impairment (FIQR), anxiety-depressive symptoms (DASS-21), cognitive impairment (MISCI), disability (WHODAS 2.0), pathological worry (GAD-7) and impression of change (PGIC/PSIC), assessed at baseline and at 3, 6 and 12 months. Perceived treatment allocation and safety were also assessed. At 3 months, mean change in pain intensity was -0.33 points with LDN and -0.64 with placebo, with an adjusted between-group difference of 0.49 (p = 0.236, d = 0.19). Secondary outcomes showed minor and inconsistent changes, with low and similar responder rates (p = 0.219-0.954). Exploratory analyses suggested some improvement among participants who believed they had received LDN, although effects were inconsistent. Adverse events, predominantly mild and transient, were reported by 33 (68.8%) participants in LDN and 36 (72%) in placebo, and no treatment-related serious events occurred. LDN was well tolerated but did not demonstrate a clinically meaningful benefit over placebo for pain-related outcomes, underscoring the need for more effective pharmacological treatments. This RCT provides the first long-term evidence on the efficacy and safety of LDN in FMS. LDN (4.5 mg), administered as an add-on treatment, has a favourable safety profile, but the findings indicate that it does not produce clinically meaningful improvements in FMS symptoms compared to placebo at short- or long-term follow-up. These findings contribute to the growing body of evidence questioning its clinical utility.

17. Real-World Outcomes and Prognostic Factors of Immune Checkpoint Inhibitor Rechallenge for Metastatic Renal Cell Carcinoma: A Multicenter Study.

期刊: International journal of urology : official journal of the Japanese Urological Association 发表日期: 2026-Jul 链接: PubMed

摘要

Combination therapies incorporating immune checkpoint inhibitors (ICIs) are widely used as first-line treatment for metastatic renal cell carcinoma (mRCC). However, the optimal sequence of subsequent therapies remains unclear. In this study, we investigated the real-world outcomes of nivolumab rechallenge after first-line ICI-based combination therapy. Twenty-eight consecutive patients with mRCC who received nivolumab monotherapy as third- or later-line treatment after first-line ICI-based combination therapy were identified from a multicenter database. The best overall response (BOR), progression-free survival (PFS), overall survival (OS), immune-related adverse events (irAEs), and prognostic factors associated with PFS were retrospectively analyzed. The median age was 68 years. Twenty-two patients (78.6%) had clear cell RCC. Nivolumab was administered as third-, fourth-, and fifth-line therapy in 19 (67.9%), 7 (25.0%), and 2 (7.1%) patients, respectively. The median follow-up period was 6.4 months. The BORs were complete response, partial response, stable disease, and progressive disease in 0, 2 (7.1%), 7 (25.0%), and 19 (67.9%) patients, respectively. The median PFS and OS were 2.2 and 8.8 months, respectively. irAEs occurred in 7 patients (25.0%), including 5 patients (17.9%) with grade 3 irAEs. No grade 4 or higher events were observed. In multivariable analysis, good performance status and a shorter duration of first-line ICI-based combination therapy were associated with improved PFS. Nivolumab rechallenge demonstrated modest efficacy in patients with mRCC after first-line ICI-based combination therapy, although a limited subset of patients may derive clinical benefit from this approach. irAEs during nivolumab rechallenge were generally manageable.

18. Outcomes of Gemcitabine, Oxaliplatin, and Paclitaxel Salvage Chemotherapy in Japanese Patients With Relapsed or Refractory Germ Cell Tumors.

期刊: International journal of urology : official journal of the Japanese Urological Association 发表日期: 2026-Jul 链接: PubMed

摘要

Gemcitabine, oxaliplatin, and paclitaxel (GOP) therapy has shown antitumor activity as a conventional-dose salvage regimen for relapsed or refractory germ cell tumors (GCTs) in European studies; however, data on Japanese patients remain limited. Therefore, we aimed to evaluate the real-world efficacy and safety of GOP therapy in a multicenter Japanese cohort and explore outcomes according to platinum sensitivity. This retrospective multicenter study included 25 patients with relapsed or refractory GCTs treated with GOP between January 2012 and May 2025 at two institutions in Japan. Treatment response was assessed using the Response Evaluation Criteria in Solid Tumors version 1.1, along with tumor marker evaluations. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Of the 25 patients, 15 (60%) and 10 (40%) had platinum-refractory disease and platinum-non-refractory disease, respectively. The median follow-up was 14.4 months. The overall response rate was 56%, with a complete response rate of 28%. The median PFS and OS were 6.9 and 23.1 months, respectively. The estimated 2-year OS and PFS rates were 48.7% and 36.0%, respectively. Survival outcomes were comparable between patients with platinum-non-refractory and platinum-refractory diseases. Overall, 40% of patients survived for more than 2 years after initiation of GOP therapy. Grades 3-4 hematologic toxicities were common but manageable, with no unexpected safety signals. GOP therapy demonstrated clinically meaningful activity and acceptable tolerability in Japanese patients with relapsed or refractory GCTs, supporting GOP as a practical, conventional-dose salvage option for platinum-refractory diseases.

19. Retinal dystrophies simulating geographic atrophy: A diagnostic challenge.

期刊: Acta ophthalmologica 发表日期: 2026-Jul-01 链接: PubMed

摘要

Geographic atrophy (GA) is the chronic loss of retinal pigment epithelium, photoreceptors and choriocapillaris, marking the dry late stage of age-related macular degeneration (AMD). GA prevalence is expected to rise in the upcoming decades. Advanced GA leads to central scotomas, reducing visual acuity and quality of life, potentially resulting in profound central vision loss. GA shares features with various retinal diseases and can therefore be complicated to distinguish from mimicking diseases. While no cure exists for GA, therapies like pegcetacoplan and avacincaptad aim to slow atrophy growth, making an accurate diagnosis essential for effective treatment. Misdiagnosis can lead to inappropriate treatment recommendations, impacting patient health and financial burden. This paper outlines the similarities and differences among prevalent diseases such as late-onset Stargardt disease, PRPH2-associated disease and maternally inherited diabetes and deafness (MIDD), resembling GA to aid in accurate diagnosis.

20. Moving From Individualized Risk-Based Prevention to Benefit-Based Prevention: Estimating Individualized Life-Years Gained From Prevention Services as a Basis for Eligibility.

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

摘要

The current bedrock of precision prevention is selecting high-risk individuals for screening or other prevention services under the assumption that those at highest risk would have the highest benefit from prevention services. However, this may not hold when disease risk and competing mortality are highly correlated. In such cases, risk-based prevention may preferentially select older individuals with multiple comorbidities who would have substantially reduced life-years gainable from the service and increased risks of harm from any resulting surgical procedures. For such prevention services, we propose a benefit-based selection strategy in which individuals are selected according to their expected gain in life-years (i.e., difference in mean survival time with and without the prevention service). We estimate the expected gain in life-years for individuals in a target screening population by combining data from a randomized trial, which may not be population-representative, and data from a population-representative survey that has larger sample size, more covariates, and longer follow-up time to evaluate mortality than the trial. We derive the Taylor-linearized variances for the estimated expected gain in life-years that take into account the randomness due to both trial and survey sample. We show that benefit-based selection of ever-smokers for lung-cancer screening can identify individuals with more favorable benefit-harm trade-offs compared to risk-based selection. Using simulation studies, we examine the conditions in which one strategy may be preferable over the other.

21. "It Depends on the Situation": Variability in How Surgical Oncologists Elicit and Integrate Patient Values.

期刊: Journal of surgical oncology 发表日期: 2026-Jul-01 链接: PubMed

摘要

Understanding what matters most to patients is central to person-centered care, particularly in surgical oncology, where decisions often involve significant tradeoffs. We explored how surgeons elicit, integrate, document, and support patient values in cancer-related decision-making. This qualitative descriptive study involved semi-structured interviews with surgical oncologists (June-September 2025). Participants were purposively sampled from a prior international survey to ensure variation in demographics. Interviews were recorded, transcribed, and analyzed using thematic analysis. Participant characteristics were summarized descriptively. Fourteen surgeons participated. Most were male (71%), White (86%), and early-career (43%), practicing primarily in gastrointestinal or hepatobiliary surgery (each 43%) at academic centers (57%) in the U.S. South or Midwest (each 36%). Surgeons described various approaches to eliciting values, including inferring values from contextual clues and clarifying tradeoffs between survival and quality-of-life. Values elicitation was largely situational, occurring in high-risk or preference-sensitive contexts. When values conflicted with recommendations, surgeons adapted plans within oncologic safety. Documentation varied and was shaped by relevance, medicolegal concerns, and workflow. Barriers included time limitations, emotional distress, family dynamics, and limited training. Values elicitation was inconsistent and situational rather than routine. More structured, earlier approaches and system-level support may better align surgical decisions with patient values.

22. Trihalomethane Exposure in Relation to Depressive Symptoms in Postmenopausal Women and underlying Mechanisms from an Organ-on-a-Chip Model.

