公共卫生研究摘要 (2026-07-07)

共收录 60 篇研究文章

1. Phenotype, Severity, and Therapy of Patients With LRP4 Antibody-Associated Myasthenia Gravis in the German Myasthenia Gravis Registry.

期刊: Neurology 发表日期: 2026-Aug-11 链接: PubMed

摘要

Lipoprotein receptor-related protein 4 antibody-positive myasthenia gravis (LRP4-Ab-positive MG) is a rare serologic subgroup with poorly defined clinical phenotype. This study investigated demographics, clinical features, treatments, and disease burden of LRP4-Ab-positive MG against other antibody-defined subgroups. Patients from the prospective longitudinal German MG registry tested for LRP4, AChR, and MuSK Abs were grouped and analyzed for symptoms, treatment, and disease burden scores (for example, Myasthenia Gravis Activities of Daily Living [MG-ADL] and Myasthenia Gravis Quality-of-Life 15-item revised version scale [MG-Qol15r]). Among 3,319 patients, 1,432 (43.1%, median age 54, 57.4% female) had complete antibody testing: 4.8% of these were LRP4-Ab-positive (2.4% single-positive; 2.4% LRP4/AChR-Ab-double-positive), 63.6% AChR-Ab-positive, 2.4% MuSK-Ab-positive, 0.8% MuSK/AChR-Ab-double-positive, and 28.4% triple seronegative. LRP4-Ab-single-positive patients reported high symptom rates, and all LRP4-Ab-positive patients showed high rates of escalation (e.g., rituximab) and rescue therapies (e.g., IVIG). Linear mixed-effects models revealed greater disease burden in LRP4-Ab-single-positive patients vs all other subgroups (e.g., vs AChrR-Ab-positive: MG-ADL -2.5 points [95% CI -3.9 to -1.2]; MG-Qol15r -8.4 [95% CI -13.3 to -3.4]). Conversely, LRP4/AChR-Ab-double-positive patients showed burden and treatment patterns comparable with other subgroups. LRP4-Ab-single-positive MG represents a distinct phenotype characterized by high disease burden and treatment needs. By contrast, LRP4/AChR-Ab-double-positive MG phenotypes align more closely with other MG subgroups. German clinical trial registry (drks.de), DRKS00024099, first patient enrolled: February 4, 2019.

2. Association of Changes in Intrinsic Capacity With Cognitive Decline and Dementia: A Prospective Cohort Study.

期刊: Neurology 发表日期: 2026-Aug-11 链接: PubMed

摘要

Previous studies found that intrinsic capacity (IC) was an important risk factor for dementia. However, these studies focused on baseline IC, without considering the dynamic changes in IC. The study aimed to investigate the associations of changes in IC with cognitive decline and dementia and assess whether these associations varied by race. A cohort study was conducted using data from the Health and Retirement Study. An IC deficit score was calculated by 7 factors reflecting 4 domains. Changes in IC were assessed by comparing the baseline IC status with that observed in the second survey. Cognitive decline was evaluated by computing a standardized z-score based on memory, executive function, and orientation. Dementia was diagnosed either through self-reported physician diagnosis or an alternative approach based on cognitive score. Linear mixed effects models and Cox models were performed to analyze the association of changes in IC with cognitive decline and dementia. A total of 7,744 participants (male: 42.4%, mean age: 75.6 years) were included. The median follow-up period was 8.9 years. Compared with participants who maintained robust IC status, those whose IC status progressed to deficit status showed accelerated global cognitive decline (β, -0.025; 95% CI -0.036 to -0.015) and increased risk of dementia (hazard ratio [HR], 1.38; 95% CI 1.10-1.72). Conversely, participants who recovered from IC deficit to robust status showed decelerated global cognitive decline (β, 0.010; 95% CI 0.001 to 0.019) and decreased risk of dementia (HR, 0.84; 95% CI 0.72-0.98) relative to those with stable IC deficit. In addition, the associations of baseline IC with cognitive decline and dementia appeared to be somewhat stronger among Black participants, relative to White participants (p for interaction = 0.011). Significantly decelerated global cognitive decline in IC deficit participants who recovered to robust status was observed exclusively among Black participants. The findings indicated that the progression of IC deficit status was associated with accelerated cognitive decline and increased risk of dementia. Conversely, recovery of IC deficit status was associated with a decelerated cognitive decline and decreased risk of dementia. Future studies with more measurement waves are warranted to validate these findings.

3. Payment integrity in government programs: Takeaways from incorporating the behavioral sciences in US federal evaluations.

期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2026-Jul-14 链接: PubMed

摘要

A primary way the US federal government delivers public goods and services is via monetary payments. Ensuring that these payments are calculated accurately, delivered on time, and made to the correct recipients is important for government fiscal health. Inaccurate or delayed payments can weaken public trust in the government and undermine government accountability. In this article, we examine findings from a set of impact evaluations assessing interventions designed to improve payment integrity in US federal programs. The low-cost, evidence-based interventions draw on insights from the social and behavioral sciences and include modification of forms, changes to how and when agencies request information, and altering existing communications. The evaluations were conducted by the US General Services Administration’s Office of Evaluation Sciences in collaboration with agency partners. We extract three takeaways across four representative evaluations. First, the real-world evaluations validate a key implication of the behavioral science literature: interventions that reduce burdens for individuals have small effects that meaningfully improve payment integrity at scale. Second, effects attenuate across interventions and over time, suggesting a need for iterative evaluation. Finally, bureaucratic hurdles and administrative complexity are the main barriers to translating academic insights into real-world government programs. Addressing these challenges will require close collaboration between behavioral scientists and practitioners throughout the intervention design and evaluation process.

4. Applied behavioral and decision sciences in support of US FDA's drug regulatory mission.

期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2026-Jul-14 链接: PubMed

摘要

The US Food and Drug Administration (FDA) makes and communicates decisions that directly affect the health choices and well-being of the US public. Behavioral and decision scientists have long supported FDA’s pharmaceutical (medical drug) regulatory and public health mission, working alongside clinical and pharmaceutical scientists. This Perspective describes four interrelated cases illustrating these collaborations: a) creating the Benefit-Risk Framework to guide regulatory decisions regarding new drug approvals; b) launching an internal decision support service to facilitate specific regulatory decisions; c) implementing the Patient-Focused Drug Development initiative to strengthen the use of patient input to inform regulatory decision making; and d) developing FDA SOURCE, a dynamic systems simulation model to assess potential strategies to address the US opioid overdose crisis. Key to the success of these efforts has been their behavioral and decision science foundations, strategically implemented by an expert team dedicated to fostering trusted collaborations with internal and external partners. These cases offer a model for other agencies facing complex decisions of public impact.

5. The role of nonfinancial factors in the Congressional Budget Office's health insurance coverage projections.

期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2026-Jul-14 链接: PubMed

摘要

Nonfinancial factors play an important role in people’s coverage decisions as premiums, cost sharing, and other factors that determine the financial value of health insurance cannot fully explain patterns in take-up rates. The Congressional Budget Office (CBO) is tasked with estimating the budgetary and coverage effects of policy and economic changes that affect health insurance markets, which includes considering the interactions between nonfinancial factors and policy design. The agency groups the nonfinancial factors it considers into three categories: ease of enrollment, awareness, and attitudes. Many recent policies have affected nonfinancial factors related to the take-up of Medicaid and marketplace insurance, such as the introduction of work requirements for Medicaid and access to zero-premium marketplace plans. This article explains how nonfinancial factors are handled and incorporated into CBO’s baseline health insurance projections and cost estimates, highlights the recent literature on the effect of these nonfinancial factors on insurance take-up decisions, and suggests future areas of research.

6. Bumblebees' orofacial reactions to tastes provide evidence for affective evaluation.

期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2026-Jul-14 链接: PubMed

摘要

Facial expressions provide a critical window into the internal states of animals, allowing the identification of affective processes and their underlying neural mechanisms. In mammals, postconsumption orofacial reactions-such as tongue protrusions to sweet tastes-are among the most robust and widely accepted behavioral markers of positive hedonic impact (liking), distinct from motivation (wanting). However, no equivalent markers have been established in insects, leaving their capacity for affective evaluation unresolved. Here, we show that bumblebees exhibit discrete orofacial reactions that are functionally analogous to those described in mammals. Bees displayed postconsumption glossa protrusions to rewarding solutions and head-shaking and mouth-wiping to aversive tastes. These reactions were not tied to any specific taste identity. Behavioral and pharmacological experiments demonstrated that glossa protrusions did not automatically occur due to consumption, were independent of ongoing feeding mechanisms and dopamine-mediated motivation, and were enhanced by the endocannabinoid anandamide. Our findings support postconsumption glossa protrusions as a fast, reliable, and evolutionarily comparable candidate behavioral marker of affective evaluation in an invertebrate. By providing evidence that a behavior which tracks liking can be dissociated from motivational (wanting) responsiveness in bumblebees, this work establishes an experimental framework for investigating the neural basis and evolutionary origins of affective processing. More broadly, these results open the door to rigorous cross-phyletic approaches to emotion.

7. Selective and direct hydrogen generation from mixed plastic waste via alkaline thermal treatment with inherent carbon storage.

期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2026-Jul-14 链接: PubMed

摘要

The global accumulation of plastic waste has spurred extensive research into chemical recycling methods to mitigate environmental issues and convert waste into valuable resources. A major challenge in plastic recycling is the requirement for presorting, which complicates processing and increases costs. Here, we demonstrate alkaline thermal treatment (ATT) as a highly efficient strategy for directly converting mixed plastic waste, including polyethylene terephthalate (PET), polyethylene (PE), and polypropylene (PP), into clean hydrogen energy at low temperatures and atmospheric pressure. Unlike conventional gasification, NaOH-assisted ATT enables plastic decomposition at significantly lower temperatures while producing high-purity hydrogen and minimizing carbon emissions. A key advancement in this work is the oxidation pretreatment of PP and PE, which enhances their reactivity in ATT and allows efficient hydrogen generation even from typically resistant polyolefins. Through systematic optimization of the NaOH-to-plastic ratio and thermal oxidation conditions, hydrogen yields of 43.7, 51.9, and 30.2 mmol/gplastic were achieved for PET, PE, and PP, respectively. Furthermore, ATT efficiently converts both individual and mixed plastic waste without requiring extensive separation, demonstrating its commercial potential and scalability with real-world waste compositions. Overall, this study establishes ATT as a promising and sustainable solution for plastic waste management and clean energy production, providing an economically viable low-carbon pathway for hydrogen generation.

8. The Comparative Effectiveness of Carvedilol Versus Other Nonselective β-Blockers in Cirrhosis.

期刊: Annals of internal medicine 发表日期: 2026-Jul-07 链接: PubMed

摘要

In cirrhosis, nonselective β-blockers (NSBBs; carvedilol, nadolol, and propranolol) reduce hepatic portal pressure and have demonstrated benefit versus placebo for preventing decompensation. Although carvedilol has emerged as the preferred NSBB, direct evidence remains limited about its effectiveness for preventing decompensation and death versus other NSBBs. To compare the effectiveness of carvedilol versus nadolol versus propranolol in cirrhosis. Database cohort study. A U.S. administrative claims database, Optum Clinformatics Data Mart (2013 to 2025). Adults with cirrhosis initiating carvedilol, nadolol, or propranolol. The primary outcome was a composite of hospitalization for major decompensation (ascites, spontaneous bacterial peritonitis [SBP], hepatorenal syndrome [HRS], hepatic encephalopathy, or variceal hemorrhage). Absolute risk differences (RDs) and risk ratios (RRs) at 6 months of follow-up were estimated using inverse probability of treatment weighting accounting for 129 preexposure covariates. Carvedilol initiators had meaningfully lower 6-month risk for major decompensation events compared with nadolol (RD, -3.69 percentage points [95% CI, -5.33 to -2.09 percentage points]; RR, 0.80 [CI, 0.72 to 0.88]) or propranolol (RD, -2.88 percentage points [CI, -4.29 to -1.49 percentage points]; RR, 0.83 [CI, 0.76 to 0.90]). This included substantially lower 6-month risk for specific decompensation events with carvedilol compared with nadolol or propranolol, including reduced risk for variceal hemorrhage (RDs, -3.51 percentage points [CI, -4.79 to -2.20 percentage points] and -1.65 percentage points [CI, -2.71 to -0.59 percentage points], respectively) and ascites, SBP, or HRS (RDs, -3.05 percentage points [CI, -4.52 to -1.75 percentage points] and -1.58 percentage points [CI, -2.77 to -0.44 percentage points], respectively). Nonrandomized treatment selection. Among U.S. patients with cirrhosis, carvedilol initiation-as opposed to nadolol or propranolol-was associated with meaningfully lower rates of major decompensation events. National Institutes of Health.

