公共卫生研究摘要 (2026-07-04)

共收录 54 篇研究文章

1. [Coordination of self-employed community healthcare professionals with the public healthcare system. SESPAS Report 2026].

期刊: Gaceta sanitaria 发表日期: 2026-Jul-03 链接: PubMed

摘要

Embedded in Spanish neighborhoods and towns, there are hundreds of thousands of self-employed healthcare professionals who provide services within the private sector. In the absence of an official term, they are referred to here as “self-employed community healthcare professionals”, as they practice within a community setting with a high degree of proximity to patients, participate to varying extents in health promotion activities, and operate independently from large organizations. Healthcare provision, whether public or private, has an impact on patients. It would therefore be reasonable for a regulated exchange of information to exist, allowing, when necessary and in accordance with the legal framework, collaboration for their benefit. In this context, it is important to better understand the reality of healthcare services delivered by self-employed professionals and the extent to which coordination with public healthcare exists, if any. Although the available knowledge about these services is limited, in most cases there is a low degree of coordination and/or collaboration with other healthcare professionals, both public and private. Despite the millions of interventions carried out, very few are captured within the electronic health record of the Spanish National Health System, resulting in two parallel and largely disconnected systems coexisting within the same territory, with minimal coordination as patients move between them. Pilot initiatives and statements from some professional groups suggest the need to integrate communication and collaboration systems to optimize patient care.

2. Water management practices under climate and infrastructure stress in Zaatari Refugee Camp: A gendered qualitative study.

期刊: International journal of hygiene and environmental health 发表日期: 2026-Jul-03 链接: PubMed

摘要

Climate change-related heatwaves and dust storms increasingly strain water, sanitation, and hygiene (WaSH) systems in displacement settings, yet little is known about how households manage water scarcity during acute climate events. Gendered roles and responsibilities in refugee camps may further influence how water scarcity is managed. This study examines how household water management practices intersect with psychosocial stress during extreme summer conditions in Zaatari Refugee Camp, Jordan. We conducted a qualitative study using gender-stratified focus group discussions with adult Syrian refugees in Zaatari Refugee Camp. Semi-structured focus groups explored experiences of water access, household water management, and stress during summer heatwaves and dust storms. Data were analyzed using inductive thematic analysis with participatory validation involving refugee co-facilitators. Participants described uneven WaSH system functioning driven by timing, pressure, and geographic location, alongside predictable summer reductions in water supply and increased demand during heatwaves and dust storms. Households and individuals employed creative water conservation strategies that were effective but amplified stress through sustained vigilance and restriction. Importantly, women more frequently reported responsibility for monitoring, rationing, and enforcing water use, alongside greater psychosocial strain, while men described episodic stress related to system failures or water procurement. In displacement contexts, water scarcity functions as a chronic psychosocial stressor shaped by infrastructure, acute climate events, and gendered household responsibilities. Addressing water insecurity in protracted displacement settings requires integrated WaSH approaches that extend beyond infrastructure to include mental wellbeing, gender-responsive programming, and meaningful engagement of refugees as lived-experience experts in governance and intervention design.

3. PM2.5-bound organophosphate esters and childhood attention-deficit hyperactivity disorder symptoms: A population-based study from China.

期刊: Neurotoxicology 发表日期: 2026-Jul-03 链接: PubMed

摘要

The association between childhood exposure to PM2.5-bound organophosphate esters (OPEs) and attention deficit hyperactivity disorder (ADHD) remains poorly understood. In this large population-based study of 131,412 children aged 6-18 years attending schools in the Pearl River Delta, China, we collected ambient fine particulate matter (PM2.5) samples from schools to quantify OPEs levels, and screened for ADHD symptoms using parent-reported ADHD/Diagnostic and Statistical Manual of Mental Disorders (DSM-Ⅳ) Scales. We employed elastic net regression for variable selection, generalized linear mixed models (GLMMs) for association estimates, and weighted quantile sum regression to evaluate mixture effects. Odds ratios (ORs) are expressed as the change in odds of ADHD symptoms per interquartile range (IQR) increase in OPE levels. Elevated PM2.5-bound OPE exposure was associated with higher odds of ADHD symptoms in children, especially for triphenyl phosphate (TPHP) (OR = 1.75, 95% CI: 1.70-1.79), tris(2-ethylhexyl) phosphate (TEHP) (OR = 1.73, 95% CI: 1.69-1.77), tris(1,3-dichloroisopropyl) phosphate (TDCIPP) (OR = 1.71, 95% CI: 1.67-1.75), and tris(3,4-dimethylphenyl) phosphate (T34DMPP) (OR = 1.45, 95% CI: 1.41-1.49). Similar associations were observed across different ADHD subtypes. Stratified analyses indicated heterogeneous associations across age, sex, and breastfeeding subgroups, with no consistent pattern of effect modification across all OPE exposures. These findings suggest that inhalation of OPE mixtures may be associated with adverse neurodevelopmental outcomes in children, highlighting a potential developmental window of susceptibility and raising public health concerns about airborne contaminants.

4. Dilemmas, decision-making, and ensuing consequences experienced by parents in the immediate aftermath of preverbal child sexual abuse by a daycare employee: A qualitative study.

期刊: Child abuse & neglect 发表日期: 2026-Jul-03 链接: PubMed

摘要

In 2010, a male daycare employee and private babysitter was suspected of having sexually abused over 150 infants and toddlers in what became known as the Amsterdam Sexual Abuse Case (ASAC). In the immediate aftermath, parents faced challenging decisions about their children’s and their own well-being. To explore dilemmas faced by parents in the direct aftermath of preverbal child sexual abuse (CSA) discovery, their decision-making considerations, and the resulting consequences. We conducted eighteen in-depth interviews with 21 parents of 19 of the children involved in the ASAC, analyzing them thematically with semantic and interpretive elements. We identified three immediate dilemmas. First, parents doubted whether or not to inform others (e.g., family, friends, school staff) of the CSA-balancing potential stigma against the need for support. Second, parents hesitated about whether or not to make use of professional support services-wavering between fears of distressing their child and their desire to aid recovery. Third, they deliberated legal action-balancing privacy concerns with a desire to pursue justice. Parents experienced both negative and positive consequences from their decisions. The discovery of preverbal CSA forced parents to make decisions with potentially significant ramifications while in crisis. This study may help professionals better understand parental dilemmas and provide support that meets families’ as they navigate the immediate aftermath of CSA discovery. Future research should explore long-term impacts on parental decision-making to deepen understanding of findings.

5. Harnessing Multiteam Systems in the Development of a Multifaceted Data Repository for Emergency Public Health Response.

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

摘要

The NIH launched the Rapid Acceleration of Diagnostics (RADx) Initiative to facilitate timely, accurate, and accessible COVID-19 testing, research, and data sharing. The RADx Data Hub (hereafter referred to as Data Hub) is a centralized repository developed to enable secure access and secondary analysis of curated, de-identified data across RADx Initiative programs. Implementing this Data Hub required extensive nested multiteam system collaboration and alignment. Here, we describe the nested multiteam system framework that effectuated data access within a global crisis as a model for future public health challenges. Our work highlights how structured team science methods can enhance the speed and efficacy of data assembly and distribution to accelerate response during public health crises.

6. Regional musculoskeletal pain in workers-is the traditional medical model increasing disability?

期刊: British medical bulletin 发表日期: 2026-Jul-03 链接: PubMed

摘要

Musculoskeletal disorders frequently cause work disability. For low back pain, a de-medicalized approach is advocated, whereas a biomedical approach is taken for shoulder and elbow/forearm pain. PubMed, Cochrane Library, Google Scholar. Guidelines for the management of low back pain recommend de-medicalization, rapid mobilization, avoidance of imaging, second-line use of pharmacological treatments, and an emphasis on self-management and remaining in or rapidly returning to work. Despite evidence for many treatment modalities, shoulder pain and elbow/forearm pain are still managed using a biomedical model that separates conditions into distinct diseases and treats them accordingly. Should pain at the shoulder and elbow/forearm be de-medicalized, with greater emphasis on maintaining mobility and work participation? Testing integrated occupational and health interventions for musculoskeletal disorders, focusing on their effectiveness in work rehabilitation and reducing disability.

7. Single-stapling versus double-stapling technique for rectal anastomosis-meta-analysis.

期刊: BJS open 发表日期: 2026-Jul-03 链接: PubMed

摘要

The single-stapling technique (SST) is an alternative to the conventional double-stapling technique (DST), particularly in low rectal surgery. This systematic review and meta-analysis compared anastomotic leak (AL) between SST and DST. A systematic review of the PubMed/MEDLINE, Google Scholar®, and Scopus databases was conducted in accordance with PRISMA guidelines from inception through December 2025. The primary outcome of interest was AL. A random-effects meta-analysis was used to compare AL, blood loss, operative time, and length of hospital stay between SST and DST. Risk ratios (RRs) were calculated for dichotomous outcomes and mean differences or standardized mean differences were calculated for continuous outcomes. Sensitivity and subgroup analyses were conducted according to surgical approach. Risk of bias was assessed, and the certainty of the evidence for AL was evaluated using the GRADE framework. Of 448 articles screened, 14 were included (2 randomized, 12 observational studies), comprising 1326 patients in the SST group and 1720 in the DST group. SST was associated with a significantly lower risk of AL than DST (RR 0.61; 95% confidence interval 0.42 to 0.90; P = 0.012), with moderate heterogeneity. Sensitivity analysis excluding studies with zero events yielded consistent results. Subgroup analyses showed no difference in AL for open intracorporeal SST compared with DST, a trend toward benefit with minimally invasive intracorporeal SST compared with DST, and a pronounced reduction in AL with transanal SST compared with DST. Although the causes of AL are multifactorial, with respect to the stapling technique, SST was associated with a lower risk of AL than DST, and this effect was primarily driven by transanal SST. However, the certainty of evidence is low, and ongoing prospective studies will better define the role of SST.

8. Development of a predictive model for postoperative body mass index and diabetes outcomes after metabolic bariatric surgery: retrospective cohort study.

期刊: BJS open 发表日期: 2026-Jul-03 链接: PubMed

摘要

Predicting postoperative body mass index (BMI) trajectories and long-term type 2 diabetes (T2D) remission after bariatric surgery remains challenging. Existing models often rely on baseline variables only and fail to incorporate dynamic postoperative changes. This study aimed to develop and validate a multicentre machine-learning framework that predicts individualized BMI trajectories and T2D remission using routinely available preoperative data and time-dependent weight evolution. This multicentre retrospective cohort study included adult patients who underwent Roux-en-Y gastric bypass or sleeve gastrectomy across 11 European centres (2012-2023). Variables with > 30% missing data were excluded; remaining missing values were imputed iteratively. A two-stage approach was used: a regression model predicting postoperative BMI at 3-60 months using an autoregressive design; and a classification model predicting T2D remission using baseline features and predicted BMI trajectories. Internal performance was evaluated with ten-fold and leave-one-clinic-out cross-validation; external validation used an independent cohort from Linköping, Sweden. Of the 11 457 patients initially identified, 9652 patients with complete baseline and follow-up information were used for the analysis. The best BMI model (HistGradientBoosting) achieved a root mean square error (RMSE) of 1.11 kg/m2 (95% confidence interval 1.07 to 1.14) and a mean absolute error (MAE) of 0.62 kg/m2 across clinics; external testing showed an RMSE of 1.12 kg/m2 (95% confidence interval 1.11 to 1.12) and an MAE of 0.63 kg/m2. The T2D remission classifier (XGBoost) obtained a Macro F1 score of 0.88 (precision 0.87, recall 0.88), with an external F1 score of 0.89. Incorporating predicted BMI trajectories improved discrimination compared with baseline-only models (C-index 0.95 versus 0.93). A two-stage machine-learning framework has high predictive performance for postoperative BMI and T2D remission up to 5 years after bariatric surgery. Dynamic incorporation of predicted weight trajectories enhances metabolic risk prediction and supports individualized counselling and postoperative management.