期刊: Environmental science & technology 发表日期: 2026-Jul-01 链接: PubMed

摘要

Trihalomethanes (THMs) are suspected neurotoxicants, yet their relationships with depression remain unclear. This study examined the associations between blood THM concentrations and depressive symptoms, assessed by the Patient Health Questionnaire-9 (PHQ-9), in 2,130 postmenopausal U.S. women. Blood concentrations of bromodichloromethane (BDCM), dibromochloromethane (DBCM), and brominated trihalomethanes (Br-THMs) showed positive dose-response associations with depressive symptoms (PHQ-9 ≥ 5; all P for trend <0.05). Compared with the lowest exposure category, participants in the highest category of BDCM (T3), DBCM (≥75th percentile), and Br-THMs (Q4) had increased odds ratios (ORs) for depressive symptoms of 1.38 (95% confidence interval: 1.04-1.82), 1.62 (1.25-2.09), and 1.46 (1.02-2.09), respectively. Further mechanistic experiments in a human neuroimmune organ-on-a-chip model (SH-SY5Y cells cocultured with THP-1 cells) showed that environmentally relevant exposure (0.001 mM BDCM and 0.0005 mM DBCM) increased interleukin-1 beta (IL-1β) levels and reduced 5-hydroxytryptamine (5-HT) levels. Low-dose BDCM exposure (0.001 mM) also induced neuronal cytoskeletal changes in SH-SY5Y cells, as reflected by changes in mean fluorescence intensity and skeletonized area. Together, our findings suggest that exposure to Br-THMs may be associated with depressive symptoms in postmenopausal women, potentially via IL-1β-mediated neuroinflammation and neurotransmitter imbalance.

23. A First Look at Shifts in Community-Entry Home Health Following Medicare Payment Reform.

期刊: Journal of the American Medical Directors Association 发表日期: 2026-Jul-01 链接: PubMed

摘要

Medicare-funded home health (HH) provides short-term nursing, physical therapy, and other services to over 3.5 million older adults each year. Currently, half of HH episodes are “community-entry,” meaning the patient was referred without an immediately preceding hospitalization. The 2020 implementation of a new payment system-the Patient-Driven Groupings Model (PDGM)-reduced traditional Medicare reimbursement for community-entry HH (CEHH). We investigated shifts in CEHH care delivery following PDGM implementation. Cross-sectional study of national 2019 and 2021 linked HH claims, assessment, HH agency, and geographic data. Traditional Medicare beneficiaries receiving a CEHH episode in 2019 or 2021 (n = 577,602). HH is provided through clinician visits to the patient’s home; therefore, visits are the primary unit of care delivery. We modeled the number of visits overall and by service type (eg, nursing, physical therapy) using national data for CEHH patients pre-PDGM (ie, 2019) and post-PDGM (ie, 2021). Models adjust for relevant patient, HH agency, and geographic characteristics (including monthly county-level COVID-19 infection rates). Following PDGM, there was an 18% decrease in total visits received, with the largest decreases in the number of physical therapy (-13%), occupational therapy (-17%), and aide (-16%) visits. Reductions in visits were greatest at HH agencies with lower Medicare Advantage penetration (and thus, greater exposure to PDGM) and for-profit agencies. Findings raise questions about HH agencies’ ongoing ability to meet the needs of patients with complex, overlapping clinical and social needs following PDGM implementation. Ongoing monitoring of how these care delivery changes impact outcomes for CEHH patients is essential to ensure that HH can continue to help high-need older adults safely age in place.

24. Understanding patients' experiences and needs around decision-making for bulbar symptom management at a multidisciplinary ALS clinic.

期刊: Disability and rehabilitation 发表日期: 2026-Jul-01 链接: PubMed

摘要

This study explored the decision-making experiences of people living with amyotrophic lateral sclerosis (ALS) for managing bulbar symptoms and their perceived needs for decision-making support from healthcare professionals. An interpretive, descriptive qualitative study was conducted. We recruited adult patients with ALS with and without any bulbar symptoms from a multidisciplinary ALS clinic in Central Canada. Patients were interviewed using a semi-structured guide. Reflexive thematic analysis was used to analyze study data. Recruitment ceased when information power was reached. Twelve participants were interviewed. Three themes were identified for patient’s decision-making experiences and needs: (1) Disease uncertainty hinders decision-making; (2) Quality information triggers decision-making; and (3) Personal values and beliefs inform decision-making. To reduce psychological consequences of disease uncertainty and complexity on bulbar-related decision-making, patients emphasized the need for specific and contextualized information and healthcare professional supports aligned with their decision-making styles and approaches, highlighting the importance of a person- and family-centred approach to ALS care. Patients with amyotrophic lateral sclerosis (ALS) experience uncertainty with bulbar disease progression and interventions, which hinders both conversations and decisions about intervention.Patients want healthcare professionals to provide information about how intervention options and intervention timing were tailored to their individual situations.Patients also want healthcare professionals to adapt their communication and guidance to patients’ decision-making styles and approaches.Attention to patient’s broader social context is needed for decision-making to support person- and family-centred ALS care.Findings highlight the need for more healthcare professional education and research to improve decision-making support in a multidisciplinary ALS clinic setting.

25. Cancer Survival for Selected Cancers in Türkiye (2008-2017): A Population-Based Study.

期刊: International journal of cancer 发表日期: 2026-Jul-01 链接: PubMed

摘要

This study estimates population-based cancer survival for selected cancers in Türkiye over a 10-year period and investigates differences across provinces. We utilised data for patients diagnosed with five most common cancers (lung, breast, colorectum, prostate and thyroid) from eight population-based cancer registries (PBCRs) in Türkiye (Antalya, Bursa, Edirne, Erzurum, Eskisehir, Izmir, Samsun and Trabzon) in 2008-2012 and 2013-2017. We estimated 5-year age-standardised relative survival (ASRS) by age, sex and extent of disease. Five-year ASRS for the leading cancers in Türkiye increased by 1.4 to 4.6 percentage points between subsequent 5-year periods, in particular for breast, prostate and colorectal cancers. Thyroid cancer consistently showed the highest 5-year ASRS, exceeding 89%, while lung cancer had the lowest 5-year ASRS, with Edirne reporting the lowest survival at approximately 10% in both periods. Improvement in 5-year ASRS was greatest in the older age group (≥ 65 years) except for lung cancer (0.6 percentage point increase in ≥ 65 years vs. 3.2 percentage points for < 65 years). Antalya and Trabzon showed the greatest 5-year ASRS and the largest survival gains over time across most cancers, while survival improvements in Erzurum were limited. In 2013-2017, 5-year ASRS for localised cancers were > 95% for breast cancer in 7 out of 8 PBCRs, and > 75% for colorectal cancer in all PBCRs. While survival for the most common cancers in Türkiye has improved, likely due to advances in the availability of and access to cancer treatment, further efforts are needed to address regional disparities and inform policy decisions across the provinces in Türkiye.

26. Understanding how food literacy is characterized and measured in the Pacific Islands region: a scoping review.

期刊: Health promotion international 发表日期: 2026-Jul-01 链接: PubMed

摘要

Food literacy is an emerging research area and focus of health promotion initiatives to improve nutrition outcomes. Food literacy is contextual, and definitions differ across specific populations or settings. Food literacy as a concept has not been well studied in Pacific Islander populations. The aim of this scoping review was to identify how food literacy is characterized and measured in the Pacific Islands context and describe food literacy health promotion initiatives that may inform policy, practice, and research. The research questions were as follows: (i) How has food literacy been defined, described, and measured in Pacific Islands countries and territories populations? (ii) What health promotion initiatives have been implemented to develop and improve food literacy in these populations? A scoping review using a published protocol was conducted to identify grey and empirical evidence that broadly defined, described, measured, or explored food literacy and/or its components within Melanesia, Polynesia, and Micronesia subregions, within the previous 30 years. The search using three academic databases and relevant websites identified 44 sources representing 16 Pacific Islands countries and territories. Of these, four sources used the term ‘food literacy’. All other sources measured or promoted a food literacy knowledge, skill or behaviour, or a skill without directly naming it, highlighting the unique sociocultural elements influencing food literacy throughout this region. Understanding food literacy from this sociocultural context can help inform public health policy and health promotion practice, leading to more effective initiatives that reflect local values and practices and support local food systems.

27. Reply to the letter: 'multimodality imaging in cardio-oncology: from detection to actionable management to the editor'.

期刊: European heart journal. Cardiovascular Imaging 发表日期: 2026-Jul-01 链接: PubMed

摘要

28. Postbiotics From Ligilactobacillus salivarius Enhance Mitochondrial Robustness Via TLR2 Signaling in Intestinal Macrophages.

期刊: Probiotics and antimicrobial proteins 发表日期: 2026-Jul-01 链接: PubMed

摘要

Postbiotics, defined as preparations of inanimate microorganisms and/or their components, have attracted increasing attention because of their stability and functional benefits. Although lactic acid bacteria (LAB) modulate immune responses and oxidative stress, their direct effects on host mitochondrial homeostasis remain poorly understood. In this study, we investigated whether postbiotics derived from Ligilactobacillus salivarius enhance mitochondrial robustness in porcine intestinal macrophages (IPIMs). To establish a model of disrupted mitochondrial redox homeostasis, mitochondrial dysfunction was induced using the mitochondrial complex III inhibitor Antimycin A (AMA). High-dose AMA induced mitochondrial reactive oxygen species (mtROS) accumulation and suppressed the expression of antioxidant genes, including SOD2. Pre-stimulation with heat-killed L. salivarius suppressed AMA-induced mtROS production in selected representative strains, with the most effective strains enhancing SOD2 expression. These mtROS-suppressive strains selectively activated Toll like receptor (TLR)1/2 and TLR2/6 signaling, whereas non-protective strains failed to induce TLR responsiveness. Pharmacological inhibition of TLR2 abolished mtROS suppression and SOD2 induction, confirming TLR2 dependency. Furthermore, Seahorse extracellular flux analysis revealed that postbiotics enhanced mitochondrial respiration, including maximal respiration and spare respiratory capacity, via TLR2 signaling. Collectively, our findings demonstrate that postbiotics function as immunometabolic modulators that reinforce mitochondrial redox homeostasis and respiratory capacity via TLR2 signaling, highlighting a novel mechanism by which microbial components contribute to intestinal immune cell homeostasis.