9. Benzodiazepine Prescriptions to Older Adults in the United States, 2015 to 2024.

期刊: Annals of internal medicine 发表日期: 2026-Jul-07 链接: PubMed

摘要

10. The Role of Telemedicine on Interhospital Transfer Outcomes : A Systematic Review.

期刊: Annals of internal medicine 发表日期: 2026-Jul-07 链接: PubMed

摘要

Interhospital transfers are essential to ensure access to appropriate levels of care, yet many transfers are potentially avoidable, leading to unnecessary resource use and patient burden. To determine the association between telemedicine and interhospital transfer rates among patients considered for an interhospital transfer. Five databases were searched from database inception to 20 January 2026. Studies including patients considered for transfer between hospitals, studies comparing telemedicine with usual care, and studies reporting interhospital transfers rates. Two independent reviewers extracted data and assessed risk of bias. The primary outcome was interhospital transfer rate; the secondary outcome was death. Grouping by patient population, clinical indication for transfer, setting, and intervention characteristic was done. Thirty-three studies representing 609 188 patients were included. Given substantial clinical and methodological heterogeneity, a structured narrative synthesis was done. Telemedicine was commonly associated with lower transfer rates in adult (13 of 17 adult only studies) and pediatric (4 of 5 studies) populations, across clinical indication for transfer (medical [9 of 14 studies] versus surgical [6 of 7 studies] versus acute care conditions [7 of 12 studies]), and rural (9 of 16 studies) and urban (9 of 10 studies) settings. Variation in the transfer rate changes was driven by differences in confounder adjustment, comparator definitions, and study design. Telemedicine was associated with lower or unchanged mortality in most studies that assessed mortality (15 of 17 studies). Included studies were mostly observational with risk for confounding, with high heterogeneity driven by variability in study populations, telemedicine models, comparator groups, clinical contexts, and methodological approaches. Telemedicine may support appropriate triage and reduce potentially avoidable interhospital transfers, with no adverse association on mortality, contributing to safe and efficient transfer decision making. None. (PROSPERO: CRD42023493486).

11. Physical Activity for Weight Loss and Health Promotion.

期刊: Circulation 发表日期: 2026-Jul-07 链接: PubMed

摘要

12. Unilateral Lower Limb Suspension Impairs Balance and Firing Rate of Soleus Small Motor Unit Action Potential Trains During Single Leg Stance.

期刊: Medicine and science in sports and exercise 发表日期: 2026-Jul-07 链接: PubMed

摘要

Postural control, which is largely determined by coordinated activation of dorsi- and plantar-flexors, is impaired following spaceflight. Unilateral lower limb suspension (ULLS) mimics spaceflight-induced reductions in motor unit recruitment, but its effects on balance are unknown. To assess postural control and motor unit action potential train (MUAPT) firing rate of the tibialis anterior (TA) and soleus (SOL) during single leg stance (SLS) before and after 13d ULLS. Thirteen healthy subjects (6 men, 7 women; age: 18-44y) completed 15s SLS pre- and post-ULLS. Center of pressure (CoP) ellipse area, total excursion (TE), and average velocity (AV) and surface electromyography (sEMG) signals from four-pin grid array sensors (Delsys Galileo) applied to TA and SOL were measured. The relationship between MUAPTs amplitude (mV) and mean firing rate (pps) for each subject were modeled with the formula y=A·e Bx where A represents the y-intercept and B represents the exponential decay coefficient. Data were compared via linear mixed models. CoP ellipse area (pre: 761.4±431.1; post: 2443.9±426.5 mm², p=0.010), TE (pre: 620.5±114.5; post: 1028.3 ± 113.4 mm, p=0.006), and AV (pre: 41.4 ± 7.6; post: 68.5 ± 7.5 mm·s⁻¹, p=0.006) were greater in the unloaded, but not loaded, limb post- compared to pre-ULLS. A significant limb × time interaction was observed for the SOL MUAPT amplitude-firing rate relationship where the y-intercept was less post-ULLS in the unloaded, but not loaded, limb compared to pre-ULLS (p=0.005). Firing rate of small (<0.025 mV), but not large, MUAPT of the SOL, but not TA, was significantly less post-ULLS compared to pre-ULLS in the unloaded limb. ULLS impairs balance and firing rate of low-amplitude MUAPT in SOL, but not TA.

13. Prolonged Short Sleep and Its Effect on Body Weight and Composition : A Pooled Analysis of Randomized Trials.

期刊: Annals of internal medicine 发表日期: 2026-Jul-07 链接: PubMed

摘要

Insufficient sleep is associated with obesity. However, the causal effect on weight status of chronic, mildly insufficient sleep and its potential variability by gender and menopausal status remain unknown. To explore the effect of 6 weeks of sleep restriction (SR) of 1.5 hours per night on energy balance and body weight regulation. Pooled analysis of 2 randomized crossover trials. (ClinicalTrials.gov: NCT02960776 and NCT02835261). Outpatient intervention with inpatient and outpatient assessments. Adults (n = 95) aged 20 years or older at elevated cardiometabolic risk with habitual sleep of 7 or more hours per night. Six weeks of sustained adequate sleep (AS) and SR of 1.5 hours per night separated by a multiweek washout. Outcome measures included adiposity (assessed using magnetic resonance imaging), body weight, waist circumference, and energy balance behaviors and biomarkers. Sleep duration was reduced by 78.4 minutes (95% CI, -83.5 to -73.3 minutes) per night with SR versus AS. Body weight (0.45 kg [CI, 0.33 to 0.57 kg]), waist circumference (0.52 cm [CI, 0.25 to 0.79 cm]), and whole-body volume (0.56 L [CI, 0.19 to 0.93 L]) were increased with SR relative to AS. Leptin levels were elevated with SR versus AS (2.03 ng/mL [CI, 0.38 to 3.68 ng/mL]). Sedentary time was increased by 17.2 minutes (CI, 11.7 to 22.7 minutes) per day with SR versus AS. The intervention duration may have been too short to identify changes in body composition, power to evaluate individual differences was limited, and effect sizes were modest. Prolonged exposure to moderately short sleep may lead to weight gain, suggesting that weight management and cardiometabolic disease prevention programs should consider incorporating sleep strategies to promote AS. National Institutes of Health and American Heart Association.

14. Policy pathways and historical insights: Canada's evolving approach to psychedelic access for end-of-life distress.

期刊: The International journal on drug policy 发表日期: 2026-Jul-06 链接: PubMed

摘要

Canada’s evolving attitudes toward psychedelic interventions in palliative and end-of-life care reflect a departure from historically prohibitionist policies and an emerging recognition of their therapeutic potential for individuals facing end-of-life distress. This shift parallels international regulatory developments in jurisdictions such as the United States, Australia and parts of Europe, where cautious policy liberalization has signaled growing acceptance of psychedelics within clinical contexts. Canada is also a relevant case because of its formative role in the development of modern palliative care, its contemporary frameworks emphasizing holistic approaches to suffering at the end of life, and its experience with medical assistance in dying, all of which have shaped national conversations about suffering, autonomy, and end-of-life care. Additionally, Canada’s distinctive historical approach to drug regulation-marked by federal flexibility, mechanisms for compassionate access, and responsiveness to patient advocacy-combined with rising public demand and incremental provincial changes, may uniquely position the country along a transitional pathway toward clinical integration of psychedelics in palliative care. At the same time, Canadian drug policy remains heterogeneous across substances and provinces, underscoring the political contingency of reform. Within this dynamic landscape, Canada’s psychedelic drug policy trajectory aligns with broader international trends toward cautious medicalization and regulated access to psychedelic therapies, while also offering an instructive case for how end-of-life frameworks and federal-provincial governance shape policy development.

15. Independent and interactive associations of green space and air pollution with blood lipid biomarkers: A longitudinal study.

期刊: Ecotoxicology and environmental safety 发表日期: 2026-Jul-06 链接: PubMed

摘要

Evidence on the independent and interactive associations of green space and air pollution with novel blood lipid biomarkers remains limited. This longitudinal cohort study aimed to examine the independent and interactive associations of green space and air pollution exposure with blood lipid biomarkers. The study included 17,242 adults undergoing health examinations in Shijiazhuang, China (2021-2023). Linear mixed-effects models estimated associations of green space and air pollution exposure with blood lipid biomarkers, including the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and the atherogenic index of plasma (AIP). Interaction terms, restricted cubic splines, and mediation analyses evaluated interaction effects, nonlinear exposure-response relationships, and mediation effects. Associations with green space were most pronounced within the 500-m buffer. Each one-standard deviation (SD) increase in NDVI was associated with lower NHHR (β = -0.103; 95% CI: -0.114, -0.091) and AIP (β = -0.009; 95% CI: -0.012, -0.006). Among air pollutants, PM₂.₅ showed a stronger positive association with NHHR (β = 0.085 per SD; 95% CI: 0.081, 0.089), whereas PM₁₀ exhibited a stronger association with AIP (β = 0.006 per SD; 95% CI: 0.005, 0.007). Significant interactions were observed between NDVI and multiple air pollutants for both biomarkers (Pinteraction < 0.05). Air pollution mixture indices statistically mediated part of the associations between green space exposure and NHHR (13.5%) and AIP (34%). Green space exposure was associated with more favorable lipid biomarkers, whereas air pollution showed adverse associations. Green space is associated with weaker air pollution-related dyslipidemia.

16. Human Papillomavirus Infection in Patients With VaIN and Vaginal Cancer: A Retrospective Cross-Sectional Study.

期刊: Journal of lower genital tract disease 发表日期: 2026-Jul-06 链接: PubMed

摘要

Vaginal cancer is a rare malignancy, and the research on it is not comprehensive yet. To explore the characteristics of human papillomavirus (HPV) infection in patients with vaginal intraepithelial neoplasia (VaIN) and vaginal cancer. This study included patients who underwent colposcopy and biopsy of suspected sites at the Second Hospital of Shanxi Medical University from January 2014 to December 2023 due to abnormal cytology results and/or positive HPV test. Those diagnosed with benign inflammatory reaction of the vagina (ie, vaginitis), VaIN and vaginal cancer according to histologic results were selected as the study objects. Clinical data such as age, menopause, clinical manifestations and previous screening history were collected. We aimed to analyze the distribution and characteristics of HPV in VaIN and vaginal cancer patients. A total of 5,180 patients were included in this study. Of the total, 2,739 patients had VaIN1, 641 had VaIN2/3, and 251 had vaginal cancer. There were 235 patients with vaginal squamous cell carcinoma (VaSCC) and 16 patients with vaginal adenocarcinoma. A total of 4,548 patients were infected with HPV. The HPV positive rate was 95.5% in VaIN2/3, 86.0% in VaSCC and 43.8% in adenocarcinoma of the vagina. The most common 5 HPV types were HPV16, 52, 58, 53, and 18. The positive rate of HPV18 in the adenocarcinoma of the vagina was the highest. HPV16, 52, 58, 53, and 18 are the predominant genotypes in VaIN and vaginal cancer in Shanxi, China. HPV testing provides additional benefits for the detection of vaginal lesions during cervical cancer screening. Active HPV vaccination may help reduce the burden of these lesions.