9. Detecting and Preventing Fraudulent Participation in Qualitative Research: Content Analysis of Two Multisite Studies.

期刊: Journal of medical Internet research 发表日期: 2026-Jul-03 链接: PubMed

摘要

The use of web-based approaches to identify, recruit, enroll, survey, and interview health-related research participants has increased over time, with rapid acceleration since the COVID-19 pandemic. These approaches can make research more accessible to a broader population, but also increase the risk of fraudulent or imposter participants infiltrating research studies. While this threat has been discussed extensively in quantitative survey research, less has been reported in qualitative and mixed methods studies. This study aims to identify recurring patterns of fraudulent study participation and to offer strategies for identification, remediation, and reporting. Encounters with fraudulent or imposter individuals during recruitment, enrollment, survey distribution, data collection, and focus group sessions in 2 multisite qualitative and mixed methods research studies are presented. Content from both studies was analyzed to identify common themes and develop strategies for prevention and remediation. Investigators across 2 multisite studies observed several indicators of suspected fraudulent activity, including large response volumes over a short period, highly repetitive email addresses, higher-than-expected proportions of phone numbers with area codes outside the study area, and unusual email/phone responses using atypical language and phrasing. Several imposter or fraudulent individuals disrupted online focus group sessions. To mitigate these issues, both studies implemented remediation strategies, including enhanced screening procedures at baseline, cross-checking of survey responses, and additional identity verification methods prior to participation. Studies took various actions to address these experiences, including notifying the institutional review board, recruitment platforms, and funders. This multisite study identified multiple ways that imposter or fraudulent participants can pose a significant and evolving threat to the integrity of qualitative and mixed methods. These types of fraudulent actors can distort data and undermine research credibility. Lessons learned highlight the importance of real-time recruitment and enrollment analysis and the need for transparent reporting. Addressing this issue will require a comprehensive approach to prevent and address fraudulent study participation that includes collaboration with multiple stakeholders and the broader research community to effectively address this issue.

10. The Rise in Homemade Sunscreen Trends and Future Impacts on Skin Cancer Risk: Systematic Review.

期刊: JMIR dermatology 发表日期: 2026-Jul-03 链接: PubMed

摘要

The trend of homemade sunscreen recipes has rapidly gained popularity over the last decade, being largely fueled by social media influencers, natural health blogs, and the growing mistrust of large health organizations like the US Food and Drug Administration (FDA). Consumers are increasingly drawn to products labeled “natural,” “organic,” “vegan,” and “cruelty-free,” often conflating these terms with safety and effectiveness. However, when applied to sun protection, these assumptions can be dangerously misleading. According to the FDA, there is no verified mathematical formula that can be used to determine an accurate sun protection factor (SPF) rating for the amount of zinc oxide used in many of the recipes found online. The objective of this review is to examine the rising popularity and efficacy of homemade sunscreens compared to commercial sunscreens and highlight the potential public health implications of skin cancer risk related to homemade sunscreen use. Multiple databases were searched to find current and relevant literature analyzing the social media impact relating to homemade sunscreens and the efficacy of homemade sunscreens compared to commercially available products. Digital content that included or discussed homemade sunscreen recipes was included as well to provide examples of information trending online. One study analyzing social media trends found that many strong, unverified claims relating to homemade sunscreen versus commercial sunscreen use are being presented in the media, potentially influencing public knowledge. Additional studies analyzing the components of homemade sunscreen recipes compared to components in commercially available products found that homemade sunscreens offer little to no sun protection, therefore increasing the risk of UV damage for individuals using homemade products. Based on the presented evidence, the adoption of unregulated homemade sunscreens presents a substantial threat to public health. Misinformation spread through social media and influencer culture may unintentionally contribute to an increase in UV-related skin cancers. Greater efforts are needed from health care professionals, regulatory bodies, and online platforms to educate the public and promote the use of scientifically validated sun protection methods.

11. Fine particulate matter exposure and long-term lung-function trajectory in adults with cystic fibrosis.

期刊: Annals of the American Thoracic Society 发表日期: 2026-Jul-03 链接: PubMed

摘要

Exposure to fine particulate matter (PM2.5), a major component of ambient air pollution, is associated with worse short-term respiratory outcomes in cystic fibrosis (CF). The relationship between air pollution exposure over time and lung disease progression in CF is unknown. To elucidate how PM2.5 affects the rate of age-related decline in forced expiratory volume in one second (FEV1) among adults with CF. Retrospective open cohort study of pwCF ≥ 26 years in the U.S. CF Foundation Patient Registry between 2003-2019. Annual average PM2.5 was estimated at the population-weighted center of each participant’s zip code using a spatiotemporal model. We examined the effect of PM2.5 on the age-related change in FEV1 z-score by mixed effects linear regression, adjusting for relevant demographic and clinical covariates, and stratifying by 5-year cohorts of birth year to account for secular improvements in FEV1 and PM2.5 over time. 11,392 adults with CF age ≥ 26 contributed 81,944 person-years of follow-up. Mean ambient PM2.5 levels over the study period were 9.1 µg/m3 (7.5-10.4). The average annual age-related change in FEV1 z-score was -0.057 (95% CI -0.081, -0.033). After covariate adjustment, we did not find evidence of an adverse association between PM2.5 and annual change in FEV1 z-score in the overall cohort [+0.002 per 3 µg/m3 change in PM2.5 (95% CI -0.001, 0.005)] or across birth cohorts. In this large U.S. study, we did not detect an effect of ambient PM2.5 exposure at the zip code level on long-term lung function trajectory in adults with CF. Consideration of other windows of potential vulnerability to exposure, such as during childhood, may help further explain the relationship between air pollution and long-term outcomes in CF. Cystic Fibrosis Foundation, CIR Northwest, Seattle Children’s Research Institute.

12. Population-Level Coexistence of Smoking and Vaping Across the Life Course in Australia: Implications for Midlife and Ageing-Related Health Burden.

期刊: Journal of applied gerontology : the official journal of the Southern Gerontological Society 发表日期: 2026-Jul-03 链接: PubMed

摘要

ObjectivesThis study examines how smoking and vaping are distributed across the life course in Australia and evaluates whether population-level patterns are consistent with substitution or coexistence, providing a life-course perspective on nicotine exposure and ageing-related health burden.MethodsUsing nationally representative, cross-sectional data from the Australian Bureau of Statistics National Health Survey 2022, population-weighted prevalence of current smoking and vaping was analysed across age and sex groups using a descriptive framework. Absolute differences and vaping-to-smoking prevalence ratios were computed, with robustness checks using alternative age groupings.ResultsVaping prevalence exceeds smoking only among adolescents aged 15-17 years. From early adulthood onward, smoking prevalence remains higher at all ages, with the gap widening across the life course. Among adults aged 45-64 years, smoking exceeds vaping by 11.7 percentage points. Patterns are consistent across sex and alternative specifications.ConclusionsSmoking and vaping coexist in an age-structured pattern rather than indicating population-level substitution, demonstrating that newer nicotine products have not displaced smoking among adult cohorts. Smoking-related risk therefore remains concentrated among populations entering later life.Implications for Public HealthThese findings challenge assumptions that vaping is reducing smoking-related harm at the population level and highlight the need for age-targeted policy responses. Tobacco control should adopt a dual strategy combining youth vaping prevention with targeted smoking cessation for midlife adults to reduce future ageing-related health burden.

13. Behavioral health providers' prioritization of tobacco and marijuana concerns during the COVID-19 pandemic: A grounded theory analysis.

期刊: Journal of health psychology 发表日期: 2026-Jul-03 链接: PubMed

摘要

Given the high co-occurrence of tobacco, marijuana use, and mental health disorders, we explored behavioral health providers’ perceptions of patient mental health and substance use during the COVID-19 pandemic. We conducted semi-structured interviews with 21 Ohio providers randomly sampled from state licensure records, analyzing data using constructivist grounded theory. Providers perceived broad increases in substance use and mental health symptoms, attributing these to isolation, reduced support access, and pandemic-related stress. Providers consciously de-prioritized tobacco and marijuana to focus on “more acute” concerns. Substance use providers emphasized “riskier” substances while mental health providers prioritized severe psychiatric symptoms. Tobacco was often excluded from abstinence frameworks due to its normalization in recovery settings. These findings highlight the need for targeted provider training, organizational policy reform, and educational interventions to address the systematic deprioritization of tobacco and marijuana in behavioral health settings, with implications extending beyond the COVID-19 pandemic to future public health crises.

14. Beyond Cash: Associations Between Social Security Benefits, Healthcare Accessibility, and Psychological Health Among Older Adults in Tanzania.

期刊: Journal of aging and health 发表日期: 2026-Jul-03 链接: PubMed

摘要

ObjectivesSocial security benefits are associated with better psychological health among older adults in resource-limited settings, yet the mechanisms underlying this association remain underexplored. We examined the role of healthcare accessibility in the relation between social security benefits and psychological health among older adults in Tanzania.MethodsWe analyzed cross-sectional data from a 2024 survey of Tanzanian adults aged 60 and above (n = 2,012) in four geographic zones. We examined associations using structural equation modeling (SEM) with bias-corrected bootstrapping (5,000 replications). Social security benefits (combining pension and health insurance receipt), self-reported healthcare accessibility, and psychological health (a composite of anxiety and depression symptoms) were included as primary variables.ResultsSocial security benefit receipt was significantly associated with better psychological health (β = -0.106, BCCI: -0.152, -0.060, p < 0.001). Healthcare accessibility was positively associated with psychological health and showed a significant association with the relationship between social security benefits and psychological health (β = -0.057, BCCI: -0.092, -0.022, p < 0.01), consistent with an indirect association in this cross-sectional analysis.ConclusionsHealthcare accessibility plays a significant role in the relation between social security benefits and psychological health, suggesting a pathway through which social security benefits may influence psychological health beyond direct financial mechanisms. These findings point to potential policy considerations, including administrative coordination between pension and health insurance schemes and interventions to improve healthcare accessibility for older adults. For low- and middle-income countries facing rapid population aging, integrated approaches to social security benefits and health systems may help maximize the health returns of social investments.

15. Prevalence and clinical characteristics of Terson syndrome among survivors of aneurysmal subarachnoid hemorrhage: a nationwide study in Japan.

期刊: Japanese journal of ophthalmology 发表日期: 2026-Jul-03 链接: PubMed

摘要

To investigate the characteristics of Terson syndrome (TS) among survivors of aneurysmal subarachnoid hemorrhage (aSAH). Retrospective study METHODS: Using the Japanese Diagnosis Procedure Combination database, we identified patients diagnosed with aSAH at admission between July 1, 2010 and March 31, 2023 in Japan. The prevalence of TS in aSAH survivors was examined, along with comparisons of patient backgrounds between survivors with TS and those without TS. We compared the characteristics and outcomes in patients with TS who underwent vitrectomy with those in patients who did not, and analyzed the laterality of the surgery. Among 143,058 patients with aSAH, 104,576 (73.1%) survived. TS was diagnosed in 860 (0.8%) survivors. The patients with TS were younger (mean [standard deviation, SD] age: 53.3 [11.4] vs 64.0 [14.6] years) than those without TS. Among the patients with TS, 243 (28.3%) patients underwent vitrectomy during hospitalization, with a median interval of 38 days from admission to surgery. Of the patients with TS who underwent vitrectomy, 160 (66.4%) and 81 (33.6%) patients underwent unilateral and bilateral vitrectomy, respectively. In this retrospective study, the prevalence of TS among aSAH survivors was less than 1%. Vitrectomy was performed in approximately one-third of the patients with TS, with one-third of these patients undergoing bilateral surgery during hospitalization.

16. "In My Community, if You're an Addict, People Don't Just Look Down on You for the Drugs, but for Being Black, Too": Black and Latine Methadone Patients' Experiences Around Addiction, Methadone Treatment, and Intersectional Stigma.