29. Ecological predictors of daily dietary intake in black adolescents with overweight and obesity in the families improving together (FIT) for weight loss trial.

期刊: Journal of behavioral medicine 发表日期: 2026-Jul-01 链接: PubMed

摘要

Healthful eating habits (i.e., increased fruit and vegetable and decreased hyperpalatable energy-dense food and drink consumption) are important for preventing chronic disease risk (e.g., obesity) and improving overall health in Black adolescents.This study examines the intrapersonal, interpersonal, and environmental factors associated with daily dietary intake in Black adolescents with overweight and obesity. Baseline data were analyzed from 241 Black parent-adolescent dyads who participated in the Families Improving Together (FIT) for Weight Loss trial (Adolescent: Mage = 12.8 years, SD = 1.8; 63% female; MBMI% = 96.6, SD = 4.3). Intrapersonal factors included dietary motivation. Interpersonal factors included social support for diet from family. Environmental factors included access to food in the home. Dietary outcomes were measured using validated adolescent self-reported surveys. Separate multiple linear regressions revealed several associations between ecological factors and daily food intake. Greater access to more-healthful foods was associated with increased daily vegetable intake (β = 0.18, SE = 0.08, p < .05), whereas greater access to less-healthful foods was associated with increased daily fruit intake (β = 0.24, SE = 0.08, p < .05). Greater access to less-healthful foods was associated with increased daily energy-dense food intake (β = 0.75, SE = 0.10, p < .001), whereas increased self-reported dietary motivation was associated with decreased daily energy-dense food intake (β = -0.24, SE = 0.10, p < .05). Greater access to less-healthful foods (β = 1.48, SE = 0.23, p < .001) and higher adolescent BMI (β = 0.84, SE = 0.40, p < .05) was also associated with increased sugar-sweetened beverage consumption. These findings suggest that access to more-healthful foods is associated with greater vegetable intake, while restricting access to less-healthful foods and increased motivation for more healthful eating were associated with lower sugar-sweetened beverage and energy-dense food consumption among Black adolescents. These findings may inform future health promotion programs across various ecological levels of dietary behaviors in Black youth with overweight and obesity.

30. A Nurse-Led, Age-Friendly Educational Program to Reduce Stroke Risk and Promote Healthy Behaviors among Older Adults: A Randomized Controlled Trial.

期刊: Journal of cross-cultural gerontology 发表日期: 2026-Jul-01 链接: PubMed

摘要

Stroke remains a major cause of disability and mortality globally, particularly among older adults in low- and middle-income countries. Integrating the 4Ms framework (What Matters, Medication, Mentation, and Mobility) into nursing-led preventive interventions offers a holistic, person-centered model for promoting healthy aging and mitigating stroke risk. This study evaluated the effectiveness of a nurse-led, age-friendly educational program, grounded in the 4Ms framework, in reducing stroke risk and enhancing health-promoting behaviors among older adults. A randomized controlled trial was conducted with 170 community-dwelling adults (≥ 60 years) attending outpatient clinics in Egypt. Participants were randomized to either a 4Ms-based educational intervention (two structured sessions and materials) or a control group receiving routine care. Outcomes were measured using the Revised Framingham Stroke Risk Profile, the Health-Promoting Lifestyle Profile II, and a stroke prevention practices questionnaire. Post-intervention, the intervention group demonstrated a significant reduction in 10-year stroke risk scores (p<.001) and significant improvements across all health-promoting behavior domains, especially physical activity, nutrition, and stress management (all p<.001). The percentage of participants with good stroke-prevention practices increased from 7.1% to 55.3%. Stroke risk was also inversely correlated with domains like health responsibility and stress management. The nurse-led educational program based on the 4Ms framework was associated with short-term improvements in reducing stroke risk indicators and improving health-promoting behaviors among older adults. Integration of age-friendly principles into preventive nursing care may offer a feasible and holistic approach for supporting healthy ageing in low-resource settings. Longer-term studies remain necessary.Trial RegistrationPan African Clinical Trials Registry (PACTR), registration number PACTR202606898663018. Registration was completed retrospectively.

31. Women Emergency Physicians and Gender Disparities from Entry to Advancement.

期刊: Annals of emergency medicine 发表日期: 2026-Jul-01 链接: PubMed

摘要

We sought to summarize the last 20 years of published research on gender experience and disparities in the emergency medicine workforce. We conducted a scoping review by searching MEDLINE ALL, Embase, Cochrane Central Register of Controlled Trials, and Scopus from 2003 to 2024, to identify original research investigating gender experience and disparities among physicians in emergency medicine in North America. We abstracted study design, sample characteristics, and outcomes. We analyzed data using an ad hoc iterative thematic analysis of the content areas as well as a synthesis of the key findings and research limitations. We identified 5,740 candidate publications and, after exclusions, included 191 (99% observational studies). We identified 15 themes: (1) workforce, (2) childbearing, (3) attrition, (4) evaluations, (5) bias and discrimination, (6) wellness, (7) professional development groups and mentorship, (8) authorship, (9) editorial board membership, (10) research grants, (11) national speakers, (12) awards, (13) leadership roles, (14) academic rank and promotion, (15) financial compensation and one subtheme (pediatric emergency medicine). We mapped these themes to 5 domains: (1) Recruitment and Retention, (2) Culture and Environment, (3) Academic Scholarship, (4) Recognition and Promotion, and (5) Clinical Care and Decisionmaking. There were 3 to 33 publications per theme. The quality of evidence was variable. We found fewer disparities, and improvement over time in the percentage of women academic faculty, women authorship, national speaking, and educational awards. We found consistent evidence of gender disparities disadvantaging women emergency physicians in financial compensation, editorial board membership, executive leadership roles, academic rank, and experiences of gender bias, with little change over time. Although some areas remain understudied, our central findings confirm that gender-based disparities continue to exist among emergency physicians. Future efforts should be redirected toward the development and assessment of interventions that combat these disparities.

32. Unknown Duration or Late Syphilis Cases with High Titers - North Carolina, 2015 & 2023.

期刊: Sexually transmitted diseases 发表日期: 2026-Jul-01 链接: PubMed

摘要

While recent national increases in unknown duration or late syphilis (UDLS) have outpaced diagnoses of earlier stages of syphilis, causes and contributors remain unknown. We evaluated changes in the proportion of UDLS cases with high nontreponemal test titers in one jurisdiction to identify if UDLS cases, which often have lower titers compared with early syphilis cases, might increasingly be early syphilitic infections. We identified UDLS cases with high titers (defined as rapid plasma reagin titers ≥1:32) reported to North Carolina during years 2015 and 2023. We evaluated changes in case counts and in the proportion of UDLS cases with high titers overall, by demographics, clinical factors, and incarceration history. When comparing years 2015 and 2023, UDLS case counts increased (628 vs. 2,498). The proportion of cases with high titers remained relatively stable between both years (51.3% vs. 50.2%), but increased among women (29.1% vs. 46.1%), women pregnant at the time of syphilis diagnosis (30.4% vs. 43.2%), men who have sex with women only (MSWO; 45.0% vs. 57.4%), and people who were recently incarcerated (41.7% vs. 52.9%). The proportion of cases with high titers decreased among men who have sex with men (66.4% vs. 58.1%), and men with HIV (68.0% vs 55.4%). The proportion of cases with high titers increased among women, MSWO, and people who were recently incarcerated, suggesting that an increasing proportion of UDLS cases in these populations might be early syphilitic infections. Future initiatives could identify methods of improving case staging to facilitate syphilis prevention and control.

33. Nanoceria Provokes Apoptosis in Different Critical Organs of Mus musculus.

期刊: Environmental toxicology 发表日期: 2026-Jul-01 链接: PubMed

摘要

Nanoceria or cerium oxide nanoparticles (CeO2NPs) is extensively utilized in numerous sectors, such as electronics, environmental protection, pharmaceutical delivery systems, medical equipment, biotechnology, and the production of food and cosmetic products. This experiment planned to assess the possible toxic impacts and health hazards of nanoceria on major organs including the spleen, liver, kidneys, and lungs of Mus musculus through biochemical evaluations, gene expression analysis and histopathological examination. Fifteen male mice were randomly allocated into three equal groups: group C functioned as the untreated control and was kept under routine laboratory husbandry conditions with ad libitum access to feed and water, without undergoing any treatment, administration, or additional handling procedures, group NC-i.p received nanoceria at a dose of 40 mg/kg body weight via i.p injection twice weekly for 21 days, and group NC-i.n received nanoceria administered i.n (dropwise into the nostrils using a micropipette) at the same dose and schedule. After 21 days, blood samples were collected for biochemical assessments, in addition to tissue samples from liver, kidney, lung, heart, and spleen for oxidative stress biomarkers, gene expression and histopathological examination. Our results revealed that nanoceria caused significant hypoproteinemia, hypoalbuminemia, hypercholesterolemia, hypertriglyceridemia, and increased creatinine levels. Moreover, malondialdehyde (MDA) level was elevated, whereas glutathione (GSH) and glutathione perpxidase (GSPx) levels were reduced, along with a pronounced upregulation of ERK1, JNK, and MAPKP38 gene expression in liver, kidney, lung, and spleen tissues. These findings highlight the potential toxicological hazards associated with nanoceria exposure.