17. Macrophage autophagy in allergic diseases: Regulatory mechanisms, immune crosstalk, and therapeutic implications.

期刊: International immunopharmacology 发表日期: 2026-Jul-06 链接: PubMed

摘要

Macrophages are pivotal effector cells within the innate immune system, playing a central role in inflammation regulation, tissue homeostasis, and immune defense. Recent studies have demonstrated that macrophage autophagy-a highly conserved process essential for cellular homeostasis-plays a critical role in dynamically balancing immune responses by selectively eliminating damaged organelles, pathogens, and protein aggregates. Macrophage autophagy is finely regulated by various signaling pathways, such as mTOR and NF-κB, and its dysfunction is closely associated with the onset and progression of allergic diseases. This review systematically synthesizes the molecular mechanisms governing macrophage autophagy and its dual role in allergic diseases, including allergic rhinitis, asthma, and atopic dermatitis. It highlights the functions of key signaling pathways (e.g., mTOR, NF-κB) and regulatory factors (e.g., p62, Beclin-1, LC3) and explores the crosstalk between macrophage autophagy, immunometabolism, and cellular polarization. Explores the crosstalk between macrophage autophagy, immunometabolism, and cellular polarization, and further elaborates the reciprocal regulatory network of autophagy and metabolic reprogramming within allergic inflammatory microenvironment. Furthermore, the review summarizes potential therapeutic strategies targeting macrophage autophagy, such as budesonide/simvastatin combination therapy and rapamycin derivatives, along with their clinical translation prospects, with the aim of providing a theoretical foundation for developing novel, autophagy-targeted precision therapies for allergic diseases.

18. Generative Artificial Intelligence Literacy Scale for Nurses: Development and Psychometric Evaluation.

期刊: Journal of medical Internet research 发表日期: 2026-Jul-06 链接: PubMed

摘要

Generative artificial intelligence (GenAI) can automate time-intensive tasks and support clinical decision-making in care settings. Nurses require appropriate competencies to ensure that integration of GenAI strengthens care quality and patient safety. However, validated literacy assessment tools remain limited. In particular, instruments tailored to nurses’ role-specific GenAI competencies, including hallucination detection, risk identification, and ethical accountability, are lacking. These gaps highlight the need for a nurse-specific GenAI literacy scale. This study aimed to develop and psychometrically validate the Generative Artificial Intelligence Literacy Scale for Nurses (GenAILS). We conducted a two-phase, cross-sectional online survey of registered nurses nationwide in Taiwan between June 2025 and October 2025. Phase 1 involved conceptualization and item generation based on a literature review, followed by content appraisal through expert discussion with 6 external reviewers. A 50-item pool was generated. Subsequently, 5 external reviewers evaluated content validity. Items with a content validity index of <0.78 or flagged for revision were revised or deleted. Phase 2 evaluated psychometric properties (item analysis, internal consistency, split-half reliability, and criterion-related validity) and construct validity via exploratory factor analysis (factor loading ≥0.60), followed by confirmatory factor analysis (CFA). The total sample was randomly split into 2 independent subsamples for exploratory factor analysis and CFA. In phase 1, the initial 50 items underwent expert content validation and were revised to 46 items (scale content validity index based on the average method=0.92). In phase 2, 1313 questionnaires were collected, of which 191 invalid responses were excluded; 1122 valid responses were analyzed. Participants had a mean age of 34.66 (SD 7.8) years. Extreme-group comparison revealed statistically significant differences for each item (P<.001). The final scale comprised 24 items across six dimensions: responsible use, updated competencies, risk identification, fundamental knowledge, critical evaluation, and ethics and law. The cumulative variance explained was 53.1%. The first-order CFA demonstrated excellent model fit: root-mean-square error of approximation=0.035, standardized root-mean-square residual=0.032, comparative fit index=0.99, goodness-of-fit index=0.94, adjusted goodness-of-fit index=0.93, nonnormed fit index=0.99, and parsimony normed fit index=0.84. The second-order CFA demonstrated excellent model fit: root-mean-square error of approximation=0.039, standardized root-mean-square residual=0.040, comparative fit index=0.99, goodness-of-fit index=0.94, adjusted goodness-of-fit index=0.92, nonnormed fit index=0.99, and parsimony normed fit index=0.87. All heterotrait-monotrait ratio values were below 0.85, supporting discriminant validity. The scale was moderately correlated with the Short Form Meta-AI Literacy Scale (r=0.57; P<.001). Reliability was excellent (Cronbach α=0.92; McDonald ω=0.92; split-half reliability=0.81). The GenAILS is a concise, nurse-specific self-report instrument with good psychometric properties across 6 clinically relevant domains. It supports needs assessment, targeted training, and intervention evaluation to promote the safe and ethical use of GenAI in nursing.

19. Health Data Quality Skill Gaps and Training Needs Among European Health Data Stakeholders: Cross-Sectional Survey.

期刊: Journal of medical Internet research 发表日期: 2026-Jul-06 链接: PubMed

摘要

The secondary use of health data is accelerating across Europe driven by growing demand for data-enabled research, innovation, and policymaking. The European Health Data Space (EHDS) establishes a regulatory framework to support this ecosystem, including Article 78, which mandates a data quality and utility labeling mechanism for datasets intended for reuse. Implementing this framework requires that data holders, data users, and health data access bodies possess sufficient skills, training, and organizational capacity to assess, document, and communicate data quality. However, little empirical evidence exists on whether European health data stakeholders currently possess these capabilities or how their needs differ across the 3 EHDS-defined roles. This study aimed to identify current skill gaps, training needs, and organizational readiness related to health data quality among European health data stakeholders within the context of the EHDS. A cross-sectional online survey was conducted between March 2024 and April 2024 using convenience sampling through the QUANTUM (Quality, Utility, and Maturity Measured; Developing a Data Quality and Utility Label for the European Health Data Space) consortium network, professional mailing lists, and health data communities. The survey targeted individuals involved in the secondary use of health data who identified as data holders, data users, or health data access bodies. The survey assessed 5 domains: stakeholder roles and data interaction, individual skills and experience, perceived challenges and skill gaps, organizational support and tools, and learning needs and preferences. Overall, 64 responses were collected from participants representing 44 institutions across 18 European countries. Overall, 82.8% (53/64; 95% CI 71.8%-90.1%) of respondents interacted with health data at least weekly, and 84.4% (54/64; 95% CI 73.6%-91.3%) rated data quality as moderately to absolutely critical for their work. Despite this, 87.5% (56/64; 95% CI 77.2%-93.8%) reported that poor data quality limited their effectiveness, with missing or inconsistent data identified as the most prevalent challenge. While 79.7% (51/64; 95% CI 67.4%-88.3%) reported prior experience with data quality tasks, key skill gaps were identified in applying data quality metrics, auditing and reporting, and metadata management. At the organizational level, only 15.6% (10/64; 95% CI 8.7%-26.6%) reported clearly defined data quality roles, and 68.8% (44/64; 95% CI 56.6%-78.8%) lacked a dedicated data quality manager or team. This study provides an empirical assessment of data quality skills and organizational readiness across the 3 EHDS-defined stakeholder groups. The findings highlight that practical experience alone does not ensure data quality competence and that structural deficits, particularly unclear roles and limited governance, constrain effective data quality management. The results offer a role-specific, evidence-based road map for capacity-building efforts essential to the successful implementation of the EHDS Article 78 data quality and utility labeling framework. This evidence underscores the urgent need for coordinated capacity building to ensure successful EHDS data quality implementation.

20. Artificial Intelligence-Assisted Screening for Patients With Diabetic Retinopathy and Age-Related Macular Degeneration in Family Medicine and Geriatric and Gerontology Care: Protocol for a Pragmatic Randomized Clinical Trial.

期刊: JMIR research protocols 发表日期: 2026-Jul-06 链接: PubMed

摘要

Diabetic retinopathy (DR) and age-related macular degeneration (AMD) are 2 of the leading causes of vision loss worldwide. As population aging and diabetes prevalence increase, timely detection of these conditions has become essential. However, limited professionalism and insufficient training in ophthalmic screening among general medicine physicians may lead to delayed diagnosis and treatment. Artificial intelligence (AI)-assisted diagnostic tools may help to improve the screening of DR and AMD in routine clinical practice. This study aims to evaluate the clinical effectiveness and cost-effectiveness of AI-assisted fundus imaging for DR and AMD screening in adults with diabetes and older adults at risk of macular degeneration. This multicenter, 2-arm, parallel-group, open-label, individual-level randomized controlled trial and patient recruitment are performed at the settings of Family Medicine and Geriatric and Gerontology Care over 4 medical centers in Taiwan. Eligibility includes (1) diabetic individuals aged ≥20 years for DR screening, and (2) individuals aged ≥50 years for AMD screening. The study protocol has been approved by the ethics committees of all participating hospitals, and all participants will provide written informed consent. The study was funded in September 2024, began on October 2, 2025, and is expected to be completed in December 2027. After the pilot implementation phase without randomization, participants will be randomized 1:1 into two groups: (1) AI-assisted screening, and (2) usual physician-only screening. The primary outcomes will include the detection rates (defined as participants with confirmed DR or AMD among all screened participants) and the positive predictive values (defined as participants with confirmed DR or AMD among those who tested positive). Cost-effectiveness analyses will be performed using data derived from the trial results. This study will provide robust evidence on the effectiveness of AI-assisted ophthalmic screening in improving patient eye health outcomes through timely screening and accurate early detection. This strategy may be cost-effective.

21. Engineering resilient gene drives for sustainable malaria control by predicting, testing and overcoming target site resistance in Anopheles gambiae.

期刊: PLoS biology 发表日期: 2026-Jul-06 链接: PubMed

摘要

CRISPR-based gene drives are selfish genetic elements with the potential to spread through entire insect populations for sustainable vector control. Gene drives designed to disrupt the reproductive capacity of females can suppress laboratory populations of the malaria mosquito, Anopheles gambiae. However, any suppressive intervention will inevitably exert an evolutionary pressure for resistance, and the likelihood of resistance emerging at natural population scales remains poorly defined. Here, we present a pipeline to quantify the evolutionary space for resistance, enabling accelerated discovery, engineering, and testing of both natural and drive-induced variants that could reverse gene drive spread. We applied our approach to stress-test a best-in-class suppression gene drive that has evaded resistance in all laboratory-contained releases to date, known as Ag(QFS)1. We showed that previously undetected resistant alleles can arise at low frequency, including a novel type of partially resistant alleles that can perturb drive-invasion dynamics. Integrating experimentally derived resistance rates with population genetic modeling shows that single-target suppression drives are unlikely to be robust at natural mosquito population sizes, even at highly constrained loci. Here, we engineer and validate multiplexed gene drives in Anopheles gambiae, that target multiple conserved sites, actively removing resistant alleles. Our models predict that such gene drives could supress large natural mosquito populations in the field.

22. Mixed-Method Process Evaluation of a Mobile Technology-Based Tailored Workplace Health Promotion Program.

期刊: ANS. Advances in nursing science 发表日期: 2026-Jul-06 链接: PubMed

摘要

This study examined participant perceptions and engagement with SIMPLE HEALTH, a 12-week mobile technology-based workplace health promotion program designed for sedentary employees. Using a mixed-methods process evaluation, we examined usability, acceptability, interaction with its components, perceived benefits, and implementation fidelity. Participants reported positive experiences with the platform’s design, tailored features, and supportive elements, along with suggestions for enhancement. All scheduled program elements were delivered as intended. Findings offer insights for optimizing multicomponent digital health programs in workplaces and highlight opportunities for occupational health professionals to adapt and scale such programs to promote healthier and more supportive workplace environments.