期刊: Journal of racial and ethnic health disparities 发表日期: 2026-Jul-03 链接: PubMed

摘要

Stigma surrounding opioid use disorder (OUD) and medications for opioid use disorder (MOUD), such as methadone, remains a significant barrier to care, despite the effectiveness of MOUD. Intersectional stigma tied to addiction, methadone treatment, structural racism, and classism disproportionately affects minoritized people with OUD, with direct consequences for health and wellbeing. Less is known about how Black and Latine people in methadone treatment think about and experience various dimensions of stigma related to addiction and the social determinants of health. Semi-structured interviews were conducted with Black and Latine patients from two Newark, NJ, United States, methadone clinics (n = 37). Participant experiences and perceptions around SUD, MOUD, and stigma were explored. Participant transcripts were thematically coded to identify recurring themes and perspectives. Three major themes emerged: First, participants rejected views of addiction as a choice or moral failing, instead framing addiction as a chronic disease shaped by environment, trauma, and social pressure. Second, participants framed methadone as a legitimate, recovery-facilitating medical treatment, directly challenging the stigma that reduces it to a mere substitute. Third, participants emphasized that intersectional stigma related to substance use, structural racism, and classism significantly harmed their care, particularly noting resource deficits that disproportionately neglect Black and Latine communities. Reducing structural stigma is critical to improving access to MOUD for populations affected by structural inequity. Institutional efforts to reduce stigma and expand low-threshold programs are critical to expanding MOUD access and uptake. Intentional efforts to build trust with minoritized populations are essential to advance equity and can be achieved by acknowledging and addressing the structural drivers that shape people’s daily lived experiences.

17. Adoption of Telemedicine in Low-Resource Settings Through the Lens of Frugal Innovation: Protocol for a Systematic Review.

期刊: JMIR research protocols 发表日期: 2026-Jul-03 链接: PubMed

摘要

Access to health care, especially in low-resource settings, remains a critical challenge for marginalized and underserved populations. Telemedicine, delivering medical advice remotely, has the potential to improve access to health care by reducing geographic and economic barriers. Its adoption, however, especially in low-resource settings, remains limited. Frugal innovation, characterized by solutions developed under tremendous resource constraints and prioritizing affordability, accessibility, and simplicity, offers valuable insights for enhancing telemedicine adoption. Rooted in a sociocultural approach, it is particularly relevant in low-resource health systems where complex, intersectoral challenges occur. Despite this potential, insights from frugal innovation have not been compared, contrasted, or studied alongside telemedicine in a systematic way. Our review aims to examine how frugal innovation contributes to the adoption of telemedicine in low-resource settings, with a particular focus on identifying frugal innovation characteristics that facilitate telemedicine adoption. Our PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-guided systematic review will examine case studies of adopted telemedicine applications in low-resource settings. Eligible studies need to demonstrate evidence of adoption and use in real-world health care settings. We will examine functions and features of telemedicine, along with frugal innovation characteristics, as demonstrated by each telemedicine application. The following databases were searched: MEDLINE ALL, Embase, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, CINAHL, PsycInfo, Scopus, Dimensions, IEEE Xplore Digital Library, EconLit, the International HTA Database, LILACS (Latin American and Caribbean Literature on Health Sciences), the World Health Organization (WHO) Global Index Medicus, and the WHO Global Health Observatory. Insights from our review will deepen the understanding of how health care technologies such as telemedicine can be positioned and configured to improve adoption in low-resource settings. Search results, delivered in February 2025, were followed by title and abstract screening in March 2025, full-text screening in April 2025, and final study selection and quality appraisal by November 2025. With dataset updates requested in December 2025, the data synthesis remains ongoing. The expected results will be published in 2026. This combined assessment will examine how frugal innovation can contribute to the adoption of telemedicine in low-resource settings. As a result, we expect that our findings will contribute to the development of frugal telemedicine as a sociotechnical artifact. The protocol is submitted to enhance transparency and rigor.

18. Antibiotic Treatment Duration for Uncomplicated Monomicrobial Enterococcal Bloodstream Infection: A Multicenter Target Trial Emulation.

期刊: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 发表日期: 2026-Jul-03 链接: PubMed

摘要

Enterococcal bloodstream infection (BSI) is common with 30-day mortality rates approaching 25-30%, yet evidence guiding optimal antibiotic treatment duration, particularly for patients with uncomplicated infection, is limited. We conducted a retrospective cohort study using a target trial emulation framework across eight hospitals in Israel (2013-2023) of adults hospitalized with uncomplicated monomicrobial enterococcal BSI. Treatment strategies were defined as short (7±2 days) vs long (14±2 days) antibiotic therapy. A cloning-censoring-weighting framework with inverse probability of censoring weights was applied to account for immortal time bias and potential confounders. The primary outcome was 30-day all-cause mortality; secondary outcomes included 90-day all-cause mortality, recurrence, length of stay, readmission and Clostridioides difficile infection. Analyses were performed using pooled logistic regression and negative binomial regression models, with prespecified subgroup and sensitivity analyses. Of 3,450 patients with enterococcal bacteremia screened, 870 were eligible, and 485 received treatment durations consistent with the study treatment strategies (short n=283, long n=202). Mean age was 74 years (±15.0); 87/485 (18%) had pre-existing cardiac hardware, 164/485 (34%) a urinary source and 180/485 (37%) had nosocomial BSI. Adjusted analyses demonstrated no difference in 30-day mortality between short and long therapy (21.6% vs 21.3%; adjusted risk ratio 1.01, 95% confidence intervals [CI] 0.84 to 1.22). There was no evidence of differences across the secondary outcomes. Results were consistent across subgroup and sensitivity analyses. Short-course antibiotic treatment was associated with comparable clinical outcomes to long-course treatment in uncomplicated monomicrobial enterococcal BSI, supporting the use of short treatment durations in appropriately selected patients.

19. Involvement of the striped dolphin (Stenella coeruleoalba) melon in immune function: A histological and immunohistochemical study.

期刊: Acta histochemica 发表日期: 2026-Jul-03 链接: PubMed

摘要

The striped dolphin (Stenella coeruleoalba) is a small pelagic dolphin. The melon, present in most odontocetes, is a rounded structure located in the center of the forehead, between the blowhole and the tip of the head. The dolphin’s melon, as well as the blubber, consists of a lipid component similar to that of adipose tissue, with large, rounded cells closely related to each other and a muscular component. The melon primarily plays a role in echolocation, but this organ can also be involved in immune function. Numerous studies have demonstrated the accumulation of contaminants, such as heavy metals, in the fatty tissues of cetaceans (melon and blubber), which alter the immune system and stimulate an inflammatory response. This study aims to describe the involvement of Stenella coeruleoalba melon in immune function. Histological samples of the melon of Stenella coeruleoalba, were used in this study. To describe the morphology of this organ, the sections of the tissue were stained with Giemsa, Masson, and Mallory staining techniques. Immunoperoxidase and immunofluorescence techniques using specific antibodies such as MHC II, Langerin/CD 207, TLR2, and CD14 were used to characterize melon immune cells, providing novel insights into their immunological features. The results showed scattered immune cells among melon adipocytes immunoreactive to the tested antibodies; macrophages are the principal immune cells infiltrating adipose tissue, and their function is to secrete proinflammatory mediators. Furthermore, the adipocytes themselves appear to be labeled with the antibodies used. This study demonstrates the involvement of the dolphin melon in immune function, helping us better understand the immune system of cetaceans, which is still little understood. Furthermore, it could also demonstrate that analyses of blubber collected from deceased individuals of highly protected species can provide valuable information on their health status and exposure to contaminants.

20. Oral Health Promotion Among Students in Special Education Schools: Protocol for a Multicity Cluster Randomized Controlled Trial.

期刊: JMIR research protocols 发表日期: 2026-Jul-03 链接: PubMed

摘要

Children with disabilities attending special education schools face significantly higher risks of oral diseases, particularly dental caries, due to physiological, cognitive, and environmental challenges. However, school-based oral health interventions targeting this population are limited in China. This study aims to assess the effectiveness of fluoride varnish (FV) application, delivered alongside oral health education for parents and teachers, in improving the oral health of students in special education schools in Guangdong Province. This is a stratified, cluster randomized controlled trial conducted in Guangdong Province, China. Schools will be stratified by regional economic development level and randomly assigned to either an intervention or control group. The intervention group will receive annual dental examinations, biannual FV applications, and oral health education. The control group will receive standard annual examinations and comparable oral health education. Participants will be students aged 5 to 22 years enrolled in selected special education schools. Baseline assessments and 12-month follow-ups will include oral examinations and questionnaires assessing oral health knowledge, attitudes, and behaviors. The primary outcome is the difference in caries prevalence between the intervention and control groups at follow-up. Secondary outcomes include changes in oral hygiene behaviors and caregiver knowledge. Data will be analyzed using multivariable regression models adjusting for potential confounders and clustering effects. This trial was funded by the Department of Education of Guangdong Province in 2025 (grant YCKJ-2025-30). As of June 2025, 12 special education schools across 3 cities had been enrolled (n=7, 58.3% intervention and n=5, 41.7% control schools), and more than 1100 students had been recruited. Baseline data collection and the first FV application are complete. Follow-up data collection is ongoing and is expected to conclude in June 2026. Data analysis has not yet started, and results are expected to be published in 2027. Biannual application of FV is expected to significantly reduce caries prevalence and improve oral hygiene behaviors among students in special education schools. This school-based intervention model aims to provide a scalable and evidence-based strategy to mitigate oral health inequities for children with disabilities in China.

21. Beyond Cigarettes: Cannabis Co-Use, ART Adherence, and Psychosocial Burden Among People With HIV Enrolled in a Smoking Cessation Randomized Controlled Trial.

期刊: Journal of studies on alcohol and drugs 发表日期: 2026-Jul-03 链接: PubMed

摘要

Cannabis co-use is common among people with HIV (PWH) who smoke cigarettes yet is infrequently measured in smoking cessation trials. We report the relationship of baseline co-use status, HIV-related variables, and factors associated with tobacco treatment success (e.g., psychosocial characteristics) among PWH enrolled in an ongoing RCT evaluating a tailored app-based smoking cessation treatment. U.S. adults who smoked ≥5 cigarettes per day and were willing to set a quit date were recruited nationally online and via community-based HIV clinics in Florida. At baseline, HIV-related variables, socio-demographics, psychosocial characteristics, tobacco use history, cannabis use history and modality, and other substance use were assessed. Participants were classified as co-using at baseline if they reported using any form of cannabis in the past 30 days. Participants who co-used cannabis (n=142, 28%) vs. did not (n=370, 72%) were more likely to be younger, Black, lesbian, gay, or bisexual, live in a household with another person who smokes, use other combustible tobacco products, report other recreational drug use in the past year, and have higher self-reported health. Compared to participants who did not use cannabis, co-use participants more often reported missed doses of ART in the past month (53% vs. 37%), loss of appetite or change in the taste of food (48% vs. 38%), frequent alcohol use, financial strain, loneliness, discrimination, and better perceived general health (p values < .05). They frequently reported blunt use and same-occasion cannabis and tobacco use. Study findings indicate that PWH who co-use experience elevated behavioral and psychosocial risk factors associated with reduced smoking cessation success and worse HIV-related outcomes.

22. A University Student-Led Hope-Based Intervention Improves Fruit and Vegetable Intake, Functional Fitness, and BMI Among Older Adults in Urban Alaska.

期刊: Journal of cross-cultural gerontology 发表日期: 2026-Jul-03 链接: PubMed

摘要

For this program, we designed and delivered a 15-week, student-led health education intervention using Persuasive Hope Theory (PHT) with a diverse sample of older adults in urban Alaska to increase feelings of hope and improve health. This mixed-methods investigation into the intervention’s efficacy utilized dependent sample t-tests to demonstrate that the number of servings of fruit and vegetables increased significantly after the program. Body mass index (BMI) was statistically lower and self-rated health was significantly higher compared to before the intervention. Descriptive statistics indicate that approximately half of participants’ functional fitness improved but there were no significant differences in self-efficacy or physical activity patterns over time. Program satisfaction results qualitatively and quantitatively indicated that participants were satisfied with the intervention that helped to decrease BMI and increase fruit and vegetable intake, self-rated health, and functional fitness, which can serve as a model for other intergenerational healthy aging initiatives across the Circumpolar North.

23. [Presence of Dermatologists on Social Media: Perception of the Portuguese Population].