34. Self-management in neurological disorders: a scoping review of behavior change theories, strategies, contents, and impact.

期刊: Disability and rehabilitation 发表日期: 2026-Jul-01 链接: PubMed

摘要

This scoping review aimed to identify and map the behavior change theories, behavior change techniques (BCTs), and effectiveness of self-management (SM) interventions designed to improve functioning outcomes in persons with neurological conditions (NDs). Following the PRISMA-ScR guidelines and the Arksey and O’Malley framework, a systematic search of PubMed, Web of Science, CINAHL, and PsycInfo was conducted. From 2,568 screened records, 18 studies met the inclusion criteria. Quantitative study characteristics were descriptively summarized, and deductive thematic analysis using the BCT Taxonomy (v1) was applied to identify and classify behavior change theories and techniques. Included studies covered stroke (n = 9), spinal cord injury (n = 4), multiple sclerosis (n = 3), mixed neurological populations (n = 1), and Parkinson’s disease (n = 1), predominantly from high-income countries. Social Cognitive Theory and Self-Determination Theory were the most frequently applied frameworks. The five most utilized BCTs were problem solving, action planning, information about health consequences, goal setting, and self-monitoring of behavior. Despite heterogeneity in BCT combinations, outcome measures, dosage, and delivery modes, functioning improvements were consistently reported. SM interventions grounded in established behavior change theories demonstrate consistent preliminary benefits for functioning in neurological rehabilitation, supporting a shift toward patient-centered, participatory, and sustainable models of care. Healthcare providers should incorporate self-management interventions as part of traditional rehabilitation.These should be tailored to address individual identity, environmental constraints, and psychosocial dynamics to support people in sustaining meaningful participation and optimizing function despite neurological condition progression.Rehabilitation professionals should actively seek opportunities to integrate self-management approaches into clinical practice and facilitate the transfer of these skills to their patients.Consider how exercise program and task-specific training delivery either supports or undermines patients’ psychological needs (autonomy, competence, relatedness) as outlined by Self-Determination Theory.

35. Exposure timing is a determinant of fine particulate matter (PM2.5) pulmonary, vascular and metabolic toxicity in male mice.

期刊: Toxicological sciences : an official journal of the Society of Toxicology 发表日期: 2026-Jul-01 链接: PubMed

摘要

Exposure to fine particulate matter (PM2.5) air pollution is associated with an increased cardiometabolic disease risk. However, while exposure timing is recognized as an important toxicity determinant, the chronotoxicity of PM2.5 exposure is less explored. To evaluate whether PM2.5 sensitivity depends on exposure timing, adult male C57/BL6 mice were exposed to concentrated ambient PM2.5 (CAP, 6 h/day, 30 days) either during the inactive (light) phase (Zeitgeber time, ZT1-7) or the active (dark) phase (ZT17-23). Metabolic health was assessed by measuring body weight, fasting blood glucose, and plasma insulin levels. Oxidative stress and inflammatory responses in aortas and lungs were examined by (qRT)-PCR, and pulmonary and circulating redox changes were measured calorimetrically. While CAP exposure during the active phase increased blood glucose levels, inactive phase exposure more profoundly increased antioxidant enzyme and inflammatory mRNA abundance in aortas and lungs. Inactive phase exposure also intensified pulmonary and systemic lipid peroxidation and increased the depletion of circulating nitric oxide and lung glutathione. Examining the ability to protect against CAP-induced pulmonary oxidative stress, we found that the pulmonary antioxidant enzyme mRNA expression showed circadian rhythmicity that peaked during the active phase. These data suggest that a superior pulmonary antioxidant defense potential during the active phase could contribute to the protection against the PM2.5-induced vascular and pulmonary effects, but not its impact on glucose homeostasis. Our study identified that exposure sensitivity depends on the exposure timing, which is of significance as it informs on timely susceptibility windows that could help to mitigate PM2.5 toxicity.

36. Rural E-Cigarette Use Higher than Urban Across Age Groups.

期刊: Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco 发表日期: 2026-Jul-01 链接: PubMed

摘要

Rural communities in the United States experience higher tobacco use and worse tobacco-related health outcomes than urban areas, with disparities increasingly extending to electronic nicotine delivery systems (ENDS). Little is known about rural-urban differences in ENDS use across detailed age groups. We analyzed data from the 2022-2023 Tobacco Use Supplement to the Current Population Survey (TUS-CPS), a nationally representative survey of U.S. adults (≥18 years). Respondents were categorized into four age groups (18-24, 25-44, 45-64, ≥65). Rural-urban residence was defined using metropolitan status. Weighted prevalence estimate of lifetime, former, and current ENDS use were calculated by age group and rural-urban residence, and gender-adjusted contrasts were estimated using survey-weighted marginal standardization. Lifetime, former, and current ENDS use were 9.6%, 6.6%, and 3.0%, respectively. Lifetime and current ENDS use were higher in rural than urban areas across most age groups, with the largest differences observed among adults aged 25-44 and 45-64 (current use PRs of 1.29 and 1.44, respectively). YAs (18-24) in rural areas had the highest prevalence (lifetime: 19.5%; current: 10.5%). Among lifetime users, adults aged 18-24 and 25-44 in rural areas were more likely to report current use than their counterparts in urban areas (18-24: 53.8% vs. 44.6%; 25-44: 35.2% vs. 29.5%). Former use was significantly higher in rural areas overall and among adults aged 25-44 and 45-64, but not among adults aged 18-24 or ≥65. These patterns of ENDS use underscore the need for age-targeted ENDS prevention and cessation interventions in rural populations.

37. DEVELOPMENTAL PROGRAMMING IN DOGS.

期刊: Biology of reproduction 发表日期: 2026-Jul-01 链接: PubMed

摘要

Developmental programming in dogs, although less studied than in other species, encompasses both nutritional and behavioural influences during gestation and early life. The most critical window corresponds to the first 120 days (pregnancy followed but the first two months of dog’s life), considered the canine equivalent of the human “first 1000 days of life.” Low birth weight, result from the intra-uterine growth, is one of the most documented examples of developmental programming in this species. Its consequences extend long beyond the neonatal period: while early effects include disproportionate head development and increased mortality during the first three weeks, long-term effects include a greater predisposition to overweight in adulthood. Gestational programming is modulated by the dam’s diet, which can affect birth weight, neonatal and paediatric health, and particularly inflammatory status. However, the postnatal period provides opportunities to counteract prenatal influences: the risk of neonatal mortality in low-birth-weight puppies that achieve adequate early growth during the first two days of life becomes similar to that of normal-birth-weight littermates. Conversely, excessive growth during the first weeks of life is suspected to increase the likelihood of adult overweight, highlighting the need for precise management of neonatal and paediatric growth to ensure healthy adult trajectories. Early-life behavioural programming, through maternal behaviour and environmental exposures, is also essential in shaping dogs for their future societal roles. Overall, developmental programming appears to be a key determinant of lifelong physical and mental health in dogs.

38. Synthesis of Protocols for Frostbite Care from the FROST Study Sites.

期刊: Journal of burn care & research : official publication of the American Burn Association 发表日期: 2026-Jul-01 链接: PubMed

摘要

Frostbite injuries can have lasting sequelae including amputations, intolerance to cold, chronic pain, paresthesia, and inability to return to work. Despite this morbidity, the treatment of frostbite remains understudied. The FRostbite ObServational Trial (FROST) aims to address this gap through a multicenter evaluation of treatment practices and outcomes. As part of FROST, we reviewed institutional frostbite care protocols from 16 participating sites across North America. Practices were categorized as demonstrating uniform agreement $\Big(\ge$90% mentioned the practice), consensus ($\ge$75%), or majority if ($\ge$50%). Uniform agreement was limited to use of rapid rewarming and thrombolytics, the latter being influenced by site selection criteria for FROST participation. Consensus was achieved in multiple areas (such as urgency of treatment, perfusion assessment, the therapeutic windows for pharmaceutical interventions, and the therapeutic dosing of IV thrombolytics). Protocols varied on grades for thrombolytic treatment initiation, prostacyclin analogue use, post-thrombolytic anticoagulation treatment and duration, the role of physical or occupational therapy, splinting, and appropriate wound care. This manuscript provides a synthesis of protocols and expert opinion for the acute management of frostbite injury. This synthesized protocol may serve as a tool for centers to develop their own standard protocol to facilitate care for frostbite patients. Additionally, current opportunities for frostbite research and improving care are detailed in the manuscript. Education regarding prevention of injury and the need for emergent treatment is needed for both the public and the medical community.