23. Effects of a head-up position on stone retrieval efficiency and intrarenal pressure using a flexible navigable suction access sheath: an in vitro study.

期刊: Urolithiasis 发表日期: 2026-Jul-06 链接: PubMed

摘要

Although flexible navigable suction ureteral access sheaths (FANS) combined with head-up positioning has shown promise in retrograde intrarenal surgery, the effects of the head-up position during the stone retrieval phase have yet to be quantified. In this study, we evaluated the effects of a 20° head-up position on stone retrieval time and intrarenal pressure (IRP) using FANS in a kidney phantom model. Using a supramolecular hydrogel kidney phantom, we performed 44 trials (22 paired comparisons). Five artificial stone fragments (2-3 mm) were placed in the renal pelvis and retrieved via suction through an 11/13-Fr FANS under continuous gravity-driven irrigation. Trials alternated between supine (Group A, 0°) and head-up (Group B, + 20°) positions. IRP was measured using a pressure sensor inserted into the upper calyx. The primary outcome was stone retrieval time, whereas mean and peak IRPs were secondary outcomes. All fragments were retrieved by suction alone without the use of a basket. Mean stone retrieval time was significantly shorter in Group B than in Group A (167.4 ± 44.5 vs. 223.0 ± 65.6 s, respectively; mean difference - 55.7 s; 95% confidence interval, - 92.1 to - 19.3; p < 0.01). Mean IRP was significantly lower in Group B (- 1.40 ± 2.34 vs. 0.51 ± 2.70 mmHg; p < 0.01), as was the peak IRP (2.40 ± 2.66 vs. 7.57 ± 3.56 mmHg; p < 0.01). Our findings provide experimental evidence supporting the integration of positional optimization in FANS-assisted retrograde intrarenal surgery.

24. Primary myotubes as an alternative to the calcium induced calcium release test in diagnosing malignant hyperthermia susceptibility.

期刊: Journal of anesthesia 发表日期: 2026-Jul-06 链接: PubMed

摘要

Malignant hyperthermia (MH) is caused by the dysregulation of calcium (Ca2+) in skeletal muscle cells. In this study, we evaluated the accuracy of a method for diagnosing susceptibility to MH using myotubes as an alternative to Ca2+-induced Ca2+ release rate (CICR) test. In this retrospective study, we retrospectively analyzed Ca2⁺ kinetics data obtained using fura-2/AM from myotubes that had been cultured from remnant muscle fibers of 98 patients who had previously undergone CICR testing for MH susceptibility in Japan. The 50% effective concentrations (EC50) of caffeine and 4-chloro-m-cresol (4-CmC) were calculated from the concentration response curves. The previously calculated cut-off values (caffeine: 3.62 mM, 4-CmC: 197 μM) were used to diagnose susceptibility to MH. The diagnostic accuracy of myotubes was compared with that of the CICR test. Statistical significance was tested using the Mann-Whitney U test. The CICR test identified 76 patients as CICR-Positive and 22 patients as CICR-Negative. The EC50 for caffeine was 2.9 (2.4-3.3) and 5.0 (4.5-5.5) mM in the CICR-Positive and CICR-Negative groups, respectively (p < 0.0001). The EC50 of 4-CmC was 130 (116-148) and 249 (226-289) μM in the CICR-Positive and CICR-Negative groups, respectively (p < 0.0001). The sensitivity for caffeine for myotubes was 98.7% (95%CI 92.9-99.9). The specificity for caffeine was 100% (95%CI 85.1-100.0). The sensitivity and specificity for 4-CmC were 100% (95%CI 95.2-100.0) and 100% (84.5-100.0), respectively. Myotubes responses to caffeine and 4-CmC can be regarded as a viable alternative to the conventional CICR test; however, further validation is needed before this test supersedes the CICR.

25. Agmatine induces mitophagy via the PTS-I2R pathway to increase autophagic flux and attenuate sepsis-induced intestinal epithelial cell apoptosis.

期刊: Inflammation research : official journal of the European Histamine Research Society … [et al.] 发表日期: 2026-Jul-06 链接: PubMed

摘要

The therapeutic options for sepsis-induced intestinal injury, which drives multiple organ dysfunction and mortality, are limited, but the role of polyamine supplements remains unclear. This study aimed to elucidate the protective effect of agmatine (AGM) on sepsis-induced intestinal injury and its mitochondrial-targeted antiapoptotic mechanism in intestinal epithelial cells (IECs). We verified the transport and subcellular localization of AGM in IECs via fluorescence assays and established in vitro and in vivo IEC apoptosis models. Functional evaluations using cell viability assays, laser confocal imaging, flow cytometry, transmission electron microscopy, and multiomics techniques were performed. AGM attenuated sepsis-induced intestinal injury, as evidenced by its ability to lower the serum levels of intestinal damage markers in septic mice, attenuate inflammatory factor production and pathological damage in the intestine, and reduce IEC apoptosis. AGM entered IECs via the polyamine transport system (PTS), but not the NMDA receptor, and inhibited IEC apoptosis induced by TNFα/CHX or TNFα/ActD. Notably, AGM exerted its antiapoptotic effect by targeting the mitochondrial imidazoline I2 receptor (I2R). Mechanistically, AGM induced mitophagy by decreasing the mitochondrial membrane potential without altering mitochondrial number or function, as ROS production, calcium ion influx, ATP generation, and oxygen consumption were unchanged. AGM also increased autophagic flux, as confirmed upon treatment with various autophagy inhibitors. AGM alleviates sepsis-induced intestinal injury via the PTS-I2R axis by promoting mitophagy and autophagic flux to inhibit IEC apoptosis, laying a foundation for the use of AGM as a potential nutritional supplement or therapeutic agent for sepsis-induced intestinal injury.

26. A multicenter study on the prediction model for chronic low back pain after lumbar decompression surgery in patients with diabetes mellitus: integration of metabolic and paraspinal muscle features.

期刊: European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 发表日期: 2026-Jul-06 链接: PubMed

摘要

Based on multicenter clinical data, this study aimed to develop and validate a predictive model for chronic low back pain (CLBP) after lumbar decompression surgery in patients with diabetes mellitus and lumbar disc herniation. The model integrated metabolic indicators and imaging-derived features of the paraspinal muscles. This study was designed as a multicenter retrospective cohort study. A total of 2776 patients with diabetes mellitus and lumbar disc herniation were included. All patients underwent unilateral biportal endoscopic (UBE) decompression between January 2021 and December 2024 across six medical centers. Postoperative CLBP was defined as persistent or recurrent low back or lumbosacral pain lasting more than six months after surgery. A visual analogue scale (VAS) score greater than 4 was used as the threshold for outcome assessment. Patients were excluded if postoperative pain could be attributed to structural complications or recurrent pathology. Patients with severe psychiatric or psychosocial conditions that might impair the reliability of pain assessment were also excluded. Data from four centers were used for model development and internal validation, while the remaining two centers served as independent external validation cohorts. Clinical variables, laboratory findings, and imaging parameters were integrated to develop multiple machine learning-based predictive models. Model performance was evaluated based on discrimination, calibration, and clinical net benefit. In addition, restricted cubic spline (RCS) analysis was performed to assess potential nonlinear relationships between key continuous variables and postoperative CLBP risk. Shapley additive explanations (SHAP) and local interpretable model-agnostic explanations (LIME) were used to interpret model predictions at both global and individual levels. Among individual models, the ExtraTrees algorithm achieved the highest discriminative performance in the validation cohort (AUC = 0.855) and showed stable performance across the two external validation cohorts. However, its sensitivity (0.413) and F1 score (0.531) remained relatively low. After comprehensive evaluation of discrimination, classification performance, and calibration, a stacking ensemble model combining XGBoost, artificial neural networks (ANN), and linear discriminant analysis (LDA) was selected as the final model due to its more balanced overall performance. In the validation cohort, this model achieved an AUC of 0.838, which was slightly lower than that of ExtraTrees. However, it demonstrated substantial improvements in sensitivity, F1 score, and accuracy by 43.8%, 24.7%, and 4.9%, respectively, along with improved calibration performance (Brier score = 0.146). Decision curve analysis demonstrated stable clinical net benefit across the validation cohort and both external validation cohorts. RCS analysis revealed significant nonlinear associations between postoperative CLBP risk and age, admission blood glucose, glycated hemoglobin, psoas muscle index, multifidus fat infiltration, albumin, alkaline phosphatase, and serum calcium. SHAP and LIME analyses identified intervertebral disc degeneration grade, age, psoas muscle index, admission blood glucose, and paraspinal muscle fat infiltration as the most important predictors in the model. This multicenter study developed and externally validated a predictive model for postoperative CLBP using integrated clinical and imaging data. The model demonstrated good discriminative ability and interpretability. It may be useful for estimating the risk of CLBP after lumbar decompression surgery in patients with diabetes mellitus. Metabolic abnormalities and paraspinal muscle degeneration-related features contributed substantially to model predictions, suggesting a statistical association with postoperative chronic pain development. The model may support individualized risk stratification, postoperative follow-up, and rehabilitation planning. However, given its limited sensitivity, further validation in prospective studies is required before clinical application.

27. Associations of Nurses' Career Attitudes, Career Management Behaviors, and Understanding and Expected Outcomes of The Career Ladder System With Intention to Stay and Career Satisfaction: A Cross-Sectional Study.

期刊: Research in nursing & health 发表日期: 2026-Jul-06 链接: PubMed

摘要

Nurses often encounter career plateaus due to limited promotion opportunities and insufficient support for career development, which can decrease career satisfaction and lower their intention to remain. This study explored nurses’ career attitudes and management behaviors, and their understanding and expectations of the Career Ladder System (CLS), to examine how these factors are associated with intention to stay and career satisfaction. This study used a descriptive cross-sectional design with a convenience sample of 394 ward nurses with at least 1 year of clinical experience from a tertiary hospital in Seoul, South Korea. Data were collected from May to June 2024, before the CLS was expanded to general ward nurses. The mean score for protean career attitude was 3.60 out of 5; career plateau averaged 2.33 out of 5, with structural career plateau significantly higher than content career plateau (p < 0.001). Career management behavior averaged 3.22 out of 5, understanding of the CLS was 2.86 out of 4, expected CLS outcomes were 2.83 out of 4, intention to stay was 35.57 out of 48, and career satisfaction was 3.25 out of 5. Differences in age and clinical experience were found in value-driven career attitudes and structural career plateaus. Hierarchical multiple regression analysis showed that content career plateau was significantly associated with both intention to stay and career satisfaction. Positive career attitudes were also significantly associated with higher intention to stay and greater career satisfaction. Hospitals may need to strengthen organizational support to create a content-driven career development environment.

28. Dental Care Access for Young Children With Medicaid: Groundtruthing Online Data and Actual Access in the Chicago Metro Area.