期刊: Acta medica portuguesa 发表日期: 2026-Jul-03 链接: PubMed

摘要

The use of social media has transformed the way medical information is disseminated, introducing new ethical challenges. The presence of dermatologists on these platforms remains limited, with much of the dermatology-related content being produced by non-medical or non-specialist sources. We conducted a cross-sectional observational study based on an online questionnaire distributed to the general population between 27th August and 10th September 2025. A total of 600 participants were included, 62.2% of whom were female. Only 24.7% reported following dermatologists on social media, with Instagram being the most frequently used platform (91.2%). Women and younger participants (< 35 years) were more receptive to the perceived positive impact of social media, whereas healthcare professionals showed a more critical attitude, more frequently associating physicians’ online presence with excessive self-promotion (p < 0.001). Higher levels of education were associated with greater refusal or discomfort regarding the use of clinical images (p < 0.001). Overall, the presence of dermatologists on social media is well accepted by the population and represents a relevant opportunity to promote health literacy, strengthen the doctor-patient relationship and enhance trust in the specialty. A utilização das redes sociais transformou a forma como a informação médica é disseminada, estabelecendo novos desafios éticos. A presença de médicos dermatovenereologistas nestas plataformas é limitada, sendo grande parte do conteúdo sobre dermatologia produzido por não médicos ou não-especialistas. Realizou-se um estudo observacional transversal, baseado num questionário online, aplicado à população geral entre 27 de agosto e 10 de setembro de 2025. Foram incluídos 600 participantes, dos quais 62,2% do sexo feminino. Apenas 24,7% seguiam médicos dermatovenereologistas nas redes sociais, sendo o Instagram a plataforma mais utilizada (91,2%). Mulheres e participantes mais jovens (< 35 anos) mostraram-se mais recetivos ao impacto positivo das redes sociais, e os profissionais de saúde manifestaram uma postura mais crítica, associando com maior frequência a presença online a publicidade exagerada (p < 0,001). Níveis de escolaridade superiores associaram-se a uma maior recusa ou desconforto quanto à utilização de imagens clínicas (p < 0,001). A presença dos médicos dermatovenereologistas nas redes sociais é globalmente bem aceite pela população e representa uma oportunidade relevante para promover a literacia em saúde, fortalecer a relação médico-doente e aumentar a confiança na especialidade.

24. Temporal trend of syphilis in pregnancy and congenital syphilis by race.

期刊: Clinics (Sao Paulo, Brazil) 发表日期: 2026-Jul-03 链接: PubMed

摘要

to analyze the temporal trend in the incidence rate of syphilis during pregnancy and congenital syphilis in São Paulo between 2012 and 2021, according to race. A key focus of this analysis is to understand and highlight any racial differences in the incidence of syphilis. This ecological study used data from the Notifiable Diseases Information System (SINAN) and the Live Births Information System (SINASC). The incidence rate was calculated by dividing the number of cases by the number of live births. The independent variables were 2012 to 2021 and race (White, Black, East Asian, Indigenous). Trends were analyzed using linear regression with the Prais-Winsten correction at the 5% significance level. The findings reveal an increase in syphilis incidence during pregnancy and in congenital syphilis in São Paulo, with a disproportionate impact on the Black population. Among the White pregnant population, the Annual Percentage Change (APC) was 17.84% (p < 0.005), while among the Black pregnant population, it was 16.86% (p < 0.005). For congenital syphilis, the incidence among White newborns rose with an APC of 7.6% (p < 0.005), while in the Black population it rose by 6.17% (p < 0.005). In 2021, the number of cases among the Black population was 1.9-times higher than among the White population, underscoring persistent racial disparities and reinforcing the urgent need for equity-driven policies to prevent vertical transmission and control syphilis.

25. Dendrobium officinale polysaccharide prevents liver injury via the regulation of Keap1/Nrf2 pathway and lipid metabolism in acute alcoholic liver injury mice.

期刊: Natural product research 发表日期: 2026-Jul-03 链接: PubMed

摘要

Alcoholic liver disease (ALD) has emerged as a critical global health concern. Dendrobium officinale polysaccharide (DOP) shows therapeutic potential against ALD. However, despite its promising effects, the protective mechanism of DOP on the ALD is unclear. To investigate the protective mechanisms of DOP, we successfully established an ethanol-induced liver injury model in mice and treated ALD mice with DOP. The results demonstrate that DOP treatment significantly reduced hepatic TG, TC, AST, ALT and MDA levels, while enhancing antioxidant capacity through elevated SOD, GST and GPx, reduced GSH and CAT activities. Mechanistically, DOP activates the KEAP1-Nrf2 signalling pathway, reduces the expression of Keap1, and simultaneously upregulates the expression of Nrf2 and its downstream target NQO1. Furthermore, DOP restored lipid homeostasis in ALD mice. In summary, these findings provide strong scientific evidence for the therapeutic potential of DOP in the treatment of ALD and establish a foundation for developing DOP based natural hepatoprotective agents.

26. Impact of Telemedicine-Enhanced Integrated Management of Gestational Diabetes on Pregnancy Outcomes and Glycemic Control: Real-World Study Using TangMama App.

期刊: Journal of medical Internet research 发表日期: 2026-Jul-03 链接: PubMed

摘要

Gestational diabetes mellitus (GDM) is associated with substantial risks of adverse maternal and neonatal outcomes. Contemporary management approaches for GDM exhibit insufficient implementation, resulting in suboptimal glycemic control and preventable perinatal complications. The rapid evolution of mobile health technologies offers potential to enhance GDM care, yet evidence from large real-world studies remains limited. This study aimed to evaluate the impact of a telemedicine-enhanced integrated management system on pregnancy outcomes and glycemic control in women with GDM and to explore the dose-response relationship between telemedicine engagement intensity and clinical outcomes. In this real-world, prospective cohort study conducted at a provincial-level medical center in China, women with GDM were categorized into a standard care group and a telemedicine-enhanced group receiving the TangMama smartphone app in addition to standard care. We compared pregnancy outcomes and glycemic parameters between the 2 groups in an inverse probability of treatment weighting population based on propensity scores. Mediation analyses and dose-response analyses were additionally conducted to explore potential mechanisms and engagement effects. A total of 4621 women with GDM were included, with 1711 in the telemedicine-enhanced group and 2910 in the standard care group. Upon inverse probability of treatment weighting analysis, the telemedicine-enhanced group demonstrated significantly lower gestational weight gain (adjusted mean difference -1.49 kg, 95% CI -1.81 to -1.17), reduced rates of excessive gestational weight gain (adjusted odds ratio [aOR] 0.61, 95% CI 0.54-0.69), cesarean section (aOR 0.80, 95% CI 0.71-0.91), hypertensive disorders in pregnancy (aOR 0.76, 95% CI 0.64-0.90), and pre-eclampsia (aOR 0.64, 95% CI 0.49-0.83). Glycemic control in the third trimester was significantly improved, with lower glycated hemoglobin A1c (HbA1c) levels (adjusted mean difference -0.05%, 95% CI -0.08 to -0.03) and higher HbA1c on-target rates. For neonatal outcomes, telemedicine-enhanced management was associated with lower rates of preterm birth (aOR 0.47, 95% CI 0.38-0.59), large-for-gestational age (aOR 0.81, 95% CI 0.69-0.96), neonatal unit admission (aOR 0.80, 95% CI 0.71-0.91), neonatal hypoglycemia (aOR 0.64, 95% CI 0.45-0.93), and neonatal hyperbilirubinemia (aOR 0.69, 95% CI 0.58-0.82). Mediation analyses identified gestational weight gain and third-trimester fasting plasma glucose as significant mediators. Higher telemedicine engagement was associated with improved glycemic control and reduced adverse outcomes in a dose-response manner. Telemedicine-enhanced integrated management is associated with improved maternal glycemic control and substantial reductions of adverse pregnancy outcomes among women with GDM. The observed dose-response relationship between engagement intensity and outcomes underscores the importance of promoting active patient participation. These findings support the broader integration of telemedicine into routine GDM care pathways to optimize maternal and neonatal health.

27. Rethinking triglycerides in the management of ASCVD.

期刊: European journal of preventive cardiology 发表日期: 2026-Jul-03 链接: PubMed

摘要

Triglycerides have traditionally occupied an uncertain role in atherosclerotic cardiovascular disease (ASCVD) prevention, often considered secondary to low-density lipoprotein cholesterol (LDL-C). Emerging evidence indicates that triglycerides are best viewed not as a direct cause of atherosclerosis, but as a clinical marker of triglyceride-rich lipoprotein (TGRL) and remnant particle burden. These apolipoprotein B-containing particles can enter the arterial wall, promote lipid deposition, and amplify vascular inflammation. Genetic and Mendelian randomization studies support a causal link between remnant lipoproteins and ASCVD that is independent of LDL-C levels and proportional to atherogenic particle number. Despite effective LDL-C lowering, substantial residual ASCVD risk persists, particularly in patients with diabetes mellitus, obesity, and metabolic dysfunction. However, reducing triglyceride concentrations alone does not consistently translate into fewer cardiovascular events. Clinical benefit appears to depend on whether therapy meaningfully reduces atherogenic particle burden or modifies causal pathways. Icosapent ethyl has demonstrated reductions in major adverse cardiovascular events, although the mechanism of benefit remains incompletely understood and is not explained entirely by triglyceride lowering. Fibrates have shown modest benefit in selected populations, whereas mixed omega-3 formulations have not consistently demonstrated cardiovascular risk reduction. Emerging therapies targeting key regulators of remnant metabolism, including apolipoprotein C-III and angiopoietin-like protein 3, offer more direct approaches to modifying causal pathways. In contemporary practice, triglycerides should be interpreted longitudinally within a framework of remnant lipoprotein biology and residual cardiovascular risk rather than pursued as an isolated therapeutic target.

28. Therapeutic Vaccines Based on Iron-Coordinated Metal-Phenolic Networks for Eradicating Drug-Resistant Staphylococcus aureus.

期刊: ACS applied bio materials 发表日期: 2026-Jul-03 链接: PubMed

摘要

Drug-resistant Staphylococcus aureus (DRSA) infections present a formidable therapeutic challenge severely threatening human health. To address this, we engineered a metal-phenolic network (MPN) platform that co-immobilizes whole-cell DRSA with immunostimulatory metal ions (i.e., Fe3+, Mn2+, Zn2+) under mild conditions. Among these, the iron-coordinated MPN (SA@FeMPN) exhibited superior potency, leveraging a dynamic valence transition mechanism to robustly amplify the TLR2/NF-κB signaling. This mechanism promoted functional polarization of macrophages to the M1 state and drove dendritic cell maturation. In a murine systemic infection model, SA@FeMPN elicited robust cellular and humoral immunity, achieving a 2-18-fold greater reduction in bacterial burden across major organs compared to other MPNs, and established durable immunological memory to prevent infection relapse. Collectively, this work establishes iron-coordinated MPNs as a rational design platform for next-generation immunotherapy and identifies SA@FeMPN as a promising therapeutic vaccine candidate that not only eradicates established DRSA infections but also confers lasting protection against recurrence.

29. Exploring Informal Caregivers' Perception of the Olera Digital Caregiving Assistance Platform for Dementia Care: Mixed Methods Evaluation Study.

期刊: JMIR formative research 发表日期: 2026-Jul-03 链接: PubMed

摘要

Informal caregivers of people living with dementia often experience high rates of caregiver burnout while providing care. Although there are many websites and mobile apps available to help caregivers, many do not use digital tools. The Olera platform was developed to be an easily adoptable web-based support tool, connecting caregivers with long-term services and supports, financial assistance, and educational resources. The platform was developed based on the Build-Measure-Learn framework with input from caregiver needs assessments and usability studies. This study aims to evaluate the quantitative and qualitative feedback of informal caregivers of people living with dementia on the second iteration of the Olera platform. The primary objective was to assess caregivers’ acceptance of this caregiving platform. The secondary objective was to use qualitative methods to explore (1) the study cohort’s challenges in daily caregiving to determine and compare them with prior literature, (2) their experience when using the Olera platform, and (3) their attitudes toward integrating artificial intelligence in caregiver services for future studies and platform development. Caregivers were recruited through various sources and screened for eligibility through an initial survey. Participants used the platform for 4 weeks and completed a survey with an adapted Technology Acceptance Survey (TAS) and qualitative open-ended questions at the end of the testing period. TAS responses were summarized with descriptive statistics, while ANOVAs, t tests, and linear regressions were used to compare the differences in the overall TAS scores by caregiver characteristics. Qualitative feedback data on the platform’s usefulness were analyzed via a thematic analysis framework approach. A total of 65 caregivers in the United States completed the study, with a mean age of 59.9 (SD 9.8) years. The majority were female (61/65, 95.3%), non-Hispanic or Latino White (45/65, 69.2%), and the adult child of their care recipient (42/65, 64.6%). Evaluation of the Olera platform showed a high acceptance rate, with each TAS item scoring above 5.0 and an overall TAS score of 5.83 (SD 0.85) out of 7. Higher platform use frequency was associated with higher TAS ratings in technology acceptance (F3,61=7.88, P<.001). Thematic analyses elicited the caregiving challenges, evaluation of the Olera platform, and feedback on artificial intelligence-assisted support. The Olera platform is an example of a beneficial web-based tool, though key features were requested to be included in the next iteration. Additionally, data supported prior findings regarding informal caregiver challenges and the insufficiency of conventional support mechanisms, indicating a need for more innovative digital solutions. Future research and development efforts using the Build-Measure-Learn approach are necessary to further iterate the platform’s key features, enhance the tool, involve more informal caregivers in its improvements, and serve as a model for customizable, person-centered online care support.