39. How the Exposome Shapes Our Respiratory Health.

期刊: American journal of respiratory and critical care medicine 发表日期: 2026-Jul-01 链接: PubMed

摘要

40. Post-stroke rehabilitation in inflammatory rheumatic diseases: outcome measures, digital tools, and patient education perspectives.

期刊: Rheumatology international 发表日期: 2026-Jul-01 链接: PubMed

摘要

Inflammatory rheumatic diseases (IRDs) represent a significant risk factor for cerebrovascular events, independent of traditional cardiovascular risk factors. The elevated risk of stroke in individuals with IRDs arises from chronic systemic inflammation, endothelial dysfunction, accelerated atherosclerosis, prothrombotic effects of antiphospholipid antibodies, and cumulative corticosteroid exposure. Post-stroke rehabilitation in patients with IRDs involves distinct clinical challenges that extend beyond standard neurorehabilitation, including joint involvement, chronic pain, fatigue, and treatment-related limitations. Assessment tools that focus exclusively on neurological recovery are inadequate for this population. Dual-layered protocols that integrate both neurological and rheumatological criteria are required. Although wearable sensors, telemonitoring, and electronic patient-reported outcome measures provide a foundation for continuous monitoring, barriers such as limited digital literacy, insufficient infrastructure, and the absence of IRD-specific content addressing symptom overlap persist. Post-stroke cognitive impairment is frequent and multifactorial in this group, necessitating cognitive assessment approaches tailored to IRD subgroups, as disease-specific manifestations may confound the interpretation of standard screening tools. Physiotherapy, occupational therapy, telerehabilitation, and virtual reality-based interventions may be beneficial when specifically adapted to accommodate joint limitations and pain. While artificial intelligence-based tools hold promise, there remains a need for clinically validated, domain-specific expert platforms. Nurses are integral to this process, providing patient education, monitoring medication adherence, offering psychosocial support, and coordinating remote care. Optimal management of stroke associated with IRDs requires multidisciplinary, technology-enabled, and patient-centered care models that integrate neurology, rheumatology, rehabilitation medicine, and digital health. Given the predominantly indirect nature of current evidence, prospective studies employing validated assessment tools are urgently needed.

41. Maternal peripartum stress: A new consensus-based definition.

期刊: Archives of women’s mental health 发表日期: 2026-Jul-01 链接: PubMed

摘要

The peripartum period is a time of increased vulnerability to stress for women, yet no consensus definition of maternal peripartum stress exists. This paper reports work from European COST Action 22114 (TREASURE), which identified key concepts related to maternal peripartum stress in the literature and developed a consensus definition via a qualitative Delphi process involving 161 international researchers and clinicians. The resulting definition supports a shared understanding, enabling more targeted research and evidence-based clinical practice to improve perinatal care.

42. Molecular dosimetry of hemoglobin adducts in mice exposed to ethylene oxide.

期刊: Archives of toxicology 发表日期: 2026-Jul-01 链接: PubMed

摘要

Ethylene oxide (EtO) is a widely used industrial compound with known carcinogenic potential in humans. Due to its high reactivity and short biological half-life, occupational exposure assessments (> 1 ppm) rely on the detection of stable biomarkers, such as N-(2-hydroxyethyl)-L-valine (HE-V), formed as hemoglobin adducts in blood. Existing analytical methods for HE-V detection often require large volumes of blood and purified hemoglobin due to limited sensitivity, restricting their application in characterizing the dose-response relationship between EtO exposure and HE-V accumulation-particularly at low environmental exposure levels relevant to assessing potential general population health risks. In this study, we aimed to characterize the molecular dosimetry of HE-V formation in B6C3F1 mice exposed by whole body inhalation to a broad range of concentrations of EtO: 0, 0.05, 0.1, 0.5, 1, 50, 100, and 200 ppm, 7 days/week for 4 weeks. To achieve this, we developed a sensitive LC-MS-based workflow for HE-V quantification, incorporating hemoglobin purification, HE-V release plus enrichment, and targeted mass spectrometric detection from as little as 10 μL of blood and 50 μg of extracted hemoglobin. A clear, dose-dependent increase in HE-V levels was observed following EtO exposure, with statistically significant elevations detected even at 0.05 ppm compared to endogenous background levels. At lower concentrations (0.5 to 1 ppm), HE-V levels increased linearly with dose, while higher concentrations (50 to 200 ppm) exhibited an upward-bending (increasing slope) dose response. No sex-specific differences were observed. Taken together, these findings indicate EtO exhibits linear systemic toxicokinetics at lower exposures that transition to nonlinear toxicokinetics in the range of higher exposures (likely due to saturation of glutathione-mediated detoxification), thus providing new quantitative insights to support improved risk assessments and toxicological evaluations of EtO exposure.

43. Acute topical menthol application and exercise performance: A systematic review and meta-analysis of perceptual and physiological responses.

期刊: Journal of thermal biology 发表日期: 2026-Jun-29 链接: PubMed

摘要

Topical menthol is increasingly used as a perceptual cooling strategy during exercise, yet its ergogenic potential and underlying mechanisms remain unclear. Unlike previous route-mixed meta-analyses, this systematic review and three-level meta-analysis specifically examined the effects of acute topical menthol application on exercise performance alongside perceptual and physiological responses. Meta-analysis. Six databases were searched from inception to March 2026. Randomized or controlled trials examining acute topical menthol application during exercise were included. Risk of bias was assessed using RoB-2. Three-level meta-analyses accounted for dependence among multiple outcomes. Prespecified moderators included sex, training status, environmental condition, application method, application site, and exercise modality. Sensitivity analyses addressed outliers and influential cases. Sixteen studies involving 191 participants were included. Topical menthol produced a small but significant improvement in exercise performance (g = 0.27, p = 0.02). Thermal sensation (g = -0.74) and perceived exertion (g = -0.35) were reduced, with a small improvement in thermal comfort (g = 0.34), whereas core body temperature was unchanged. Performance benefits were most evident in aerobic endurance tasks, following rub-on application methods, and under temperate conditions, whereas effects in hot environments (≥30 °C) were smaller and not statistically significant. Several subgroup findings were sensitive to influential observations and should be interpreted cautiously. Acute topical menthol may provide a small ergogenic benefit primarily through perceptual cooling rather than physiological heat strain. Effects appear context dependent and most relevant for endurance exercise. Further well-controlled studies are needed to clarify optimal application strategies and environmental conditions.

44. Contextualizing the adolescent social brain: Links to social health using data from the Adolescent Brain Cognitive Development Study.

期刊: Developmental cognitive neuroscience 发表日期: 2026-Jun-27 链接: PubMed

摘要

Social health, defined as adequate quantity and quality of social relationships (Doyle & Link, 2024), is essential for human well-being. The social brain, a network of regions involved in social cognition, ostensibly facilitates social health; however, few studies assess how social brain function relates to different profiles of social health. We tested this association during early adolescence when close relationships with peers gain increased importance. We used baseline (8- to 11-years old) brain data and year 2 (10- to 13-years old) social health data from 5832 adolescents in the Adolescent Brain Cognitive DevelopmentSM (ABCD) Study. We focused on an fMRI task that implicitly elicited emotion processing when viewing faces and applied latent profile analysis on variables associated with peer relationships: the number of friends (close and general), experiences with aggression and victimization, relationships with prosocial and rule-breaking peers, and support from peers. We identified three profiles (“concerning”: 12.96% of sample; “robust”: 33.95%; “selective”: 53.09%). We found a significant interaction between sex and amygdala reactivity to emotional faces, indicating that boys and girls differed in likelihood of belonging to profiles reflecting greater (concerning, robust) vs weaker (selective) peer involvement. Exploratory analyses revealed that associations with other brain regions were only detected when examining individual social health outcomes. This study highlights divergent pathways in how social brain function informs both general social health patterns and individual health outcomes, setting the stage for future research.

45. Basic human values, responsiveness, and dignity in geriatric organizations in Israel: A qualitative study of state regulations.

期刊: Health policy (Amsterdam, Netherlands) 发表日期: 2026-Jun-24 链接: PubMed

摘要

Patient dignity is a foundational principle in geriatric care, yet how health regulations conceptualize and promote dignity for elderly patients remains underexplored. Israel offers a particularly instructive case given its universal healthcare system serving a diverse aging population. This study examines how Israeli state health regulations promote patient dignity and responsiveness in geriatric hospitals, and analyzes these regulatory provisions through the lens of Schwartz’s refined theory of basic human values. We conducted a qualitative content analysis of 150 regulatory documents issued by Israel’s Ministry of Health between 2009 and the present. Coding proceeded inductively using thematic analysis (Braun & Clarke, 2019), with AI-assisted software supporting coding identification and organization. Themes and sub-themes were subsequently mapped onto Schwartz’s value framework through a theory-informed process. Four core dignity-related themes were identified: ethical treatment, patient-centered care, safety and comfort, and end-of-life care. Each theme was systematically mapped onto Schwartz’s value dimensions: ethical treatment aligning with conformity and security; patient-centered care with self-direction and benevolence; safety and comfort with security, universalism-concern, and hedonism; and end-of-life care with universalism-concern, and self-direction. Schwartz’s value framework offers an analytically productive lens for understanding how organizational regulations encode and enact human values in geriatric care. The findings point to concrete policy implications: regulations should be understood not merely as procedural tools but as value-oriented instruments that shape the moral culture of care organizations. Future research should examine how these regulatory values translate into actual clinical practice.