期刊: Journal of public health dentistry 发表日期: 2026-Jul-06 链接: PubMed

摘要

Many dental clinics reportedly accept Medicaid for young children per online sources, but parents’ experiences suggest that this differs from actual access. Recognizing potential differences between reported and realized access, we studied realized dental care access and neighborhood-level barriers to care in the Chicago metro area. We created a list of Medicaid-accepting dental clinics using the Centers for Medicare and Medicaid Services Insurekidsnow.gov “Find a Dentist” search engine tool. Limited to Coordinated Oral Health Promotion Chicago Cohort Study participants’ ZIP Codes (N = 51), research staff called each clinic posing as parents trying to schedule their Medicaid-insured children for appointments. Dental clinic and participant addresses were geocoded; using American Community Survey data, we estimated the population’s actual access to Medicaid-accepting clinics and neighborhood-level barriers. We used an Enhanced Two-Step Floating Catchment Area analysis to determine realized access and identify disparities. Of the 379 dental clinics identified online as taking Medicaid insurance for children, only 240 (63.32%) confirmed accepting Medicaid. The catchment area overall met the Health Professional Shortage Area threshold (1 dentist: 5000 population), indicating adequate access for the Medicaid-insured population. Yet, some southern Chicago/southwestern suburbs had exceptionally poor access (< 1 dental clinic: 10,000 population). Online data showed many dental clinics accepted Medicaid for children, but our study revealed that realized dental care access varied dramatically, with the fewest clinics in areas with the highest portion of children on Medicaid and the largest socioeconomic barriers. Multilevel change is needed to ensure access to critical dental health services for all.

29. Electron-driven proton transfer behaviors in oxidative DNA lesion 8-oxoguanine: A computational study.

期刊: Talanta 发表日期: 2026-Jul-06 链接: PubMed

摘要

Recent research has highlighted the DNA replicative misinsertion of adenine into 8-oxoguanine (8OG), resulting in the formation of the A-8OG conformation. This misinsertion alters the balance among three mispair structures: Aanti-8OGsyn, Asyn-8OGanti, and Aanti-8OGanti. This study reveals the reactive mechanisms involved in excited-state intermolecular proton transfer (ESIPT) and photo-isomerization of A-8OG mispairs. Our findings indicate that the excited-state intermolecular double proton transfer reactions occur along the stepwise reaction path (N∗→SPT∗→DPT∗), and three types of SPT∗ products after photo-isomerizations are found to be stable. Evidence regarding hydrogen bonding parameters and frontier molecular orbitals confirms that the interaction energy of hydrogen bonds, when photo-induced, is enhanced, thus increasing the likelihood of ESIPT reactions. Analysis of absorption spectra and electron density distribution further indicates that electron transfer-driven proton transfer in the excited state also raises the probability of isomerization in A-8OG. Furthermore, the study examines the impact of a uniform electric field on the electronic properties of A-8OG. The findings demonstrate that while the electric field can regulate the interactions of hydrogen bonds, it has minimal influence on electron transfer behavior.

30. Real-World Mapping of Multiple Primary Carcinoma Combinations and Survival Outcomes in Shanghai, China: Retrospective Registry-Based Study.

期刊: JMIR public health and surveillance 发表日期: 2026-Jul-06 链接: PubMed

摘要

Multiple primary carcinomas (MPC) represent a clinically significant yet underexplored phenomenon, where patients develop more than one distinct primary malignancy. While prior studies have examined MPC within specific cancer types, comprehensive real-world patterns of primary malignancies and their subsequent primary malignancies remain limited. Moreover, the survival outcomes associated with these MPC patterns, particularly in relation to demographic and clinical characteristics, are not well characterized. This study aimed to establish the patterns and combinations of MPC across a wide range of cancers and to assess whether the mortality status of patients with MPCs varies according to their demographic characteristics and disease status. We conducted a retrospective analysis of 1560 patients with MPC in Shanghai, China, from 2002 to 2015. Data were extracted from the Shanghai Cancer Registry, with follow-up until December 2017. Cause of death was ascertained through linkage with the Shanghai Vital Registration System. The distribution of the frequency and proportion of primary carcinoma (PC) combinations were depicted, and a life table was used to calculate the 1- to 5-year survival rates. Cox regression analysis was performed to analyze the survival risk factors of the first and second PCs. Among the 1560 patients (809/1560, 51.86% male and 751/1560, 48.14% female), the most frequent first PCs were colorectal, breast, and stomach cancers, while the most frequent second PCs were lung, colorectal, and stomach cancers. The most common combinations included colorectal and lung, colorectal and stomach, and colorectal and prostate. Survival rates were lowest for first PCs of skin (5 years=46.95%) and lung (5 years=41.54%) cancers, and for second PCs of pancreatic (5 year=9.13%) and liver (5 years=14.19%) cancers. A latency period of 12 months between PC diagnoses was associated with significantly higher cancer-specific mortality for both the first primary cancer (hazard ratio [HR] 3.539, 95% CI 2.822-4.438; P<.001) and the second primary cancer (HR 1.369, 95% CI 1.103-1.699; P=.004). Older age (>65 years) and advanced tumor stage (III+IV) were also significant independent risk factors for poor survival in both first PC (age: HR 2.049, 95% CI 1.689-2.485; P<.001; stage: HR 1.496, 95% CI 1.315-1.703; P<.001) and second PC (age: HR 1.575, 95% CI 1.242-1.996; P<.001; stage: HR 3.933, 95% CI 3.182-4.861; P<.001) analyses. This study provides a comprehensive, real-world map of MPC patterns and highlights important findings: high-risk cancer combinations and key factors associated with poorer survival, including a short interdiagnosis interval (12 months), advanced age, and advanced tumor stage. Comprehensive prevention and control strategies for MPC should be developed, and clinicians should be aware of the risks of MPC in vulnerable populations during the early diagnosis stage.

31. Health-Related Digital Engagement and Incident Stroke Among Older Adults: Prospective Cohort Study.

期刊: Journal of medical Internet research 发表日期: 2026-Jul-06 链接: PubMed

摘要

Most studies examining internet use and health outcomes in older adults rely on cross-sectional designs and binary exposure measures, which are insufficient to capture the multidimensional nature of health-related digital engagement over time. The high collinearity between digital engagement and socioeconomic factors makes it challenging to disentangle independent effects from marker effects. Longitudinal evidence linking health-related digital engagement to incident stroke remains limited. This study aimed to examine the longitudinal association between a composite Health-Related Digital Engagement Index (HDEI) and incident stroke among community-dwelling older adults, and to quantify the extent to which socioeconomic factors account for this association. This prospective cohort study used data from the National Health and Aging Trends Study, Waves 1-10 (2011-2020). The HDEI (range 0-4) was constructed from 4 health-related internet behaviors assessed at baseline. The primary outcome was incident stroke ascertained by self- or proxy-reported physician diagnosis. Discrete-time hazard models with a complementary log-log link were fitted across 4 nested models, progressively adjusting for demographics, socioeconomic factors, chronic disease burden, functional disability, and social isolation. Among 5384 participants followed for a median of 5 (IQR 2-9) years, 472 incident stroke events were observed; 81.6% (4395/5384) had an HDEI score of 0, 10.5% (566/5384) had a score of 1, and 7.9% (423/5384) had a score of 2 or higher. In the unadjusted model, each 1-point increase in HDEI was associated with a lower risk of stroke (hazard ratio [HR] 0.76, 95% CI 0.66-0.88; P<.001). After adjustment for age and sex, the association was attenuated but remained statistically significant (HR 0.84, 95% CI 0.72-0.96; P=.01). After further adjustment for race or ethnicity, education, and household income, the association was no longer statistically significant (HR 0.92, 95% CI 0.79-1.06; P=.23); fully adjusted analyses yielded similar results (HR 0.91, 95% CI 0.79-1.05; P=.21). Subgroup patterns observed in demographically adjusted analyses were attenuated after socioeconomic adjustment, and no statistically significant interaction remained in the primary model 3 framework. Sensitivity analyses showed similar patterns of attenuation. Greater health-related digital engagement was associated with a lower risk of incident stroke in unadjusted and demographically adjusted models; however, this association was substantially attenuated and was no longer statistically significant after adjustment for socioeconomic factors. These findings are consistent with socioeconomic confounding and suggest that health-related digital engagement may, at least in part, reflect broader socioeconomic advantage among older adults. Future studies should further examine whether digital engagement has an independent role in stroke prevention beyond the socioeconomic and structural determinants of health.

32. Clostridium Abundance and Lower Weight-for-Age z Scores Among 6-Month-Old Infants: Nested Cross-Sectional Study.

期刊: JMIR pediatrics and parenting 发表日期: 2026-Jul-06 链接: PubMed

摘要

The gut microbiota plays a crucial role in infant nutrition through its effects on energy metabolism, nutrient absorption, and immune regulation. However, evidence from Indonesian infants remains limited. This study aimed to examine the association between genus-level gut microbiota abundance and weight-for-age z scores (WAZ) among 6-month-old infants in coastal Banggai District, Central Sulawesi, Indonesia. We conducted a nested follow-up cross-sectional observational analysis of 88 six-month-old infants, including 42 (47.7%) who were born to mothers who were assigned to receive Moringa oleifera enriched with royal jelly group and 46 (52.3%) who were assigned to receive a multiple micronutrient supplement in a previous maternal supplementation trial. Maternal and infant characteristics were collected via structured interviews and standardized anthropometric measurements. WAZ was calculated using the World Health Organization Child Growth Standards, and underweight (WAZ <-2 SD) was reported as a secondary indicator. Stool samples were analyzed using genus-specific quantitative polymerase chain reaction to quantify Bifidobacterium, Lactobacillus, Bacteroides, Clostridium, and Escherichia coli (log10 colony-forming unit/mL). Associations between bacterial abundance and WAZ were assessed using multivariable linear regression adjusted for maternal supplementation allocation and relevant maternal, environmental, and infant covariates. The pooled mean WAZ was -0.47 (SD 1.09), and 8% (7/88) of the infants were underweight. The combined abundance of beneficial genera was higher than that of opportunistic bacteria (E coli and Clostridium; Wilcoxon signed-rank test; P=.002). Higher Clostridium abundance was inversely associated with WAZ (unadjusted β=-.094, 95% CI -0.173 to -0.015; P=.02; adjusted β=-.091, 95% CI -0.172 to -0.010; P=.03). No statistically significant associations were observed for Bifidobacterium (P=.13), Lactobacillus (P=.19), Bacteroides (P=.70), or E coli (P=.18) in adjusted models. Among 6-month-old infants in coastal Central Sulawesi, higher genus-level Clostridium abundance was independently associated with lower WAZ. Given the cross-sectional design and genus-level quantitative polymerase chain reaction assessment, temporality and species-level mechanisms cannot be established. Longitudinal studies using more comprehensive microbiome profiling are warranted to clarify potential pathways linking gut microbiota and early-life growth.

33. Indoor Radon Concentrations and Hematologic Traits in the Women's Health Initiative.

期刊: Epidemiology (Cambridge, Mass.) 发表日期: 2026-Jul-06 链接: PubMed

摘要

We examined radon’s association with the complete blood count and leukocyte differential to better understand radon-related risks of stroke and myocardial infarction (MI) previously observed in the Women’s Health Initiative (WHI). We conducted a repeated measures analysis in this prospective cohort of post-menopausal women enrolled in 1993-1998 and examined at 5 visits over 19 years in 40 US clinical centers (n=154,630). We estimated indoor radon concentrations (pCi/L) at time-varying, geocoded addresses of participants (1993-2013) by linking them to the US Geological Survey Radon Index (1993) zoned by US Environmental Protection Agency Action Levels. We estimated covariate-adjusted, longitudinal associations of radon concentrations with complete blood count components using linear mixed-effects models. In a subset (n=6,313), we evaluated cross-sectional associations with the complete blood count differential using multivariate compositional data analysis. At 2-4 and >4 pCi/L, adjusted mean (95% confidence interval) leukocytes were 48 (33, 63) and 78 (58, 98) cells/μL lower than at <2 pCi/L, while platelets, hematocrit, and hemoglobin were higher: 315 (-280, 910) and 2,033 (1,248, 2,818) cells/μL; 0.27% (0.24%, 0.30%) and 0.23% (0.19%, 0.27%); and 0.09 (0.08, 0.10) and 0.09 (0.07, 0.10) g/dL. Nonlinear spline models of the Radon Index revealed similar associations. Lymphocyte percentages were lower and other percentages were higher at higher (>4 pCi/L) vs. lower (<2 pCi/L) radon concentrations in nonlinear compositional data analysis. The radon-related cardiovascular implications of these modest, pro-thrombotic, myeloid shifts in the complete blood count/differential among postmenopausal women in the WHI remain unknown.