30. Lung Health Lessons Learned Abroad Are Critical To Understanding Lung Health at Home.

期刊: Annals of the American Thoracic Society 发表日期: 2026-Jul-03 链接: PubMed

摘要

31. Using Ecological Momentary Assessment to Document and Investigate Caregiver Practices Between Pediatric Therapy Sessions: Prospective Pilot Cohort Study.

期刊: JMIR formative research 发表日期: 2026-Jul-03 链接: PubMed

摘要

Determining the appropriate dosage of pediatric occupational therapy, physical therapy, and speech-language pathology services is important when supporting families of children with disabilities. However, therapy dosage is inconsistently reported, and caregiver-delivered practice between sessions is rarely documented. Ecological momentary assessment (EMA) offers a method to capture caregiver practice in real time and to examine factors that influence it. This study aims to pilot the use of EMA to measure caregiver practices between therapy sessions and to compare EMA-reported practices with caregiver recall. This pilot prospective cohort study used convenience sampling to recruit caregivers of children receiving therapy services. During September 2024, participants completed a confidential baseline Qualtrics survey in their homes, which included recall of home practice from the previous week. Participants were then invited to complete 30 days of EMA logging of daily practice. Five participants enrolled in the EMA phase, which began 24 to 72 hours after baseline survey completion and took place during October and November 2024. Semistructured follow-up interviews were conducted immediately after the 30-day EMA period. Of the 34 survey participants, 5 continued to the EMA phase, contributing 150 days of data, with 82 completed entries (82/150, 55%). Caregivers primarily completed EMA logs on days when practice occurred; missing entries were coded as zero practice based on caregiver reports. Recalled practice averaged 4.5 (SD 5.65) bouts/day and 11.6 (SD 6.35) minutes/bout, totaling 71.2 (SD 121.02) minutes/day. EMA-reported practice across all days (n=150) averaged 2.7 (SD 4.39) bouts/day and 6.5 (SD 6.45) minutes/bout, totaling 23.2 (SD 14.12) minutes/day, which was substantially lower than recalled estimates. On days when practice was reported (n=82), EMA-documented practice averaged 5.2 (SD 3.28) bouts/day and 6.5 (SD 6.45) minutes/bout, totaling 23.9 (SD 14.72) minutes/day. Variability in recalled practice was high (mean 71.19, SD 121.02 min/d). Caregivers described practice as occurring in short, frequent bouts embedded within daily routines, with routine integration, child engagement, and recall of therapist strategies identified as key facilitators. Caregiver-delivered practice occurred in short, frequent bouts integrated into daily routines. EMA-reported practice was substantially lower than caregiver recall, suggesting that retrospective recall and prospectively reported EMA data may differ substantially. These findings highlight the importance of teaching strategies that are brief, engaging, and easily incorporated into daily routines. Despite the small sample, EMA was acceptable to a subset of caregivers who completed participation; however, substantial attrition between survey enrollment and EMA initiation suggests significant feasibility and participation barriers that warrant further investigation.

32. The Effects of Neuromuscular Electrical Stimulation and Leap Motion-Based Exercises on Hand Function Parameters in Children With Cerebral Palsy: Study Protocol for a Randomized Controlled Trial.

期刊: JMIR research protocols 发表日期: 2026-Jul-03 链接: PubMed

摘要

Cerebral palsy (CP) is a group of permanent but nonprogressive disorders that affect movement and posture, often accompanied by upper extremity impairments such as abnormal muscle tone, spasticity, weakness, and impaired motor control. Neuromuscular electrical stimulation (NMES) and Leap Motion-based interventions that promote neuroplasticity through different mechanisms. However, studies directly comparing these 2 approaches in children with spastic CP are limited. This study primarily aims to investigate the effects of NMES and Leap Motion-based exercise interventions on hand function in children with spastic CP and to compare the effectiveness of these 2 modalities. The secondary objective is to evaluate and compare the effects of these interventions on wrist extensor muscle activation, wrist joint range of motion, selective motor control, and hand use in daily activities. This study is a 2-arm, parallel-group randomized controlled trial with a 1:1 allocation ratio and will include 30 children aged 6-15 years with spastic CP and distal upper extremity involvement. All participants meeting the inclusion criteria will undergo baseline assessments at T0, where wrist range of motion will be measured using an electronic goniometer; selective motor control will be evaluated using the Selective Control of the Upper Extremity Scale (SCUES); hand function will be assessed using the Jebsen-Taylor Hand Function Test; daily hand use will be evaluated using the ABILHAND-Kids questionnaire; and wrist extensor and flexor muscle activation will be assessed using surface electromyography (sEMG). All participants will then undergo a 4-week conventional exercise program (3 sessions per week, 40 minutes per session). At the end of the 4 weeks, all baseline measurements will be repeated (T1). Subsequently, participants will be randomly assigned into 2 groups: the Leap Motion group (n=15) and the NMES group (n=15). Both groups will participate in an 8-week exercise program consisting of 3 sessions per week, 60 minutes per session (including 20 minutes of either Leap Motion-based exercise or NMES application, followed by 40 minutes of conventional exercise). At the end of this 8-week program, all assessments will be repeated (T2). Data collection started in January 2026. The study is expected to be completed by September 2026. To our knowledge, the study will be the first randomized controlled study to evaluate and compare the effects of NMES and Leap Motion-based training on hand functions in children with spastic CP. The findings are expected to contribute to evidence-based clinical practice by guiding the selection of effective upper extremity rehabilitation strategies for pediatric populations. Findings may inform future rehabilitation protocols by highlighting the benefits of integrating advanced technology-based interventions alongside conventional therapy approaches.

33. The Role of Veterans Health Administration Intensive Primary Care in Optimizing Medication Regimens: A Qualitative Study of Patient and Provider Perspectives.

期刊: The Journal of ambulatory care management 发表日期: 2026-Jul-02 链接: PubMed

摘要

To identify actionable steps from a Veterans Health Administration (VA) Intensive Primary Care (IPC) pilot in five VA sites that primary care teams and health care systems can take to optimize medication regimens in high-risk patients, many of whom have polypharmacy and poor medication adherence. We conducted semi-structured, qualitative interviews between 2014 and 2018 with 27 IPC providers and 16 IPC patients. Interviews were analyzed using inductive and deductive approaches to thematic analysis. Patient respondents were an average of 67 years old and more likely to be male (94%), divorced (44%), Black (50%), hypertensive (88%), and have two or more comorbidities (81%). IPC patients and providers described IPC as helping to identify and/or address specific medication adherence barriers that were not adequately understood or addressed in usual primary care. IPC providers’ greater understanding of adherence barriers allowed them to optimize patient medication regimens, closing the gap between care provided and patient needs. IPC program elements that enabled care improvements included interdisciplinary care teams, care team accessibility, home visits, and close provider-patient relationships. Primary care teams can adopt some IPC program elements to help patients optimize medication regimens, such as greater involvement of extended team members, increasing accessibility of care teams through telephone and secure messaging, utilizing home visits for assessment of patients’ needs, and developing strong provider-patient relationships.

34. Early reported effects of the 2026 CMS Physician Fee Schedule on patient access to CAMPs in wound care: a national clinician and practice survey.

期刊: Journal of wound care 发表日期: 2026-Jul-02 链接: PubMed

摘要

In 2026, the US Centers for Medicare & Medicaid Services implemented an update to the Physician Fee Schedule establishing a unified reimbursement rate for skin substitutes, also referred to as cellular, acellular and matrix-like products (CAMPs). This policy change introduced a fixed payment of [Formula: see text]127.14 per cm2, regardless of product type or regulatory classification. The aim of this work was to assess perceived impacts of the revised fee schedule that went into effect on 1 January 2026. The Wound and Hyperbaric Association conducted an online national survey of wound care practitioners and practices from 4 February 2026 to 14 April 2026. The Access Crisis Feedback Form consisted of 13 questions, including two open-ended items. Over the 69 days that the survey was open, 130 (~3%) responses were received from a comparative pool of 4551 National Provider Identifiers that had applied a CAMP in 2024. Collectively, respondents reported providing care to approximately 12,000 patients with wounds per week. Geographic representation included 36 of 50 (72%) states and Washington DC, and 8 of 12 (67%) Medicare Administrative Contractors. Most respondents (82%) practiced in non-facility settings; however, hospital-affiliated outpatient wound centres, and ambulatory surgery centres were also represented. The most severe concern identified was the ‘Closure or planned closure of a wound care practice or service line’, reported by just over 45% of responding settings. Only five (4%) respondents reported no significant impact, indicating that 96% perceived at least one operational impact following implementation of the revised payment policy. The most frequently cited concern (61%) was ‘Authorisation delays for clinically eligible patients’. Analysis of the survey data suggests widespread impacts of the implemented CAMPs universal fee schedule across diverse wound care delivery settings in the US, including a substantial risk of service line closures. These findings raise concerns that a uniform CAMP product payment may not achieve site-of-care neutrality when hospital outpatient departments receive a separate application facility payment, while non-facility providers do not. Respondents reported that patients are already experiencing reduced access to advanced wound care, with associated complications such as: infection; sepsis; amputation; wound deterioration or enlargement; hospital readmission; the need for surgical debridement in the operating room setting; and flap- or graft-based salvage procedures. Responding wound care providers and practices, across diverse care settings and geographic regions, urge reevaluation of the current reimbursement framework to ensure the financial sustainability of wound care services, and to protect patient access and outcomes.

35. Provision and use of focused rigidity casts in the public health setting: a modified Delphi study.

期刊: Journal of wound care 发表日期: 2026-Jul-02 链接: PubMed

摘要

Focused rigidity casts (FRCs) are used by podiatrists in the promotion of wound healing and to offload bony prominences and foot ulcers. The aim of this study was to gain expert consensus on the best method of FRC application to inform the development of a clinical guideline. A modified Delphi study was conducted comprising three rounds. The first round consisted of open-ended questions around clinical guideline content, from which three researchers independently identified themes from expert responses. Survey rounds two and three sought to gain agreement on statements identified from the first round. Consensus was defined as >70% expert agreement on the importance of inclusion of statements in the guideline. Experts from six Melbourne metropolitan health services in Australia contributed to the development, then rated the importance, of 86 statements for inclusion in a clinical guideline. Statements addressed key clinical considerations, including: indications and contraindications; educational and training requirements; organisational procedures and guidelines; and the perceived benefits of the technique. Consensus was gained for 42 items and a draft guideline has been produced. Consensus was gained on 42 statements for inclusion in a clinical guideline on the use of FRCs. In light of the limited research evidence on the use of the technique, this guideline provides an important contribution to clinicians implementing it.

36. Chronic obstructive pulmonary disease: diagnosis, monitoring and chronic management in nursing practice.

期刊: British journal of nursing (Mark Allen Publishing) 发表日期: 2026-Jul-02 链接: PubMed

摘要

Chronic obstructive pulmonary disease (COPD) is a progressive condition and a leading cause of morbidity and mortality in the UK. Characterised by persistent airflow limitation, breathlessness, cough and frequent exacerbations, it is often linked to smoking and other environmental exposures. This article reviews COPD from a nursing perspective, outlining definition, pathophysiology and evidence-based management. Pharmacological and non-pharmacological strategies are discussed, with emphasis on smoking cessation, inhaler technique, pulmonary rehabilitation and holistic care. The central role of nurses in supporting self-management, co-ordinating multidisciplinary care and addressing comorbidities is highlighted. Aligning practice with National Institute for Health and Care Excellence guidance can improve outcomes and reduce avoidable admissions.