46. National estimates of exposure to potentially traumatic events among individuals with obsessive-compulsive disorder: Findings from The National OCD Survey.

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

摘要

Epidemiological research suggests that most individuals in the U.S. will be exposed to potentially traumatic events (PTEs) at some point in their lifetime. Despite this, published rates of PTE exposure among individuals with obsessive-compulsive disorder (OCD) vary widely, ranging from 34-82%. Thus, presently available PTE estimates are too wide to be clinically informative and are incongruent with general population estimates, where the rate of PTE exposure would be expected to be comparable if not higher. Using data from The National OCD Survey, a large geographically representative study of adults with OCD across the U.S., demographically weighted PTE estimates were computed in a sample of 2808 participants with OCD (M age = 33.6 years). PTE rates were notably higher than previously reported in OCD research and better aligned with general population estimates. Nearly all participants endorsed at least one PTE (97.9%), including, most commonly, transportation accidents, sexual assault, physical assault, natural disaster, and life-threatening illness or injury. The present study is the first to provide robust PTE estimates among individuals with OCD, supporting the frequency of these experiences and highlighting the need for adequate assessment of trauma in clinical practice.

47. Multivitamin supplementation and COVID-19 incidence and symptom severity in the COcoa Supplement and Multivitamin Outcomes Study (COSMOS) randomized trial.

期刊: The American journal of clinical nutrition 发表日期: 2026-Jun-09 链接: PubMed

摘要

The effect of long-term daily multivitamin-mineral (MVM) supplementation on Coronavirus Disease 2019 (COVID-19) prevention and symptom severity remains unclear. We tested the hypothesis that a daily MVM reduced COVID-19 incidence or symptom severity among generally healthy older adults. We conducted a secondary analysis in the COcoa Supplement and Multivitamin Outcomes Study, a randomized, double-blinded, placebo-controlled trial (June 2015 to December 2020), evaluating daily MVM and cocoa extract supplementation for the prevention of cardiovascular disease and cancer among 21,442 United States adults. The primary outcome was incident COVID-19 between 1 January, 2020 and 31 December, 2020, defined as the first occurrence of a self-reported positive test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, a physician’s diagnosis, hospitalization, or death due to COVID-19. The prespecified secondary outcomes were symptomatic COVID-19 and symptom count among nonfatal cases through 31 August, 2020, when detailed symptoms were collected. We conducted intention-to-treat (primary) and per-protocol (secondary) analyses among consistently adherent participants. The final year of the COcoa Supplement and Multivitamin Outcomes Study intervention phase from January 2020 to December 2020 coincided with the start of the COVID-19 pandemic. Of the 18,205 participants who remained in the trial and were adherent to study pills as of 1 January, 2020, 382 were randomly assigned to MVM and 404 to MVM placebo (no MVM) and reported a COVID-19 infection through 31 December, 2020. In intention-to-treat analysis, the hazard ratio for MVM compared with placebo was 0.93 for COVID-19 incidence [95% confidence interval (CI): 0.81, 1.07]. Among the 338 cases with detailed symptom data, the odds ratio for symptomatic COVID-19 comparing MVM with placebo was 0.70 (95% CI: 0.44, 1.11). In per-protocol analyses, among participants compliant with study pills during 2020, the odds ratio for symptomatic COVID-19 was 0.60 (95% CI: 0.37, 0.99). A daily MVM supplement, compared with placebo, does not significantly reduce COVID-19 incidence among older adults but shows a promising signal lowering the odds of symptomatic COVID-19 illness. The Cocoa Supplement and Multivitamin Outcomes Study was registered at clinicaltrials.gov as NCT02422745.

48. Teleconsultation in primary care: conceptual model and implementation in favela territories.

期刊: Ciencia & saude coletiva 发表日期: 2026-May 链接: PubMed

摘要

Primary Health Care is central to ensuring access to healthcare and is the preferred gateway to the Unified Health System. The municipality of Rio de Janeiro has made progress in coverage, but still faces challenges, especially in vulnerable areas. An innovative teleconsultation model was proposed in the Maré favelas compound, integrating public authorities (Ministry of Health and Rio de Janeiro Municipal Health Department), academia (Fiocruz), and community-based organizations (Redes da Maré). Therefore, this article presents the pilot implementation stages, emphasizing the territorial context, stakeholders involved, resources, and governance. It proposes a conceptual framework, combined with qualitative and quantitative methods, to describe the experience. A total of 1.017 teleconsultations were conducted (November 2024 to June 2025) with the following profiles: follow-up on recent appointments (58%), chronic conditions and life cycles (33%), acute conditions (5%), and prescription issuance (2%), even during territorial conflicts. However, barriers were encountered, such as difficulty using the tools, data insecurity, and accessibility. The model proved successful in its initial phase, providing support for a national teleconsultation policy for vulnerable territories. A Atenção Primária em Saúde é central na garantia do acesso à saúde, sendo a porta de entrada preferencial para o Sistema Único de Saúde. O município do Rio de Janeiro avançou em cobertura, mas ainda enfrenta desafios, especialmente nos territórios vulnerabilizados. Nesse sentido, propôs-se um modelo inovador de teleconsulta, no conjunto de favelas da Maré, integrando poder público (Ministério da Saúde e Secretaria de Saúde do Município do Rio de Janeiro), academia (Fiocruz) e organização de base comunitária (Redes da Maré). O artigo apresenta as etapas da implementação do piloto, enfatizando o contexto territorial, atores envolvidos, recursos e modelo de governança e propõe um framework conceitual, combinado a métodos qualitativos e quantitativos, para descrever a experiência. Entre novembro de 2024 e junho de 2025, foram realizadas 1.017 teleconsultas: seguimento à atendimentos recentes (58%), condições crônicas e ciclos de vida (33%), condições agudas (5%) e emissão de receitas (2%), mesmo em conflitos territoriais. Contudo, foram encontradas barreiras, como: dificuldade em manusear as ferramentas, insegurança dos dados e acessibilidade. O modelo mostrou-se exitoso em sua fase inicial, trazendo subsídios para uma política nacional de teleconsultas para territórios vulnerabilizados. La Atención Primaria de Salud es fundamental para garantizar el acceso a la atención médica y es la puerta de entrada preferida al Sistema Único de Salud. El municipio de Río de Janeiro ha avanzado en la cobertura, pero aún enfrenta desafíos, especialmente en áreas vulnerables. En ese sentido, se propuso un modelo innovador de teleconsulta en el complejo de favelas de Maré, con la integración de las autoridades públicas (Ministerio de Salud y Secretaría Municipal de Salud de Río de Janeiro), la academia (Fiocruz) y organizaciones comunitarias (Redes da Maré). Este artículo presenta los pasos de la implementación piloto, enfatizando el contexto territorial, los actores involucrados, los recursos y el modelo de gobernanza. Propone un marco conceptual, combinado con métodos cualitativos y cuantitativos, para describir la experiencia. Entre noviembre de 2024 y junio de 2025, se realizaron 1.017 teleconsultas: seguimiento de servicios recientes (58%), enfermedades crónicas y ciclos de vida (33%), enfermedades agudas (5%) y emisión de recetas (2%), incluso durante conflictos territoriales. Sin embargo, se encontraron barreras, como la dificultad para usar las herramientas, la inseguridad de los datos y la accesibilidad. El modelo resultó exitoso en su fase inicial, trayendo subsidios a una política nacional de teleconsulta para territorios vulnerables.

49. Use of artificial intelligence and environmental data to estimate respiratory hospitalizations in support of SUS management.

期刊: Ciencia & saude coletiva 发表日期: 2026-May 链接: PubMed

摘要

This study developed a predictive model of hospital admissions due to respiratory diseases using environmental and meteorological data from São Paulo (2017-2022). It analyzed hospitalizations classified under ICD-10 codes J00-J99. Weekly public data on air pollutants (PM2.5, PM10, O3, NO2, SO2, CO) and climate variables (temperature, humidity, precipitation, among others) were used. The methodology included feature engineering (lags, moving averages, interactions, trend, seasonality), Lasso regression for variable selection, and application of the CatBoost algorithm optimized via GridSearchCV. The model showed strong performance (R²≈0.895), with good accuracy in estimating healthcare demand. The Shapley Additive Explanations (SHAP) technique ensured model explainability, identifying the most influential predictors of respiratory admissions. The results highlight the potential of AI as a strategic Digital Health tool, especially for early outbreak detection and resource allocation within Brazil’s Unified Health System (SUS).