34. Forest-river interfaces shape lobomycosis risk in the Amazon Basin.

期刊: PLoS neglected tropical diseases 发表日期: 2026-Jul-06 链接: PubMed

摘要

Lobomycosis is a chronic implantation mycosis caused by the uncultivable fungus Paracoccidioides lobogeorgii. The disease occurs predominantly in the Amazon Basin and has traditionally been associated with traumatic inoculation during exposure to forest environments. However, many patients live, work, or travel in riverine landscapes, suggesting that environmental determinants beyond forest exposure may influence the spatial occurrence of disease. We conducted a spatial case-background study including 192 confirmed lobomycosis cases and two environmental background locations per case. Using annual land use and land cover data aligned with the estimated year of infection, we quantified the composition and configuration of forests and water bodies at two spatial scales: 3 km2 and 10 km2. Generalized additive models were used to assess associations between environmental variables and lobomycosis occurrence while accounting for spatial structure. Models incorporating landscape configuration outperformed those based on landscape composition alone. Water-body dominance, measured by the largest patch index, and proximity to rivers were associated with lobomycosis occurrence, supporting a role for forest-river interfaces in the spatial distribution of disease. These findings suggest that lobomycosis occurrence in the Amazon is shaped not only by forest cover but also by the spatial configuration of forest and aquatic environments. Forest-river interfaces may represent ecological and human activity zones where environmental suitability and exposure opportunities overlap. These results provide new insights into the environmental ecology of lobomycosis and may help guide surveillance and prevention strategies in riverine Amazonian landscapes.

35. A Cross-Sectional Study on Immune-Inflammatory Responses: Exposure to Polycyclic Aromatic Hydrocarbons Alters Pteridine Metabolism and Activates the Kynurenine Pathway.

期刊: Chemical research in toxicology 发表日期: 2026-Jul-06 链接: PubMed

摘要

Polycyclic aromatic hydrocarbons (PAHs) are common environmental pollutants generated from the incomplete combustion of organic materials and represent an important source of occupational and environmental exposure. Aside from their carcinogenic properties, PAHs are known to exert immunomodulatory and proinflammatory effects. Immune activation is closely associated with alterations in pteridine metabolism and activation of the kynurenine pathway; however, evidence linking PAH exposure to these immune-inflammatory pathways in humans remains limited. This study aimed to investigate the systemic biological effects of occupational exposure to PAHs from asphalt fumes in road construction workers, with a particular focus on alterations in pteridine metabolism and activation of the kynurenine pathway, using a combined panel of exposure and mechanistic biomarkers. Routine clinical parameters remained within normal ranges while urinary 1-hydroxypyrene, a well-established biomarker of internal PAH exposure, was significantly elevated, confirming substantial PAH exposure. Key findings revealed profound alterations in two critical metabolic pathways: (i) Pteridine metabolism was shifted, with increased neopterin and decreased biopterin levels, indicating activation of cell-mediated immunity and reduced cofactor availability; (ii) the kynurenine pathway was concurrently activated, as reflected by elevated kynurenine, reduced tryptophan, and increased estimated indoleamine 2,3-dioxygenase activity. These findings indicate that low-level but chronic PAH exposure induces sustained Th1-type immune activation and metabolic disturbances in the absence of overt clinical pathology, representing a state of subclinical biological adaptation.

36. Validation of the Standardized Outcomes in Nephrology-Life Participation (SONG-LP) Instrument in People with CKD.

期刊: Kidney360 发表日期: 2026-Jul-06 链接: PubMed

摘要

Life participation has been identified as a critically important core outcome by people with CKD not yet requiring kidney replacement therapy. In this study we aimed to validate the Standardised Outcomes in Nephrology Life Participation (SONG-LP) instrument. A psychometric evaluation of the SONG-LP was conducted in adults with CKD not yet requiring kidney replacement therapy. The instrument includes four equally-weighted domains of life participation including leisure, family, work and social activities, scored on a five-point Likert scale that specifies frequency over a one month recall period from never (0) to always (4) with a range of 0 to 4 possible (calculated as a mean of the 4 responses). Internal consistency, test-retest reliability, convergent validity, hypothesis testing, and acceptability were assessed. In total, 179 participants from 16 countries participated. The SONG-LP instrument demonstrated strong internal consistency (Cronbach’s a = 0.92, 95% confidence interval [CI]: 0.89- 0.94; baseline; McDonald’s ω = 0.93, CI: 0.91-0.95; baseline ) and strong test-retest reliability over one week (n=165, intraclass correlation coefficient of 0.81; 95% CI: 0.76-0.86) with mean scores 2.97 ± 0.91 and 3.07 ± 0.92 at baseline and at week one, respectively. There was strong positive correlation with the PROMIS Ability to Participate in Social Roles and Activities Short Form 8a that assesses a similar construct (0.81; 95% CI: 0.72-0.86), and moderate correlation with measures that assess related concepts including EQ5D (0.72; 95% CI: 0.63-0.79), and PROMIS Cognitive Functional Abilities Subset Short Form 4a (0.61; 95% CI: 0.50-0.70). The SONG-LP instrument is a valid, reliable and internally consistent instrument to assess life participation in people with CKD not yet requiring kidney replacement therapy. It can potentially facilitate routine and consistent assessment of life participation in trials and routine clinical care in people with CKD.

37. Strain and recovery activities over a week predict short-term changes in processing speed measured in everyday environments: A survey response-time study in workers from a large internet panel.

期刊: Neuropsychology 发表日期: 2026-Jul-06 链接: PubMed

摘要

Both recovery and strain are highly relevant to worker productivity and cognitive performance. Prior research suggests that survey response times (RTs) may serve as an approximation of everyday processing speed. We examined associations between strain-related experiences and recovery behaviors over a week, a time frame seldom considered prior, and subsequent survey RT-based processing speed. We analyzed approximately 1 year of data from 5,303 workers in a U.S.-based Internet panel study. Participants completed a survey on a biweekly to monthly basis regarding their experiences during the COVID-19 pandemic (April 2020-July 2021). Within individuals, longer survey RTs (indicating slower processing speed) were associated with working 50 or more hours (B = 0.016 log seconds, 95% confidence interval [0.004, 0.025]), having work hours reduced (i.e., job insecurity, B = 0.031, 95% CI [0.016, 0.044]), a positive COVID test (B = 0.041, 95% CI [0.03, 0.055]), fever (B = 0.012, 95% CI [0.003, 0.024]), feelings of fatigue (B = 0.019, 95% CI [0.012, 0.025]), headache (B = 0.018, 95% CI [0.011, 0.027]), body aches (B = 0.017, 95% CI [0.009, 0.025]), higher stress levels (B = 0.006, 95% CI [0.001, 0.01]), and increased depressive symptoms (B = 0.009, 95% CI [0.006, 0.011]) in the week prior. Unexpectedly, for individuals who typically infrequently engaged in general relaxation or socializing, engaging in these activities more often in the prior week was associated with reduced processing speed (B = 0.005, 95% CI [0.002, 0.008] and B = 0.006, 95% CI [0.002, 0.01], respectively). Everyday processing speed, as measured by survey RT, was sensitive to strain and recovery engagement experienced over the week prior. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

38. Unraveling the Exosome-Derived ceRNA Network of Cartilage Injury in Kashin-Beck Disease Chondrocytes.

期刊: Biological trace element research 发表日期: 2026-Jul-06 链接: PubMed

摘要

This study sought to develop and validate an exosome-derived competitive endogenous RNA (ceRNA) regulatory network in chondrocytes impacted by Kashin-Beck disease (KBD) and to elucidate its functional implications in selenium deficiency-induced cartilage damage. Exosomes were isolated from the chondrocytes of KBD patients (n = 3) and matched healthy controls (n = 3). Exosomal RNA microarrays and high-throughput miRNA sequencing were employed to identify differentially expressed long non-coding RNAs (lncRNAs), microRNAs (miRNAs), and messenger RNAs (mRNAs) using predefined thresholds of |fold change| ≧ 1, P < 0.05, or TargetScan_score ≧ 50 and miranda_Energy < - 10. Through an integration of bioinformatics analysis and experimental approaches, we constructed a KBD-specific exosome-derived ceRNA network and validated the expression patterns of core molecules in C28/I2 chondrocyte and SD rat models. Transcriptomic profiling revealed numerous dysregulated exosomal lncRNAs, miRNAs, and mRNAs in KBD chondrocytes, which were predominantly enriched in pathways associated with cartilage damage, oxidative stress, and extracellular matrix metabolism. Furthermore, a comprehensive analysis identified six distinct lncRNA-miRNA-mRNA regulatory axes within the ceRNA network, encompassing five lncRNAs, miR-423-5p, miR-654-5p, and their target genes CDC42 and SETD8. Validation through RT-qPCR and immunohistochemistry (IHC) revealed aberrant expression patterns in KBD induced by selenium deficiency: lncRNAs were markedly upregulated, miRNAs were significantly downregulated, and both CDC42 and SETD8 were substantially upregulated. These findings imply that exosome-derived ceRNA interactions may play a role in selenium deficiency-associated cartilage damage by modulating CDC42 and SETD8. In conclusion, this exploratory study systematically constructs and preliminarily validates an exosome-derived ceRNA network in KBD chondrocytes. The results indicate that this network may mediate cartilage damage induced by selenium deficiency and T-2 toxin via the lncRNA-miR-423-5p/miR-654-5p-CDC42/SETD8 axes. These molecules hold potential as candidate diagnostic biomarkers for KBD, although further validation in larger cohorts is necessary.

39. METEOR: a data-adaptive Mendelian randomization method for powerful detection of shared and specific exposures underlying multiple outcomes.

期刊: Briefings in bioinformatics 发表日期: 2026-Jul-03 链接: PubMed

摘要

Accurate identification of causal exposures for multimorbidity can benefit the co-prevention and co-management of multiple-related outcomes. This goal can be conceptually addressed within a multi-outcome Mendelian randomization (MR) framework. However, existing multi-outcome MR methods suffer from restrictions on format and availability of data inputs, fail to account for the potential sample overlap, rely on pre-selected independent instrumental variables (IVs), and are unable to account for horizontal pleiotropy. Here, we propose METEOR, a novel MR method that jointly models one exposure and multiple outcomes to identify both shared and outcome-specific causal exposures. METEOR accounts for sample overlap between exposure and outcomes, allows outcomes from different genome-wide association studies (GWAS) datasets, self-adaptively determines IVs from correlated single-nucleotide polymorphisms, and explicitly models horizontal pleiotropy. Using summary statistics, METEOR infers causal effects under a joint-likelihood framework with a scalable, sampling-based algorithm. Simulations show that METEOR presents well-calibrated $P$-values for both global and single-outcome tests, and achieves average power improvements of 55.33% and 56.50% over five existing MR methods in the global and single tests, respectively. In real data applications, METEOR produces the most accurate causal effect estimates in positive control analyses, reduces false positives by 18.75% in negative control analyses, and highlights that controlling BMI could benefit the co-management of multiple cardiovascular diseases (CVDs) and multiple gastrointestinal (GI) diseases, while controlling blood pressure could benefit the co-management of multimorbidity across CVDs and mental disorders (MDs), as well as across GI diseases and MDs.

40. How social, psychological, and spiritual needs are supported in the last months of life: evidence from the English Longitudinal Study of Ageing end-of-life interviews.