37. Hydrogeochemical investigation of uranium and radon in groundwater and age-dependent radiological health risk assessment in Sulaymaniyah Governorate, Iraq.

期刊: Applied radiation and isotopes : including data, instrumentation and methods for use in agriculture, industry and medicine 发表日期: 2026-Jul-01 链接: PubMed

摘要

Groundwater resources may harbor naturally occurring radioactive elements, particularly uranium and radon, presenting potential health hazards via ingestion and inhalation pathways. This investigation examined uranium and radon concentrations in groundwater samples obtained from Sulaymaniyah Governorate, Iraq, evaluating radiological safety and physicochemical characteristics. Uranium concentrations ranged from 0.7 ± 0.1 to 9.3 ± 0.5 μg/L, with a mean of 3.5 ± 2.5 μg/L. All samples complied with WHO permissible thresholds (30 μg/L); however, merely 15% (3 of 20 sites) satisfied ICRP guidelines (1.9 μg/L). Radon levels varied from 2.7 ± 0.5 to 22.3 ± 1.1 Bq/L with a mean of 11.0 ± 5.9 Bq/L. Eight sampling locations surpassed the USEPA recommended limit (11.1 Bq/L), while all measurements remained below WHO standards (100 Bq/L). Age-stratified annual ingestion dose calculations for uranium and radon revealed that most demographic groups remained within WHO recommended thresholds (100 μSv/y), with infants demonstrating the highest exposure levels (up to 103 μSv/y for radon), slightly exceeding the WHO limit. Pearson correlation analysis indicated weak to moderate associations between radionuclide concentrations and conventional water quality parameters, suggesting predominantly geogenic origin. Overall, the groundwater exhibits minimal radiological risk for consumption; nevertheless, continuous monitoring is advisable to ensure sustained public health protection and safe groundwater resource management.

38. Letter to the editor: Attrition as a proxy for acceptability in digital CBTi: Conceptual limitations and methodological priorities.

期刊: Sleep medicine reviews 发表日期: 2026-Jul-01 链接: PubMed

摘要

39. Ultra-sensitive determination of cyclopiazonic acid in complex food samples via competitive time-resolved luminescence immunoassays coupled to green microextraction.

期刊: Talanta 发表日期: 2026-Jul-01 链接: PubMed

摘要

In this study, an ultra-sensitive competitive luminescence immunoassay for detecting and quantifying the mycotoxin cyclopiazonic acid (CPA) in food was developed. Analyses were conducted in 96-well plates using magnetic beads as support for a CPA-mimetic peptide, enhancing the surface area available for competition. Light emission from an anti-CPA antibody fragment linked to a long-lifetime luminescent Tb (III) chelate, serving as optical label, was measured in time-resolved luminescence (TRL) mode upon binding to the mimetic peptide. In the presence of the target toxin, emission intensity decreased proportionally to analyte concentration. The TRL readout provided an improved measurement of CPA concentrations when compared to two other optical detection methods, namely fluorescence and colorimetry, through effective background reduction and noise suppression. The broad applicability of the method was tested by examining two highly dissimilar matrices for the toxin: corn and blue cheese. The latter is especially relevant due to the use of Penicillium fungi, one of the main CPA producers alongside Aspergillus, in the fermentation process. Two different strategies for analyte extraction were applied, i.e., a traditional solvent mixture (methanol and water) and a sustainable alternative: a choline chloride and ethylene glycol natural deep eutectic solvent (NADES). The use of the NADES improved the removal of the lipophilic toxin from the fatty matrix as well as its handling during the sample preparation stage. The immunoassay exhibited remarkable selectivity and sensitivity, with limits of detection of 0.022 μg/kg and 4.0 μg/kg, and limits of quantification of 0.040 μg/kg and 8 μg/kg, for corn and cheese, respectively. This integrated approach offers a robust and environmentally sustainable platform for monitoring CPA contamination in food, contributing to improved food safety and public health protection.

40. Integrated tuberculosis-multimorbidity management in India: A SWOT analysis.

期刊: The Indian journal of medical research 发表日期: 2026-Jul 链接: PubMed

摘要

Tuberculosis multimorbidity is an emerging burden to the healthcare system in India, but the national programmes like the National TB Elimination Programme (NTEP), the National Programme for Prevention and Control of NCDs (NP-NCD), and the National Mental Health Programme (NMHP) are still operating in silos, leading to fragmented and inefficient care. This paper employs a SWOT (strengths, weaknesses, opportunities, threats) analysis to evaluate the integration potential of these programmes within the platform of Ayushman Arogya Mandirs (AAMs). The analysis identifies key strengths, such as NTEP’s robust surveillance and NP-NCD’s wide screening network, and critical weaknesses, including isolated digital platforms and a lack of cross-programme training for health workers. Significant opportunities exist through linking digital systems like Ni-kshay and the NP-NCD application, and training frontline workers in composite care. Major threats include persistent policy fragmentation and patient stigma. We conclude that a strategic shift from vertical, disease-specific programmes to a person-centred, integrated model is essential. This requires collaboration at the policy level, the integration of comprehensive digital health records, and the delegation of responsibilities to primary care teams, including AAMs, to effectively manage multimorbidity, improve patient outcomes, and advance India’s goals of attaining Universal Health Coverage of tuberculosis.

41. Sero surveillance of human brucellosis and leptospirosis among veterinary personnel in Sikkim, India: A descriptive cross -sectional study.

期刊: The Indian journal of medical research 发表日期: 2026-Jul 链接: PubMed

摘要

A cross-sectional sero-surveillance study was conducted across the five districts of Sikkim to determine the seroprevalence of Brucella and Leptospira antibodies among veterinary and para-veterinary personnel. Serum samples were tested for Brucella using the Rose Bengal Test, Standard Agglutination Test, and ELISA (IgG/IgM), while Leptospira antibodies were detected using ELISA (IgG/IgM). Brucella seroprevalence was 18.8%, and Leptospira seroprevalence was 20.5%. The findings indicate a considerable level of exposure to both infections in this occupational group, underscoring the need for strengthened surveillance and preventive measures within a One Health framework.

42. Mediolateral trunk control, rather than temporal gait control, is associated with treadmill walking adaptation in healthy older adults.

期刊: Journal of biomechanics 发表日期: 2026-Jun-30 链接: PubMed

摘要

Treadmill training improves gait performance and reduces fall risk in older adults; however, inter-individual variability in training response has been reported. Insufficient adaptation to treadmill walking may limit training effectiveness and potentially increase fall risk. This study aimed to identify baseline gait characteristics associated with adaptation to treadmill walking in healthy older adults. Seventeen older adults walked on a treadmill at 2.7 km/h for 5 min while wearing a triaxial accelerometer on the lower trunk and a foot switch on the right shoe. Walking data were segmented into ten 30-s bins. Treadmill adaptation was defined as the slope of the stride-time coefficient of variation (CV) across bins. Baseline gait characteristics were calculated from the first three bins and included the root mean square of mediolateral acceleration (RMS_ML; magnitude of mediolateral trunk acceleration), the mediolateral harmonic ratio (HR_ML; temporal symmetry), and stride-time CV (temporal consistency). Spearman’s and exploratory partial Spearman’s correlations adjusted for comfortable overground walking speed were performed. Treadmill adaptation was significantly correlated with baseline stride-time CV (ρ = -0.56) and RMS_ML (ρ = 0.52). After adjusting for comfortable walking speed, only RMS_ML remained significant (ρ = 0.50). Additionally, HR_ML demonstrated a significant correlation only after speed adjustment (partial ρ = -0.58). These findings suggest that lower mediolateral trunk acceleration at baseline is associated with early temporal stabilization during treadmill walking in healthy older adults.

43. Influence of iliofemoral ligament laxity on hip joint contact forces during gait.

期刊: Journal of biomechanics 发表日期: 2026-Jun-30 链接: PubMed

摘要

The iliofemoral ligament (ILFL) is crucial for hip joint stability, and its laxity contributes to hip joint instability. However, the effects of ligament laxity on hip kinetics remain unclear. This study aimed to develop a musculoskeletal model incorporating the ILFL and investigate the effects of ILFL laxity on hip contact forces (HCFs) during gait. Gait data were collected from 22 healthy young adults, and 21 participants with complete data were used for subsequent analyses. A musculoskeletal model incorporating the ILFL was used to investigate HCFs and muscle forces during gait. Statistical Parametric Mapping Paired t-test was used to compare HCFs and muscle forces during the stance phase of gait between a model with normal ILFL properties (normal model) and a model with ILFL laxity (laxity model). ILFL force was significantly lower in the laxity model than in the normal model. The laxity model exhibited a significant increase in the anterior HCF and a significant decrease in the medial HCF during the latter half of the stance phase. Muscle forces in the hip flexors and abductors were significantly increased. ILFL laxity increased the anterior HCF and decreased the medial HCF. These changes may contribute to instability, anterior soft-tissue injuries, and secondary hip muscle disorders.

44. Associations of sagittal spinal alignment with shear wave velocity, thickness, and echo intensity of muscles attached to the spine and pelvis in healthy women.

期刊: Journal of biomechanics 发表日期: 2026-Jun-30 链接: PubMed

摘要

This study aimed to explore the association between sagittal spinal alignment and the properties of the muscles attached to the spine and pelvis in healthy women. In 83 healthy women (aged 21-82 years), the shear wave velocity, thickness, and echo intensity of the upper and lower limb and trunk muscles were measured using ultrasonography. A Spinal Mouse was used to assess the sagittal spinal alignment (thoracic kyphosis angle, lumbar lordosis angle, and sacral anterior inclination angle) in the standing position. Simple regression analysis examined associations among spinal alignment, age, and the properties of the muscles attached to each spinal region. Forced-entry multiple regression analyses were then performed for each alignment angle using the significant muscle variables as independent variables, with age as an adjusted variable (p < 0.05). There was no significant association between the thoracic kyphosis angle and age or muscle properties. While the lumbar lordosis angle was associated with muscle thickness and echo intensity in several muscles, these associations were not significant after adjusting for age or after additionally adjusting for menopausal status and body mass index. In simple regression analyses, the sacral anterior inclination angle was associated with several muscle properties. After adjusting for age, only lower multifidus muscle thickness remained associated with a smaller sacral anterior inclination angle, which remained significant after additionally adjusting for menopausal status and body mass index. The results showed that a thinner multifidus was associated with a smaller sacral anterior inclination angle in healthy women.

45. Antiproliferative effects of HIV integrase strand transfer inhibitors in experimental models for cancer research: A narrative review.

期刊: The Journal of pharmacology and experimental therapeutics 发表日期: 2026-Jun-16 链接: PubMed

摘要

A growing body of literature suggests that integrase strand transfer inhibitors (INSTIs), a cornerstone of antiretroviral therapy for the treatment of HIV infection, seem to possess antiproliferative properties against some types of cancer and/or anti-invasion effects. Preclinical studies describe as INSTIs, including dolutegravir, raltegravir, cabotegravir, and elvitegravir and some 1,2,3-triazole derivatives, can inhibit the growth of various cancer cell lines and some of them seem to also have direct inhibitory effects on human endogenous retrovirus reactivation. This review comprehensively synthesizes and analyzes this evidence, detailing the proposed multimechanistic actions behind these effects, such as induction of DNA damage, inhibition of key oncogenic pathways, triggering of oxidative stress and diverse cell death modalities. All described compounds seem to have potential effects on cancerous cells, and these effects may be also independent from their antiretroviral activity, that is, may be separated from the mere effect on suppression of human endogenous retrovirus reactivation in cancerous cells. Although the type of target cancer, the mechanisms of action (ie, enzyme or protein inhibition, oxidative stress, DNA methylation, and DNA damage) or the ultimate effects (ie, cell proliferation, migration, or invasion) were different in most of the studies and sometimes inconsistent, all these studies suggest several potential targets of INSTIs that deserve further investigations. Although the incidence of many cancers is higher in people with HIV infection compared with the general population, the relative risk has been decreasing over time for many cancers. Further studies are then needed to assess the effects of INSTI therapies on malignancies in people living with HIV. SIGNIFICANCE STATEMENT: Currently, the effects of using integrase strand transfer inhibitors (INSTIs) on cancer development in people living with HIV are difficult to determine because of the multifactorial cause of cancer in these patients and the long period in which cancer manifests. This review examines the antiproliferative properties of INSTIs, describing the proposed mechanisms through which they may exert this effect in preclinical studies.