50. Patient preferences for the integration of exercise for depression into mental health care.

期刊: Translational behavioral medicine 发表日期: 2026-Jan-07 链接: PubMed

摘要

Exercise is an evidence-based treatment for depression, yet it is rarely integrated into mental health care in the United States. The purpose of this study was to examine patient experiences with and preferences for integrating exercise into mental health care. Participants were 457 US adults with depression who reported current or past receipt of mental health care and completed an online survey assessing experienced and preferred levels of exercise integration using parallel three-level ordinal scales. Related samples Wilcoxon signed-rank tests compared experienced versus preferred levels of exercise integration. Multivariable ordinal logistic regression examined predictors of preferred exercise integration. 22.5% preferred no discussion of exercise in the context of mental health care, 56.5% preferred general education and encouragement around exercise in mental health care, and 21.0% preferred structured exercise goal setting in mental health care. Participants preferred significantly greater exercise integration than they had experienced (Z = 6.8, P < .001). In multivariable analyses, prior experience with exercise being integrated into mental health care and greater belief in exercise’s antidepressant effects were associated with higher preferred integration, whereas current antidepressant use and physical health conditions limiting exercise were associated with lower preferred integration. Preference for integration of exercise into mental health care was unrelated to depression severity or physical activity level. US adults with depression prefer greater integration of exercise into mental health care than they currently receive, but most prefer limited integration. These findings highlight the importance of flexible, patient-centered approaches to exercise integration into mental health care. Exercise is known to help reduce symptoms of depression, but discussion of exercise is not often included in mental health care in the United States. This study explored how adults with depression feel about including exercise promotion in their care. We surveyed 457 US adults who had received mental health care and asked about their past experiences with exercise being included, as well as their preferences for how it should be incorporated. Most participants wanted some level of integration of exercise promotion into their care, with over half preferring general education and encouragement and about one in five preferring structured goal setting. Overall, participants wanted more integration of exercise than they had previously experienced. Preferences were influenced by prior experience of exercise integration in mental health care and beliefs about exercise benefits, but not by depression severity or physical activity level, suggesting discussion of exercise may be a good fit regardless of symptom severity or current activity levels. These findings suggest many people are open to including exercise promotion in mental health care, but approaches should be flexible and tailored to individual preferences.

51. Systematization of nursing care as a professional practice model in nursing in Brazil: a critical-epistemological proposition.

期刊: Revista da Escola de Enfermagem da U S P 发表日期: 2026 链接: PubMed

摘要

To analyze the historiography of the concept of Systematization of Nursing Care (SAE) as a Professional Practice Model in Nursing in Brazil, improving the understanding of its conceptual and operational limitations. A theoretical and reflective essay, grounded in documentary research. Regulatory acts were examined in a proposed analysis of the concept of SAE, in addition to reference books and indexed articles, composing SAE historiography in Brazil and its interfaces with the Nursing Process. The analysis was conducted through analytical reading and narrative synthesis. The structural pillars of the SAE concept, “method”, “personnel,” and “tools,” closely correspond to the essential components of the Professional Practice Models described in the international literature. It is concluded that the SAE, despite its history marked by conceptual ambiguities, remains a significant construct in the organization of professional nursing practice in Brazil. It is considered a Professional Practice Model; aligned with its pillars, it allows for its reinterpretation not as a synonym for the Nursing Process, but as an expanded model of care management within the macropolitical dimension of planning, networking, and the Brazilian Public Health System (SUS) policies.

52. [Disease, social, and economic burden of smoking in Brazil and the impact of tax increases on the economy and on the reduction of morbidity and mortality].

期刊: Cadernos de saude publica 发表日期: 2026 链接: PubMed

摘要

This study aimed to estimate the disease, social, and economic burden of smoking in Brazil in 2022 and to predict the benefits of tax increases, including its effects of the illegal market. A probabilistic Markov microsimulation model was applied in which individuals aged 35 years or older were followed in hypothetical cohorts and quantified deaths, health events, the direct cost of medical care, and the indirect cost due to productivity losses. A model to estimate health and economic gains from 10-year tax increase scenarios was developed. Data on smoking prevalence, the Brazilian demographic structure, mortality, and morbidity were obtained from official databases and the literature. The used health resources were obtained from the literature and consultations with specialists. Smoking caused 174,000 deaths and 5.7 million years of life lost due to premature death and disability. Its economic burden totaled BRL 153 billion, of which BRL 67 billion was attributed to direct costs and BRL 45 billion to indirect costs. The cost of informal caregivers equaled BRL 41 billion. In the scenario with the illegal market for tobacco products, a 50% increase in the price of cigarettes may generate economic benefits of BRL 161 billion in 10 years. The current tax reform currently in Brazil may constitute a permanent pricing and tax policy. Este estudo buscou estimar a carga da doença, social e econômica do tabagismo no Brasil em 2022 e prever os benefícios do aumento de impostos, com a inclusão dos efeitos do mercado ilegal. Aplicou-se um modelo de microsimulação probabilística de Markov no qual indivíduos a partir de 35 anos foram acompanhados em coortes hipotéticas, quantificando as mortes, os eventos de saúde, o custo direto da assistência médica e o custo indireto por perda de produtividade. Foi desenvolvido um modelo para estimar os ganhos em termos de saúde e econômicos a partir de cenários de aumento de impostos em dez anos. Obteve-se os dados de prevalência do tabagismo, da estrutura demográfica brasileira, de mortalidade e morbidade em bases de dados oficiais e na literatura. Os recursos de saúde utilizados foram obtidos por meio da literatura e de consultas a especialistas. O tabagismo causou 174 mil mortes e 5,7 milhões de anos de vida perdidos por morte prematura e por incapacidade. A carga econômica foi de R$ 153 bilhões, sendo R$ 67 bilhões atribuídos ao custo direto e R$ 45 bilhões ao custo indireto. O custo do cuidador informal alcançou R$ 41 bilhões. No cenário com o mercado ilegal de produtos do tabaco, um aumento de 50% no preço dos cigarros tem o potencial de gerar benefícios econômicos de R$ 161 bilhões em dez anos. A Reforma Tributária atualmente em curso é oportuna para que o país possua uma política de preços e impostos permanente. El objetivo de este estudio fue estimar la carga de la enfermedad, social y económica del tabaquismo en Brasil en 2022 y predecir los beneficios del aumento de los impuestos, incluidos los efectos del mercado ilegal. Se aplicó un modelo de microsimulación probabilística de Markov en el que se siguió a individuos de más de 35 años de edad en cohortes hipotéticas y se cuantificaron las muertes, los eventos de salud, el costo directo de la atención médica y el costo indirecto de la pérdida de productividad. Se desarrolló un modelo para estimar las ganancias sanitarias y económicas a partir de escenarios de aumento de impuestos a diez años. Los datos sobre la prevalencia del tabaquismo, la estructura demográfica brasileña, la mortalidad y la morbilidad se obtuvieron de bases de datos oficiales y de la literatura. Los recursos sanitarios utilizados se obtuvieron de la literatura y consultas con especialistas. El tabaquismo causó 174.000 muertes y 5,7 millones de años de vida perdidos por muerte prematura y discapacidad. La carga económica fue de BRL 153 mil millones, de los cuales BRL 67 mil millones se atribuyeron a costos directos y BRL 45 mil millones a costos indirectos. El costo del cuidador informal alcanzó los BRL 41 mil millones. En el escenario con el mercado ilegal de productos de tabaco, un aumento del 50% en el precio de los cigarrillos tiene el potencial de generar beneficios económicos de BRL 161 mil millones en diez años. La Reforma Tributaria actualmente en curso es oportuna para que el país tenga una política permanente de precios e impuestos.

53. Public accountability and health policy: the case of the 60-day Law in ensuring access to breast cancer treatment in São Paulo State.

期刊: Einstein (Sao Paulo, Brazil) 发表日期: 2026 链接: PubMed

摘要

This article analyzed the impact of Law No. 12,732/2012 on breast cancer care in São Paulo State (Brazil) between 2013 and 2024, as well as the role of external oversight. This qualitative-quantitative study used 58,892 records from the São Paulo Oncocenter Foundation database and cases judged by the São Paulo State Court of Accounts. The analysis revealed significant and persistent delays in diagnosis (31.3-66.8%) and treatment initiation (38-72%) across all Regional Health Directorates, although delays fluctuated over time, no consistent trend toward reduced delays was observed between the 2013-2024 period. The São Paulo State Court of Accounts, as an external oversight mechanism, focused on formal analyses rather than results-oriented evaluations, particularly regarding the identified delays. Our findings led us to conclude that the 60-day Law has had a limited impact in ensuring timely access to breast cancer diagnosis and treatment in the state, as delays have remained high and have not consistently improved over time. It is recommended that external control strategically strengthen this public policy by inducing managerial accountability and ensuring the right to access and comprehensive care.

54. From Brazil to Japan: war, education and circulation of knowledge in the travels of Robert King Hall, 1940-1946.

期刊: Historia, ciencias, saude–Manguinhos 发表日期: 2026 链接: PubMed

摘要

This article analyzes the relationship between observations by the American educator Robert King Hall on the national integration of immigrants in Brazil and his proposals for education in postwar Japan. Hall’s 1940 trip to Brazil under the aegis of the Good Neighbor Policy exposed him to Japanese teaching methods, knowledge which equipped him to subsequently participate in educational reforms in occupied Japan. In line with studies on the circulation of knowledge, this analysis addresses Hall’s work on Brazilian and Japanese education, and argues that his experience in Brazil was important for his role as an intellectual in the service of the US government.

55. Association of clinical consequences of untreated caries in early childhood with oral health-related quality of life.