期刊: Age and ageing 发表日期: 2026-Jul-02 链接: PubMed

摘要

End-of-life care includes social, psychological, and spiritual support in addition to medical care. Population-level evidence on whether these non-medical needs are met in the last months of life, who provides such support, and how it is perceived remains limited. We analysed end-of-life proxy interviews from deceased participants aged 55 years and older in the English Longitudinal Study of Ageing (n = 507). Outcomes included whether social, psychological, and spiritual needs were met in the last three months of life, and how support was provided and perceived. Analyses included multivariate probit models adjusted for sociodemographic and end-of-life factors. Individuals died at a mean age of 83 years (range 55-105). Social and psychological needs were met for most individuals (81.8% and 77.8%); among those with spiritual needs (n = 227), 74.4% had these needs met. Support was provided predominantly by family members, with limited involvement of formal services, and was generally rated as good or excellent and helpful. Living alone was associated with lower probabilities of having social, psychological, and spiritual needs met, while dementia was associated with lower probabilities of having social and psychological needs met (P < .05-.01). Higher educational attainment was associated with a higher probability of having spiritual needs met (P < .05-.01). Reliance on informal networks creates inequities in non-medical end-of-life support, particularly for older adults living alone or with dementia, underscoring the need for more integrated public health approaches.

41. Are there sex differences in the influence of insomnia symptoms and sleep duration on the trajectory of neuromuscular strength decline?

期刊: Age and ageing 发表日期: 2026-Jul-02 链接: PubMed

摘要

A few longitudinal studies investigating the effect of sleep problems on the decline in neuromuscular strength (NMS) have produced conflicting results. To examine sex differences in how insomnia symptoms (IS) and sleep duration (SD) affect the trajectory of NMS decline. A longitudinal study with an eight-year follow-up period was conducted involving 6429 participants from the English Longitudinal Study of Ageing (ELSA) aged 50 or older. Participants with grip strength ≥27 kg for men and ≥16 kg for women were included. IS were investigated using a questionnaire adapted from Jenkins. SD was classified as short (≤6 h), ideal (>6 to <9 h), and long (≥9 h). Grip strength was the outcome. Generalised linear mixed models, stratified by sex and adjusted for sociodemographic, behavioural, clinical, and anthropometric variables, were used to estimate rates of NMS decline as a function of IS and SD. While an increase in IS was linked to a greater NMS decline rate in men (-0.02 kg per year; 95% CI: -0.04 to -0.01), women with SD ≥9 h experienced a higher rate of decline (-0.14 kg per year; 95% CI: -0.26 to -0.03). Sex differences were observed in the influence of sleep problems on the rate of NMS decline. Insomnia has a greater effect on men, whereas longer SD affects women more.

42. Pharmacokinetics and pharmacodynamics of a long-acting monoclonal antibody against malaria in African adults.

期刊: The Journal of clinical investigation 发表日期: 2026-Jul-02 链接: PubMed

摘要

CIS43LS is a long-acting mAb that targets the Plasmodium falciparum circumsporozoite protein. A phase 2 trial showed that a single dose of CIS43LS conferred >85% sterile protection against infection in Malian adults over 6 months. Understanding the pharmacokinetics and pharmacodynamics (PK/PD) of CIS43LS is critical for the further development of CIS43LS and other anti-malaria mAbs. Using 3,777 serum samples collected from 348 trial participants over the 6-month study period, we performed a PK/PD analysis of CIS43LS that included assessments for anti-drug antibodies and target-mediated drug disposition. A two-compartment, non-linear mixed effects population PK model that evaluated demographic, anthropometric, hematologic, baseline parasitemia, and endogenous IgG and IgG1 as potential covariates was used to estimate PK parameters and serum concentrations required to achieve 80% efficacy. The median CIS43LS t1/2 was 63.2 days (95%CI 59.4-67.2 days). Serum concentrations ≥64 μg/mL (95%CI 49-93 μg/mL) corresponded to ≥80% efficacy against infection over 6 months. A simulated dose of 30 mg/kg maintained serum concentrations >64 µg/mL in >97.5% of individuals for 4 months, the timeframe for the World Health Organization preferred product characteristics for anti-malaria mAbs. There was no evidence of anti-drug antibodies. Among infected individuals who received CIS43LS, no marked evidence of target-mediated drug disposition was observed. This study indicates that protective CIS43LS levels can be maintained over the course of a single malaria season and provides guidance for PK/PD analyses of anti-malaria mAbs in malaria-endemic populations. NCT04329104. National Institutes of Health and Gates Foundation.

43. TiO2 nanoengineering for high-performance photoelectrochemical biosensors: From fundamental strategies to frontier applications.

期刊: Talanta 发表日期: 2026-Jul-02 链接: PubMed

摘要

Titanium dioxide (TiO2), owing to its high stability, low cost, and good biocompatibility, has become a key material in the field of Photoelectrochemical (PEC) biosensors. However, its inherently wide bandgap and severe photogenerated charge carrier recombination fundamentally limit its photoelectric conversion efficiency, confining its light absorption primarily to the ultraviolet region. This review systematically summarizes recent advanced nanoengineering strategies developed to address these bottlenecks, including element doping, heterojunction construction, defect engineering, and multicomponent hybridization. It analyzes how these strategies modulate the electronic and optical properties of TiO2 to promote charge separation and broaden its photoresponse range. Furthermore, this work showcases the cutting-edge applications of engineered TiO2 nanomaterials in the highly sensitive detection of disease biomarkers, food contaminants, and environmental pollutants. Finally, the major challenges currently hindering the practical application of TiO2-based PEC biosensors, such as stability in complex matrices and scalable fabrication, are discussed. Future research directions are also discussed, with particular emphasis on flexible and wearable devices, microfluidic integration, and AI-assisted data analysis. These directions may promote the practical translation of TiO2-based PEC biosensors toward POCT and continuous health monitoring.

44. Identification of key substances and mechanisms of action for the pleasurable aroma of Shaoxing Huangjiu based on GC-MS, molecular docking, and sensory evaluation.

期刊: Food chemistry 发表日期: 2026-Jul-02 链接: PubMed

摘要

Shaoxing Huangjiu, a traditional Chinese rice wine, is renowned for its distinctive aroma. However, the key compounds responsible for its pleasurable sensory experience remain unclear. This study integrates GC-MS data, molecular docking, network pharmacology, and sensory evaluation to identify the aroma compounds and their receptor mechanisms. Among 100 identified volatiles, 34 emotion- or reward-related receptors (e.g., DRD2, HRH3, GPR119, and S1PR1) were targeted. Molecular docking revealed that benzyl benzoate (BB) exhibited the strongest affinity (-9.2 kcal/mol), interacting with multiple receptors via hydrophobic and π-π interactions. Sensory evaluation confirmed that BB and 2-phenylethyl acetate elicited the highest hedonic scores. These findings identify key aroma compounds responsible for Huangjiu’s pleasurable aroma and propose a molecular framework linking aroma perception with receptor-level interactions. This study provides new insights for optimizing the flavor and functional properties of traditional fermented beverages.

45. Sterilization Activity and Mechanism of 3,4,5-Trihydroxy-biphenyl From Sorbus pohuashanensis Against Candida glabrata.

期刊: Chemistry & biodiversity 发表日期: 2026-Jul 链接: PubMed

摘要

Candida glabrata is a common opportunistic pathogen in clinical settings, often exhibiting resistance to antifungal therapies. Exploring novel compounds that inhibit C. glabrata holds significant clinical and translational value. Our team recently identified a biphenyl compound 3,4,5-trihydroxy-biphenyl (THB) from Sorbus pohuashanensis; however, its antifungal activity against C. glabrata and the associated molecular response remain unclear. This study represents the first analysis of THB against C. glabrata based on the minimum inhibitory concentration (MIC) and offers preliminary insights into the molecular mechanism of action through transcriptomic sequencing. The results demonstrated that the MIC of THB against C. glabrata was 1.77 µg/mL. Transcriptomic sequencing revealed 785 differentially expressed genes (DEGs) following treatment of C. glabrata with THB, with 332 genes significantly upregulated and 453 genes significantly downregulated. Gene ontology (GO) analysis indicated that the DEGs were primarily associated with cellular processes, metabolic pathways, and cellular component (CC) organization or biogenesis. Additionally, Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis revealed that these DEGs were primarily enriched in pathways related to translation, carbon metabolism, amino acid metabolism, and energy metabolism. qRT-PCR results confirmed similar expression patterns for mak16, brx1, CAGL0C03223g, and CAGL0E05984g as observed in the RNA-Seq analysis. These findings indicate that THB has potent in vitro antifungal activity against C. glabrata, supporting its potential as a lead compound for further antifungal investigation.

46. A New Perspective on Endometriosis: How Gut and Reproductive Tract Microbiota Influence Disease Progression?

期刊: Obstetrical & gynecological survey 发表日期: 2026-Jul-01 链接: PubMed

摘要

Endometriosis, a chronic inflammatory condition affecting 10% of reproductive-aged individuals, remains underdiagnosed and poorly managed due to a limited understanding of its pathogenesis. Emerging evidence highlights the gut and reproductive tract microbiota as key modulators of estrogen metabolism, immune dysregulation, and inflammation, offering novel insights into disease mechanisms and therapeutic opportunities. To synthesize current evidence on the mechanistic roles of microbiota in endometriosis pathogenesis, evaluate the diagnostic and therapeutic potential of microbial biomarkers and microbiota-targeted interventions, and identify priorities for translational research. A systematic review of PubMed, Scopus, and Web of Science databases identified preclinical and clinical studies exploring microbiota-endometriosis interactions. The search strategy incorporated the terms “endometriosis” in combination with “microbiota,” “reproductive tract,” and “gut” to investigate microbial associations within gastrointestinal and reproductive systems in the context of the disease. Dysbiotic microbial profiles, characterized by reduced Lactobacillus and elevated Fannyhessea species, correlate with altered estrogen metabolism, pro-inflammatory cytokine production (eg, IL-6, TNF-α), and impaired immune surveillance in endometriosis. Preclinical studies demonstrate that probiotics and FMT attenuate lesion growth and inflammation in animal models, though human data remain limited. Noninvasive microbial signatures show promise for diagnostic applications, while causal validation in germ-free models and personalized microbiota-based therapies represent critical research gaps. The microbiota modulates endometriosis progression through hormonal, immune, and inflammatory pathways. Microbial biomarkers and therapies may improve diagnosis and treatment but require rigorous clinical validation. Advancing microbiota research could enable noninvasive diagnostics, precision therapies, and prevention strategies.

47. Leishmanicidal Potential of Eugenia pyriformis Cambess. (Myrtaceae) Leaf Extracts: Metabolomics and Mechanism of Action.

期刊: Chemistry & biodiversity 发表日期: 2026-Jul 链接: PubMed

摘要

Developing new therapies and discovering bioactive compounds to treat cutaneous leishmaniasis are critical to improving patients’ quality of life. More effective, less toxic, and affordable compounds are needed. Thus, discovering such compounds could significantly enhance the management and control of cutaneous leishmaniasis. Brazil has a biodiversity of flora and microorganisms that remains unexplored, mainly for evaluating extracts and compounds with anti-Leishmania activity. This study aimed to screen the leishmanicidal activity of extracts and fractions from leaves of Eugenia pyriformis Cambess. collected during different seasons (winter and summer) in Rio de Janeiro, Brazil. Extracts from summer-collected leaves showed higher effectiveness against Leishmania (Leishmania) amazonensis promastigotes and amastigotes. The IC50 values for the extract from leaves collected in summer (Ep1) were significantly lower than those for winter extracts. Extracts showed low toxicity to human macrophages and a high selectivity index (SI > 12). In addition, the Ep1 extract induced G0/G1 phase arrest and necrosis in promastigotes. UHPLC-HR-ESI-MS/MS analysis combined with molecular networking revealed that flavonoids and terpenoids were predominant in active fractions. The study highlights the potential of E. pyriformis Cambess. as a source of leishmanicidal compounds from leaves collected during the summer season.