46. Nasal carriage of Staphylococcus aureus and hygiene practices among food handlers in Skopje, North Macedonia.

期刊: Arhiv za higijenu rada i toksikologiju 发表日期: 2026-Jun-01 链接: PubMed

摘要

Nasal carriage plays a key role in Staphylococcus aureus transmission, particularly among individuals working in the food sector. The aim of this cross-sectional study was to investigate the relationship between personal hygiene and nasal carriage of S. aureus among workers in food production, distribution, and trade. It was conducted in Skopje from November 2021 to March 2022 and included 289 workers undergoing mandatory health and hygiene examinations. Data were collected through a structured questionnaire and microbiological testing of nasal swabs. The overall prevalence of S. aureus nasal carriage was 12.5 % (95 % CI: 8.7-16.3 %). Methicillin-susceptible S. aureus (MSSA) prevailed in 11.8 % (95 % CI: 8.1-15.5 %) and the methicillin-resistant variety (MRSA) in only 0.7 % (95 % CI: 0-1.7 %). We found no significant associations between nasal carriage and demographic or hygiene variables (assessed using the chi-squared test) but did observe higher carriage rates among men (15.7 %), cooks (28.6 %), and individuals with untidy nails (17 %). However, our findings should be interpreted with caution, and future studies should address the limitations of the present study. Targeted training, routine screening, and consistent adherence to good hygiene practices remain important for minimising colonisation and reducing the risk of S. aureus transmission. Prisutnost bakterije Staphylococcus aureus u nosu ima ključnu ulogu u njezinoj transmisiji, osobito među osobama zaposlenima u prehrambenom sektoru. Cilj ovog presječnog istraživanja bio je ispitati povezanost osobnih higijenskih navika i nosnog kliconoštva bakterije S. aureus među radnicima u proizvodnji, distribuciji i prometu hrane. Istraživanje je provedeno u Skoplju od studenoga 2021. do ožujka 2022. te je uključilo 289 radnika podvrgnutih obveznim zdravstvenim i higijenskim pregledima. Podaci su prikupljeni strukturiranim upitnikom i mikrobiološkim testiranjem obrisaka nosa. Ukupna prevalencija nosnog kliconoštva bakterije S. aureus iznosila je 12,5 % (95 %-tni interval pouzdanosti: 8,7–16,3 %). Meticilin-osjetljivi S. aureus (MSSA) zabilježen je u 11,8 % ispitanika (95 %-tni interval pouzdanosti: 8,1–15,5 %), a meticilin-rezistentni S. aureus (MRSA) u svega 0,7 % ispitanika (95 %-tni interval pouzdanosti: 0–1,7 %). Nije utvrđena statistički značajna povezanost između nosnog kliconoštva i demografskih odnosno higijenskih varijabli procijenjenih hi-kvadrat testom, no više stope kliconoštva zabilježene su među muškarcima (15,7 %), kuharima (28,6 %) i osobama s neurednim noktima (17 %). Iako nisu utvrđene statistički značajne povezanosti, uočene razlike upućuju na važnost kontinuiranog praćenja higijenskih navika i jačanja preventivnih mjera u prehrambenom sektoru.

47. Fatal pufferfish poisoning 1000 km inland: a case series from eastern Turkey.

期刊: Arhiv za higijenu rada i toksikologiju 发表日期: 2026-Jun-01 链接: PubMed

摘要

We report the first tetrodotoxin (TTX) poisoning cases from Van, Eastern Turkey, a city located more than 1000 km inland. Three male patients presented in December 2020 after eating Lagocephalus sceleratus, which a local vendor mistook for an edible fish. One patient, a 41-year-old man who consumed the fish liver, rapidly developed severe signs of poisoning (adverse event grade 4) with complete paralysis and respiratory failure. Arterial blood gas analysis showed severe acidosis (pH 7.179) and high lactate levels (5.3 mmol/L). Despite intensive care, including mechanical ventilation and high-dose vasopressors, the patient died on the fourth day of hospitalisation due to refractory cardiac arrest. The other two patients, who consumed less fish and no liver, had only mild symptoms (adverse event grades 1 and 2) and recovered completely within 24 h. This incident illustrates the extreme danger of consuming pufferfish and particularly its visceral organs, which typically contain substantially higher tetrodotoxin levels. Finding these cases so far inland reveals serious gaps in the Turkish food distribution system. The fish likely travelled from Mediterranean ports to Van in mixed fish crates without having been identified. Fish vendors need proper training to identify toxic species, and supply chains require better oversight to prevent such tragedies. Ovo je prvi prikaz niza slučajeva trovanja tetrodotoksinom (TTX) u gradu Vanu u istočnoj Turskoj, smještenom više od 1000 km od obale. Tri muškarca primljena su u hitnu službu u prosincu 2020. nakon konzumacije otrovne napuhače, vrste Lagocephalus sceleratus, koju je mjesni prodavač zamijenio s jestivom ribom. Jedan bolesnik, 41-godišnji muškarac koji je pojeo riblju jetru, ubrzo je dobio teške znakove trovanja (4. stupanj štetnih događaja) s potpunom paralizom i respiratornim zatajenjem. Analiza plinova arterijske krvi pokazala je tešku acidozu (pH 7,179) i povišene vrijednosti laktata (5,3 mmol/L). Unatoč intenzivnom liječenju, uključujući mehaničku ventilaciju i primjenu visokih doza vazopresora, bolesnik je preminuo četvrtoga dana hospitalizacije zbog refraktornoga srčanog zastoja. Druga dva bolesnika, koja su pojela manju količinu mesa ribe i nisu jela jetru, imali su samo blage simptome (1. i 2. stupanj štetnih događaja) te su se potpuno oporavili unutar 24 sata. Ovaj incident potvrđuje iznimnu opasnost konzumacije napuhača, osobito iznutrica, koje obično sadržavaju znatno više razine tetrodotoksina. Činjenica da je do trovanja došlo tako daleko od obale upozorava na ozbiljne propuste u turskom sustavu distribucije hrane. Riba je vjerojatno dopremljena iz mediteranskih luka u Van u sanducima s miješanom ribom, a da pritom nije bila identificirana. Prodavači ribe trebaju proći odgovarajuću edukaciju za prepoznavanje otrovnih vrsta, a opskrbni lanci morali bi imati bolji nadzor kako bi se spriječile ovakve tragedije.

48. Glyphosate internal dose estimation: comparing passive dosimetry and biomonitoring in simulated heavy residential herbicide application.

期刊: Arhiv za higijenu rada i toksikologiju 发表日期: 2026-Jun-01 链接: PubMed

摘要

Glyphosate exposure is commonly assessed using either passive dosimetry or biomonitoring. This study tests the hypothesis that internal dose estimates derived from passive dosimetry are higher and more uncertain than those derived from biomonitoring by comparing concurrently collected passive dosimetry and biomonitoring data from a controlled simulation of heavy residential herbicide application. The two predominant exposure routes were evaluated separately: six applicators were protected from dermal exposures with hooded Tyvek® coveralls and gloves and six were protected from inhalation exposure with a respirator. Urine was serially collected from all applicators between 30 min prior to and up to 36 h after application, while breathing-zone air samplers (left and right lapel) and four dermal patches were collected from dermally protected applicators. Internal doses were independently estimated from air and dermal patch measurements (passive dosimetry) and from urinary glyphosate residues (biomonitoring; dilution-adjusted). Average total internal daily doses of glyphosate estimated from passive dosimetry were approximately seven times greater than biomonitoring-based estimates. This overestimation appeared attributable to the dermal pathway and was consistent with the uncertainty in the assumed dermal absorption and clothing penetration factors as well as with the uncertainty introduced by extrapolating a limited number of dermal patch measurements to larger body regions. Even so, the highest individual internal daily dose of glyphosate derived from passive dosimetry remained below the internal-dose benchmark derived from conservative regulatory health-based guidance values (60 µg/kg/day), suggesting a low likelihood of adverse health effects under the tested conditions. By directly comparing concurrently collected passive dosimetry and biomonitoring data in applicators with detectable urinary glyphosate, this study provides empirical support for using biomonitoring to evaluate and refine dermal passive-dosimetry assumptions in glyphosate exposure assessment. Izloženost glifosatu obično se procjenjuje primjenom pasivne dozimetrije ili biomonitoringa. U ovom je istraživanju testirana hipoteza da su procjene interne doze izvedene iz pasivne dozimetrije više i nesigurnije od onih dobivenih biomonitoringom, i to usporedbom istodobno prikupljenih podataka pasivne dozimetrije i biomonitoringa iz kontrolirane simulacije intenzivne primjene herbicida u kućanstvu. Pritom su zasebno procijenjena dva prevladavajuća puta izloženosti: šest primjenitelja otopine glifosata bilo je zaštićeno od dermalne izloženosti kombinezonima Tyvek® s kapuljačom i rukavicama, a šest je nosilo kratke hlače i majicu, ali i zaštitnu masku s respiratorom radi zaštite od izloženosti glifosatu udisanjem. Mokraća je prikupljana od svakog primjenitelja, počevši od 30 minuta prije primjene pa do 36 sati nakon nje. Usto je svaki primjenitelj u zaštitnom kombinezonu nosio četiri vanjska dermalna jastučića i dva uzorkivača zraka (lijevi i desni) u zoni disanja. Interne doze neovisno su procijenjene na temelju mjerenja iz zraka i s dermalnih jastučića (pasivna dozimetrija) te iz ostataka glifosata u mokraći (biomonitoring). Prosječne ukupne interne dnevne doze glifosata procijenjene pasivnom dozimetrijom bile su približno sedam puta veće od procjena temeljenih na biomonitoringu. Ova se procijenjenost može pripisati dermalnom putu unosa te je u skladu s nesigurnošću u pretpostavljenim čimbenicima dermalne apsorpcije i prodiranja kroz odjeću, kao i s nesigurnošću uvedenom ekstrapolacijom ograničenog broja mjerenja s dermalnih jastučića na veće dijelove tijela. Unatoč tomu, najviša pojedinačna interna dnevna doza glifosata izvedena iz pasivne dozimetrije ostala je ispod referentne vrijednosti interne doze izvedene iz konzervativnih regulatornih zdravstvenih smjernica (60 µg/kg/dan), što upućuje na nisku vjerojatnost štetnih učinaka na zdravlje u testiranim uvjetima. Izravnom usporedbom pasivne dozimetrije i biomonitoringa ovo istraživanje empirijski podupire odabir biomonitoringa za evaluaciju i ugađanje pretpostavki za bolju procjenu izloženosti glifosatu na temelju pasivne dozimetrije.