期刊: Revista brasileira de epidemiologia = Brazilian journal of epidemiology 发表日期: 2026 链接: PubMed

摘要

To evaluate the association between the pulp involvement, ulceration, fistula, abscess (PUFA) index and oral health-related quality of life (OHRQoL) of 5-year-old Brazilian children. This was a cross-sectional, population-based study using data from the oral health survey SB Brasil 2023. A total of 7,198 children examined by trained teams were included. The exposure variable was the presence of clinical consequences of untreated caries in primary teeth, assessed by PUFA. OHRQoL was assessed using the SOHO-5 instrument for 5-year-olds. The analysis considered a complex sampling design, using Poisson regression to estimate prevalence ratios (PR) and linear regression. The prevalence of clinical consequences of untreated caries (PUFA≥1) was 41.1%, with a higher prevalence among Black, Brown, Asian, and Indigenous children compared to White children. Attending school (PR 0.69; 95%CI 0.53-0.90) and a family income above R$ 4,000.00 (PR 0.59; 95%CI 0.42-0.84) showed a protective effect. The North and Central-West regions had higher prevalence rates than the Southeast. and OHRQoL was worse among children of mixed race and indigenous descent compared to those of white skin color. Furthermore, children with dental caries had a 1.44-point higher OHRQoL score (β=1.44; 95%CI 1.01-1.86), which indicates a worse OHRQoL. The clinical consequences of untreated dental caries have a negative impact on the OHRQoL of Brazilian children, influenced by social and racial determinants. These findings reinforce the need for public policies aimed at reducing regional inequalities and expanding oral health promotion and prevention actions.

56. Feasibility of a generative AI chatbot to support breastfeeding in the Brazilian Unified National Health System.

期刊: Cadernos de saude publica 发表日期: 2026 链接: PubMed

摘要

This exploratory feasibility study aimed to evaluate the usability, user experience, and preliminary impacts of a generative language model-based chatbot (Lhia 2.0) on maternal self-efficacy and attitudes toward breastfeeding. A total of 13 mothers receiving care at the Human Milk Bank of the University Hospital of the Federal University of Maranhão interacted with the chatbot via WhatsApp over 15 days. The following instruments were applied before and after the use of Lhia 2.0: the Breastfeeding Self-Efficacy Scale - Short Form (BSES-SF) and the Iowa Infant Feeding Attitude Scale (IIFAS). The User Experience Questionnaire - Short Version (UEQ-S) was applied after the interaction. Results indicated excellent usability (pragmatic quality = +2.36; hedonic quality = +2.57) and high engagement (average interaction time = 92 minutes). Statistically significant improvements were observed in BSES-SF (mean difference = 3.00; p = 0.042; Cohen’s d = 0.778) and in IIFAS (mean difference = 3.50; p = 0.021; Cohen’s d = 0.778). The results indicated high acceptance among mothers, with notable user engagement, excellent perceived usability, and positive effects on confidence and attitudes toward breastfeeding. Based on these findings, Lhia 2.0 is considered a feasible and promising tool for integration into breastfeeding promotion strategies, particularly within the context of the Brazilian Unified National Health System.

57. The effect of a mobile application-based music intervention on pain levels and analgesic consumption following surgery: a randomized controlled trial.

期刊: Revista da Associacao Medica Brasileira (1992) 发表日期: 2026 链接: PubMed

摘要

The aim of this study was to evaluate the effect of mobile application-based musical tonalities delivered at different times of day on postoperative pain and analgesic consumption after orthopedic trauma surgery. This randomized controlled study included 80 patients undergoing orthopedic trauma surgery at a university hospital. Tonalities (Rast, Nihavend, Neva) were delivered via an Android-based mobile application in the morning (T1), afternoon (T2), and evening (T3). Pain was assessed using the Numerical Rating Scale, and analgesic consumption was recorded. Baseline characteristics were largely comparable; however, body mass index (p=0.002) and marital status (p<0.001) differed between groups. Pain scores decreased significantly over time in both groups (p<0.001). After Bonferroni correction, baseline pain did not differ between groups, whereas post-intervention pain scores differed at all post-intervention time points (T1b, T2b, T3b; p<0.0083), with lower scores in the control group. Analgesic consumption did not differ significantly between groups (p>0.05). In robust regression analyses controlling for baseline Numerical Rating Scale, body mass index, and marital status, the intervention group showed significantly higher Numerical Rating Scale scores at all measurement times, and baseline Numerical Rating Scale was the strongest predictor of postoperative pain. Postoperative pain decreased over time in both groups, and baseline pain level was the strongest determinant of postoperative pain perception; no significant between-group difference was observed in analgesic consumption.

58. Development of a Nomogram for Predicting Hospital-Acquired Pressure Injuries Risk in Cardiovascular Intensive Care Unit Patients: A Comparison Cohort Study.

期刊: Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society 发表日期: 链接: PubMed

摘要

The purpose of this study was to establish a nomogram model for predicting the hospital-acquired pressure injury (HAPI) occurrences in patients receiving care in a cardiovascular intensive care unit (CICU). Comparison Cohort study. A review of medical records identified 260 patients that were randomly divided into 2 groups. One group provided a dataset for an AI program to determine the nomogram, (n = 208) and a second group (n = 52) used to test the predictive power of the algorithm. The study setting was Wuhan University, located in central China. We examined the electronic medical records of patients cared for in our CICU between January 2023 and June 2023. Factors associated with HAPI occurrences were identified using univariate and multivariate logistic regression analyses, and the screened indicators were integrated into a nomogram. The effectiveness of the nomogram was evaluated and verified using receiver operating characteristic curve and decision curve analysis. Univariate and multivariate logistic regression analysis showed that vasopressor use (OR = 2.54, 95% confidence interval [CI] = 1.18-5.46, P = .017), B-type natriuretic peptide (OR = 2.85, 95% Cl = 1.35-6.03, P = .006), elevated lactic acid levels (OR = 12.18, 95% Cl = 4.96-29.95, P < .001), elevated procalcitonin levels (OR = 1.22, 95% Cl = 1.02-1.46, P = .033), and low albumin levels (OR = 0.84, 95% Cl = 0.76-0.93, P < .001) emerged as independent risk factors for HAPI occurrences in the CICU. Based on these factors, we established a nomogram for predicting the risk of HAPI risk in patients cared for in a CICU. The nomogram was well calibrated and showed good discriminative ability (AUC = 0.868). The nomogram model developed in this study demonstrated good predictive capability for predicting CICU patients at risk of developing HAPIs. Findings from this study also have the potential to guide preventive interventions.

59. Dermalix enhances angiogenesis and collagen remodeling in an ischemic colon anastomosis rat model.

期刊: Acta cirurgica brasileira 发表日期: 2026 链接: PubMed

摘要

To evaluate the effect of Dermalix on anastomotic healing in a rat model of ischemic colon anastomosis. Forty rats were divided into three groups: negative control (n = 10), control (n = 15), and experimental (n = 15). Only laparotomy was performed in the negative control group. In the control group, ischemia and end-to-end colon anastomosis were performed, while in the experimental group, Dermalix was applied circumferentially around the anastomosis. On postoperative day 7, anastomotic segments were evaluated for burst pressure, adhesion, and histopathological parameters. Abscess formation related to anastomotic leakage occurred in two rats in the control group and in one rat in the experimental group. Mean burst pressure was 134.7 mmHg in the control group and 194.7 mmHg in the experimental group (p = 0.005). No significant differences were observed in inflammation, epithelial regeneration, or granulation tissue formation. Neovascularization (p < 0.001) and collagenization (p = 0.032) were significantly higher in the Dermalix group. There was no significant difference in adhesion or foreign body reaction. Dermalix improved key histological and mechanical indicators of anastomotic healing under ischemic conditions, providing preliminary evidence of its potential as a bioactive adjunct. Further studies are warranted to confirm these findings and assess clinical relevance.

60. Astaxanthin alleviates autophagy, inflammation, and oxidative stress in ventilator-associated lung injury rats by inhibiting MAPK/ERK1/2 pathway.

期刊: Acta cirurgica brasileira 发表日期: 2026 链接: PubMed

摘要

Improper use of mechanical ventilation may result in ventilator-induced lung injury (VILI). This work seeks to explore the preventive impact of astaxanthin on VILI. In this study, we established the VILI rat and drug intervention model, then evaluated lung tissue damage by observing the appearance and hematoxylin-eosin staining. Oxidative stress was evaluated by determining the levels of myeloperoxidase, catalase, and malondialdehyde. Our data showed that, compared with the control group, mechanical ventilation increased the mRNA and protein expression levels of interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF)-α, LC3II/I, and Beclin1, as well as the phosphorylation level of ERK1/2 in the lung tissues of VILI rats (p < 0.0001), while the expression level of P62 protein decreased (p < 0.0001). After pretreatment with astaxanthin, autophagy and inflammatory response were significantly reduced. The phosphorylation of ERK1/2 was also inhibited. Notably, these effects were reversed after using the p-ERK agonist Ro67-7476. Astaxanthin can inhibit autophagy levels and suppress inflammation and oxidative stress in mechanically ventilated rat lung tissue through inhibiting the MAPK/ERK signaling pathway, thus alleviating lung tissue injury. Therefore, astaxanthin may represent a promising preventive strategy for VILI.