49. Testicular toxicity of Aroclor 1254 in selenium-deficient and selenium-supplemented rats.

期刊: Arhiv za higijenu rada i toksikologiju 发表日期: 2026-Jun-01 链接: PubMed

摘要

Aroclor 1254 (A1254) is a mixture of polychlorinated biphenyl (PCB) congeners known to induce testicular toxicity through oxidative stress, apoptosis, and hormonal disruption. Selenium (Se), an essential trace element for male reproduction, contributes to antioxidant defence, DNA repair, and spermatogenesis. Given the worldwide prevalence of Se deficiency and its potential impact on reproductive health, this study investigated the effects of A1254 exposure on testicular function in Sprague-Dawley rats with different Se status. Rats assigned to the Se-deficient group were receiving a ≤0.05 mg/kg Se diet, while those assigned to the Se-supplemented group were receiving 1 mg/kg Se for five weeks. A1254-treated groups were receiving 10 mg/kg/day of A1254 by oral gavage for 15 consecutive days. A1254 exposure caused significant reductions in testis weight, sperm count, motility, and plasma testosterone levels, accompanied by extensive germ cell apoptosis and enhanced lipid and protein oxidation. Total antioxidant capacity also dropped significantly, confirming redox imbalance in A1254-exposed testes. These adverse effects were substantially exacerbated in the Se-deficient group, whereas Se supplementation ameliorated but did not fully prevent histological and biochemical changes induced by A1254. Our findings demonstrate that Se plays a crucial protective role against PCB-associated testicular injury, primarily by mitigating oxidative stress and apoptotic pathways. However, Se supplementation alone may not completely counteract the reproductive toxicity caused by persistent environmental contaminants such as A1254. Aroclor 1254 (A1254) mješavina je kongenera polikloriranih bifenila (PCB), za koje je poznato da prouzročuju toksičnost u testisima putem oksidacijskoga stresa, apoptoze i hormonskih poremećaja. Selen (Se), esencijalni element u tragovima važan za mušku reprodukciju, pridonosi antioksidacijskoj obrani, popravku DNA i spermatogenezi. S obzirom na raširenu pojavnost nedostatka selena u svijetu i njegov mogući utjecaj na reproduktivno zdravlje, u ovom su istraživanju ispitani učinci izloženosti A1254 na funkciju testisa u Sprague-Dawley štakora s različitim statusom selena. Štakori u skupini s manjkom selena primali su ga u hrani u masenoj frakciji ≤0,05 mg/kg, dok su životinje u nadomjesnoj skupini primale 1 mg/kg selena tijekom pet tjedana. Skupine tretirane A1254 primale su ga 10 mg/kg/dan oralnom gavažom tijekom 15 uzastopnih dana. Izloženost A1254 prouzročila je značajno smanjenje mase testisa, broja i pokretljivosti spermija te razine testosterona u plazmi, uz zamjetnu apoptozu zametnih stanica i pojačanu oksidaciju lipida i proteina. Ukupni antioksidacijski kapacitet također se značajno smanjio, što potvrđuje narušenu redoks ravnotežu u testisima izloženima A1254. Ovi štetni učinci bili su znatno izraženiji u skupini s manjkom Se, dok je nadomjestak ublažio, ali nije potpuno spriječio histološke i biokemijske promjene izazvane A1254. Naši rezultati pokazuju da selen ima ključnu zaštitnu ulogu protiv oštećenja testisa povezanih s PCB-ima, ponajviše ublažavanjem oksidacijskoga stresa i inhibicijom apoptotskih putova. Međutim, sama suplementacija selenom možda nije dostatna za potpuno suzbijanje reproduktivne toksičnosti prouzročene postojanim okolišnim onečišćivalima poput A1254.

50. Combined in vitro effects of temozolomide and erucic acid on U87 MG cell viability, oxidative stress, and expression of genes involved in apoptotic signalling.

期刊: Arhiv za higijenu rada i toksikologiju 发表日期: 2026-Jun-01 链接: PubMed

摘要

Limited efficacy of glioblastoma treatment with temozolomide (TMZ) due to resistance has prompted researchers to look for adjuvants capable of enhancing TMZ-associated cytotoxicity. The aim of our in vitro study was to evaluate such effects of erucic acid when combined with TMZ in human U87 MG cells. Cells were treated for 24 or 72 h with vehicle (control), TMZ (200 ng/mL), or TMZ plus EA (20, 40, 80, or 160 µg/mL). Cell viability was assessed using the MTT assay, membrane integrity with lactate dehydrogenase (LDH) release, and intracellular redox balance by measuring total antioxidant capacity (TAC) and total oxidant status (TOS). The mRNA expression of apoptosis-related genes (p53, p21, Bax, Bcl-2, Bcl-xL, and caspase-3) was analysed by reverse transcription-quantitative polymerase chain reaction (RT-qPCR). Compared with the vehicle control, TMZ plus EA reduced cell viability and increased LDH release, with more pronounced effects at higher EA concentrations and at 72 h. These changes were accompanied by lower TAC and higher TOS, indicating a shift toward a pro-oxidant intracellular environment. At the transcriptional level, the combination induced increased pro-apoptotic Bax, caspase-3, p53, and p21 expression and reduced Bcl-2 and Bcl-xL expression. In conclusion, EA potentiated TMZ-associated cytotoxic responses in U87 MG cells with accompanying oxidative imbalance and apoptosis-related transcriptional changes. Ograničena djelotvornost liječenja glioblastoma temozolomidom (TMZ) zbog nastanka rezistencije potaknula je potragu za adjuvansima koji će pojačati njegovu citotoksičnost. Cilj našeg in vitro istraživanja bio je na humanim stanicama glioblastoma U-87 MG procijeniti ima li eruka kiselina takav učinak u kombinaciji s TMZ-om. Stanice smo izložili DMSO (kontrola), TMZ-u (200 ng/mL) ili kombinaciji TMZ-a i eruka kiseline (20, 40, 80 ili 160 µg/mL) 24 sata odnosno 72 sata. Vijabilnost stanica utvrđena je MTT testom, a integritet membrane, otpuštanje laktat-dehidrogenaze (LDH) i unutarstanična redoks ravnoteža procijenjeni su mjerenjem ukupnog antioksidacijskog kapaciteta (engl. total antioxidant capacity; TAC) i ukupnog oksidacijskog statusa (engl. total oxidant status; TOS). Ekspresija mRNA gena povezanih s apoptozom (p53, p21, Bax, Bcl-2, Bcl-xL i kaspaza-3) analizirana je metodom kvantitativne lančane reakcije polimerazom nakon reverzne transkripcije (RT-qPCR). U usporedbi s kontrolom, kombinacija TMZ-a i eruka kiseline smanjila je vijabilnost stanica i povećala otpuštanje LDH-a, pri čemu su učinci bili izraženiji pri višim koncentracijama eruka kiseline i nakon 72 sata. Ove promjene popraćene su nižim TAC-om i višim TOS-om, što upućuje na pomak prema prooksidacijskom unutarstaničnom okolišu. Na transkripcijskoj razini kombinacija je inducirala povećanu ekspresiju proapoptotskih proteina Bax, kaspaza-3, p53 i p21 te smanjenu ekspresiju Bcl-2 i Bcl-xL. Naši rezultati potvrđuju da eruka kiselina pojačava citotoksičnost TMZ-a za stanice U-87 MG kroz oksidacijski stres, što objašnjava indukciju apoptotskih signalnih putova.

51. The Effect of Preoperative Hydration on Cardiac Surgery-Associated Acute Kidney Injury.

期刊: Brazilian journal of cardiovascular surgery 发表日期: 2026-Apr-01 链接: PubMed

摘要

The aim of this study was to determine the effect of preoperative intravenous saline hydration on postoperative renal functions and the prevention of acute kidney injury subsequent to open-heart surgery. Our investigation was designed as a prospective, randomized, and controlled single-center trial. We included 110 patients with basal renal functions that were not disrupted and who were undergoing cardiac surgery from October to December 2020. The first group (control) had fluid restriction for 12 hours prior to surgery (n = 55), and the second group (case) was hydrated with 0.9% normal saline for 12 hours before surgery (n = 55). In the hydration group, creatinine values dropped below the preoperative values (P = 0.008) and the glomerular filtration rate values rose above the preoperative levels (P = 0.003). The early-term mortality rates were 0% for the hydration group and 5.45% for the control group (n = 3). Besides, in the hydration group, the glomerular filtration rate values on the 30th day and 360th day after surgery increased to levels even higher than those recorded preoperatively. As a result of much effort, we showed that preoperative hydration can prevent severe cardiac surgery-associated acute kidney injury and related in-hospital mortality.

52. The popular press and the 1950s moral crusade against British army 'bull(shit)'.

期刊: Modern British history (Oxford, England) 发表日期: 2026-Jan-08 链接: PubMed

摘要

Throughout the 1950s, the Daily Mirror led a campaign by the popular press against petty, tyrannical discipline, commonly known as ‘bull(shit)’, within the British Army. Acting as moral entrepreneurs, tabloid newspapers positioned what they regarded to be the deviant behaviour exhibited by over-zealous non-commissioned officers towards national servicemen as a threat to the normative contours of British society. By doing so, the campaign against ‘bull’ sought to exploit latent fears about large standing armies in peacetime to pressure the Army to reform and modernize its methods of discipline. The article argues that the campaign against ‘bull’ was effective in that it elevated military discipline as an issue of public concern during a period in which the British Army was actively seeking to enhance its public image to improve soldier recruitment and retention as it prepared to revert back to being an all-volunteer force after the decision was made in 1957 to terminate National Service. By framing ‘bull’ as an archaic form of social control that was damaging to both morale and efficiency, the moral crusade compelled the Army to explain and justify its methods of discipline amidst increasing public and parliamentary concern.

53. Behavior change technique delivery during routine smoking cessation advice in primary care and associations with abstinence.

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

摘要

Little is known about the content of routine smoking cessation support in primary care and how it relates to abstinence. While 121 behavior change techniques (BCTs) have been identified for cessation treatment, English treatment guidelines recommend 30 across cessation consultations. We sought to identify: (1) BCTs delivered during routine cessation support in primary care in England; (2) associations between abstinence and (a) the total number of BCTs used, (b) delivery of the 30 recommended BCTs, (c) delivery of individual BCTs. In an evaluation trial across 32 English General Practices, 149 pre-quit consultations (across 29 practitioners trained in cessation support) from a multisession cessation program were audio-recorded, transcribed, and analyzed for BCT delivery using a modified BCT taxonomy v1 and smoking-specific taxonomy. Abstinence was collected at 4-weeks (biochemically verified), 8-weeks (primary outcome, self-reported), and 6-months (self-reported) post quit date. Multilevel modelling assessed associations. Of 121 BCTs, 85 were delivered in at least one consultation. A mean of 13.4 (SD = 2.76) of recommended BCTs were delivered, with 33% (10/30) delivered in at least half of the consultations. Total BCTs delivered were not associated with abstinence. Delivery of more guideline-recommended BCTs was only associated with abstinence at 4 weeks (OR = 1.03, 95% CI 1.00-1.06; P = .03). One BCT was positively associated, and one negatively associated with abstinence. One-third of recommended BCTs were delivered in at least 50% of initial consultations, with delivery associated with short-term abstinence. Limited practitioner time may constrain BCT delivery and is a consideration for future guidelines. The Clinical Trials Registration #ISRCTN 56702353. Stop smoking support is regularly provided in primary care. However, it is not clear what this support includes (e.g. which behavior change techniques [BCTs]), how well this follows recommended guidelines, and whether the included content actually leads to people quitting. There are 121 known BCTs that can support quitting, but guidelines suggest using 30 key BCTs. We analyzed 149 recorded conversations between patients and primary care health professionals before their planned quit date, checking which BCTs were used and if they were linked to quitting success. We found that 85 different BCTs were used at least once, but on average, 13 of the recommended 30 were used. Overall, using more BCTs did not link to better quit outcomes. However, using more of the recommended BCTs was linked to quitting success at 4-weeks, but not at 8-weeks or 6-months. Only one specific BCT helped, while another seemed to hinder success. This suggests that short-term quitting may benefit from using more guideline-recommended BCTs, but time limits in appointments may prevent full use. Future guidelines may need to account for this challenge.

54. Obesity in young adults: The differentiated impact of LEP, LEPR, and FTO gene variants.

期刊: Genetics and molecular biology 发表日期: 2026 链接: PubMed

摘要

Obesity is a global public health issue, increasingly affecting young adults. Its association with other diseases highlights the urgency of developing prevention strategies. Genetic factors play a significant role in susceptibility to obesity, making the identification of risk-associated variants essential for prevention strategies. Therefore, this study aimed to analyze LEP, LEPR, and FTO variants as potential genetic risk factors for obesity in Brazilians aged 18-35 years. The participants were classified with, or without obesity/overweight. Genotyping was performed by ASO-PCR, RFLP, and DNA sequencing. A questionnaire was applied to collect anthropometric data, and personal and family medical history. Preliminary analyses indicated that obesity was significantly associated with individuals over 25 years of age; therefore, to specifically investigate early-onset obesity, the primary genetic association analyses were restricted to the 18-25 age group. A significant association was found between the LEP rs7799039 variant and BMI ≥ 25 Kg/m², and LEP rs17151919 was strongly associated with BMI ≥ 30 Kg/m² in this age group. These findings underscore the importance of identifying genetic variants that increase the risk of obesity in young adults and suggest contributing to the development of more effective and personalized prevention strategies, integrating knowledge from genetics, medicine, and nutrition.