48. School-Based Occupational Therapy Interventions Through the Lens of the F-Words Framework: A Scoping Review.

期刊: Child: care, health and development 发表日期: 2026-Jul 链接: PubMed

摘要

School participation plays a critical role in children’s development; however, the extent to which school-based occupational therapy (SBOT) interventions align with the ‘F-words for Child Development’ (Functioning, Family, Fitness, Friendships, Fun, Future) has not been systematically examined. This study aims to systematically scope SBOT interventions published between 1990 and 2025 and classify them according to the F-words framework. The review adopted the Arksey-O’Malley scoping review framework as the foundational methodological structure and incorporated Levac et al.’s refinements to enhance rigour. The review was informed by Joanna Briggs Institute (JBI) guidance for scoping reviews, and reporting followed the PRISMA-ScR checklist. PubMed, Scopus and Web of Science were searched using strategies grounded in the OTPF-4 and MeSH. Eligibility criteria included peer-reviewed intervention studies delivered in schools to students aged 3-18 years, published in English between 1990 and 2025. Of 2406 records, 35 studies met the inclusion criteria. Most originated from North America and Australia. The distribution of interventions across the F-words domains was uneven: Functioning appeared in 34 studies (97%), Fitness in 29 (83%), Fun in 23 (66%), Family in 18 (51%), Future in 11 (31%) and Friendships in only 7 (20%). SBOT research predominantly emphasizes Functioning and Fitness, while Friendships and Future are comparatively neglected. A more balanced application of the F-words framework would provide a broader understanding of how SBOT interventions are distributed across child development domains.

49. Sun Exposure and Cancer Outcomes (Incidence, Treatment, Survivorship) in Outdoor Workers.

期刊: Journal of drugs in dermatology : JDD 发表日期: 2026-Jul-01 链接: PubMed

摘要

Outdoor workers in the Western United States (US), such as farm laborers, landscapers, and construction crews, face daily sun exposure far above safe limits, often up to ten times more than indoor workers, placing them at high risk for non-melanoma skin cancers and melanoma. Yet, despite decades of evidence, US regulations still do not classify solar ultraviolet (UV) radiation as a workplace hazard. Existing protections, like California’s heat illness rules, address temperature but ignore cumulative UV burden. In contrast, countries such as Australia and Germany treat solar UV as an occupational carcinogen and require employers to provide protective clothing, shade, and worker education. In the US, prevention remains inconsistent, weakened by regulatory gaps, poor data on work-related skin cancers, and barriers such as limited sunscreen use and cultural norms. These shortcomings fall hardest on immigrant and low-wage workers, who often have the least access to protection and care. This population-level occupational health case analysis calls for urgent policy reform to recognize solar UV as a workplace hazard and adopt stronger protections to reduce preventable skin cancer disparities.

50. Deep learning of multiplexed mitochondrial morphology identified natural compound combinations against skin photoaging.

期刊: Phytomedicine : international journal of phytotherapy and phytopharmacology 发表日期: 2026-Jun-29 链接: PubMed

摘要

Skin photoaging is primarily driven by mitochondrial dysfunction. Although natural products have demonstrated protective effects against Ultraviolet (UV)-induced damage, efficient screening strategies for mitochondrial-targeting compounds remain limited. Artificial Intelligence (AI)-assisted high-content screening strategy offers a valuable approach to identify bioactive candidates and elucidate their mechanisms. This study aimed to employe an AI-assisted high-content screening strategy to identify mitochondrial-enhancing natural compounds that prevent skin photoaging and to evaluate their protective efficacy. This study employed an AI-assisted high-content screening strategy to identify mitochondria-targeting compounds that mitigate photodamage. UVB-induced models were established in cells, zebrafish, and mice with UVB lamp irradiation. Mitochondrial morphology and function were quantified using JC-1, TMRM, and MitoTracker probes. Cell viability, SA-β-gal activity, and protein expression were assessed by CCK-8 assay, SA-β-gal staining, and Western blotting, respectively. Using AI-assisted high-content screening, we identified quercetin, spermidine, adenosine, Vitamin K2, and Mirabilis jalapa extract as mitochondrial protective compounds. Two optimized combinations, CC-1 and CC-2, restored ATP production, TCA cycle flux, and mitochondrial morphology in UVB-exposed human dermal fibroblasts (HDFs), reduced SA-β-gal activity, and upregulated COLLAGEN I, LAMIN B1, and SIRT3 expression. Both combinations alleviated the UVB-induced senescence phenotype by upregulating SIRT3. In a UVB-exposed zebrafish tail amputation model, CC-2 markedly promoted fin regeneration. These findings were validated in UVB-irradiated mice, where CC-2 demonstrated superior efficacy. Using AI-assisted high-content screening, we formulated two optimized combinations that alleviate UVB-induced skin photoaging, with CC-2 exhibiting superior efficacy, highlighting its potential as cosmetic additive.

51. Ambient air pollution and risk of active tuberculosis: a population-based cohort study in Taiwan.

期刊: International journal of epidemiology 发表日期: 2026-Jun-24 链接: PubMed

摘要

Available evidence on the relationship between long-term exposure to particulate matter with an aerodynamic diameter of ≤2.5 μm (PM2.5) and tuberculosis has been limited and inconsistent. We conducted a longitudinal cohort study on individuals aged ≥12 years who participated in four rounds of the National Health Interview Survey. PM2.5 exposure was estimated by using data from air-quality monitoring stations and microsensors. Incident tuberculosis was identified based on International Classification of Diseases codes and the prescription of anti-tuberculosis drugs in the National Health Insurance Database. Time-dependent Cox regression analyses were conducted to estimate the linear and nonlinear associations between PM2.5 level and tuberculosis risk. Among 55 316 individuals with a median follow-up time of 12 years, 429 cases of incident tuberculosis were identified. The annual mean baseline PM2.5 concentration was 34.5 μg/m3 (interquartile range: 28.7-39.2 μg/m3). After adjustment for age, sex, body mass index, cigarette smoking, alcohol use, education level, income, and tuberculosis history, the adjusted hazard ratio was 1.16 (95% confidence interval: 1.00-1.34) for every 10-μg/m3 increase in the PM2.5 level. The results of the restricted cubic spline Cox regression analysis revealed a potential nonlinear relationship (P for nonlinearity: .04), with the risk of tuberculosis increasing more rapidly when the annual mean concentration of PM2.5 exceeded 30 μg/m3. In this large population-based cohort study, a positive association between PM2.5 and tuberculosis was observed, particularly at moderately high concentrations of PM2.5 exposure. These findings highlight the need for air-pollution control strategies to mitigate tuberculosis risk.

52. A Three-Dimensional Culture Model Supporting Human Secondary-to-Antral Follicle Development In Vitro.

期刊: Journal of visualized experiments : JoVE 发表日期: 2026-Jun-16 链接: PubMed

摘要

Human ovarian folliculogenesis is a complex, tightly regulated process that is challenging to study directly in vivo. Although in vitro models are essential for mechanistic research, existing systems remain suboptimal because they cannot recapitulate the spatiotemporal dynamics of follicle development. This study presents a 3D culture model that supports human follicle development from the secondary to the antral stage. This model successfully recapitulates key in vivo morphological events, including sustained follicular growth, a distinct diameter expansion phase from day 10, and antral cavity formation around day 20. Importantly, this developmental progression culminated in the successful retrieval of viable oocytes at the germinal vesicle (GV) stage. Furthermore, immunofluorescence analysis revealed distinct expression patterns of gonadotropin receptors in somatic cells, consistent with granulosa and theca cell identity. Inner granulosa-like cells exhibited high follicle-stimulating hormone receptor (FSHR), whereas outer theca-like cells showed high luteinizing hormone receptor (LHR) expression. This model offers a valuable platform for studying human folliculogenesis and reproductive toxicology and provides a reference for optimizing in vitro follicle culture systems for secondary-to-antral stage development.

53. Evaluating the Safety of Tranexamic Acid in Cancer Surgery: Clinical Evidence and Biological Rationale.

期刊: Transfusion medicine reviews 发表日期: 2026-Jun-13 链接: PubMed

摘要

Tranexamic acid (TXA) is widely used to reduce blood loss and red cell transfusion in major surgery. Its safety in oncologic surgery remains uncertain, given theoretical risks of venous thromboembolism (VTE) and tumor progression. We conducted an analytic review of clinical and laboratory evidence evaluating TXA in cancer surgery or cancer-relevant models. We performed a clinically focused review of experimental and clinical evidence examining TXA use in oncologic settings. Key influential studies were prioritized and supplemented by a structured literature search of MEDLINE, Embase, CENTRAL, and Web of Science from database inception through May 2025. Findings were synthesized narratively across preclinical, interventional, and observational evidence, with emphasis on clinical outcomes and biological plausibility. While retrospective and single-center clinical studies in cancer populations demonstrated reduced red cell transfusion with TXA, the oncology trials demonstrated decreased blood loss but no reduction in transfusion, suggesting that any effect is attenuated under modern perioperative practice. Across studies reporting VTE, postoperative DVT/PE rates were typically 0% to 3% and did not differ between TXA and controls. Only a small number of clinical studies evaluated oncologic outcomes, alssssl observational and underpowered, with no evidence of harm. Laboratory findings were equivocal, with some models showing increased invasion or migration at supratherapeutic concentrations, whereas others demonstrated neutral or protective effects. The impact of TXA on transfusion need in oncologic surgery is ambiguous, and recent randomized trials in oncology do not show reductions in allogeneic transfusion. Available data do not indicate increased VTE risk, and no clinical signals of oncologic harm have been observed, though evidence remains limited. Cancer-specific studies with long-term follow-up are needed to define oncologic safety and to clarify whether indirect effects through transfusion avoidance influence cancer outcomes.

54. The scaffolding protein AKAP79/150 shapes innate immune responses to allergen.

期刊: Journal of immunology (Baltimore, Md. : 1950) 发表日期: 2026-Jun-07 链接: PubMed

摘要

Inhalation of house dust mite-derived allergens is a major factor leading to the development of asthma both in children and adults. Allergens stimulate Ca2+-dependent pro-inflammatory cytokine and chemokine gene expression through the opening of ORAI1 Ca2+ channels in the surface membrane of various immune cell-types within the lung. ORAI1 participates in a signalosome with the scaffolding protein A-kinase anchoring protein (AKAP)79/150 (encoded by the Akap5 gene), which binds numerous protein kinases, calcineurin and transcription factors required for cytokine expression. However, the role of AKAP79/150 in immune cell activation and the development of airway inflammation in response to allergens has not been established. We found that AKAP79/150 is expressed in mast cells and macrophages, where it has a pivotal role in driving pro-inflammatory cytokine production in response to house dust mite challenge. By contrast, AKAP79/150 expression in T cells was low and had little impact on cytokine release following T cell activation. Akap5-/- mice exhibited significantly reduced type 2 inflammation in the lungs following HDM exposure compared with wild-type controls. Our data demonstrate that AKAP79/150 is an important co-ordinator of inflammation within the lung in response to airborne allergens, through actions primarily on cells of the innate immune system.

55. Knowledge of menopause-associated symptoms and non-hormonal strategies: an Italian survey on social media platforms.

期刊: Post reproductive health 发表日期: 2026-Jun 链接: PubMed

摘要

we aimed to provide data collected in women who were active on social media platforms about menopause-associated symptoms and their impact, as well as resources, preferences and needs, with a specific focus on non-hormonal strategies. a cross-sectional observational study conducted via an anonymous online survey involving patient associations (namely vulvodynia, endometriosis, premature menopause, and natural menopause) in Italy. selected items of a comprehensive questionnaire co-developed by a multidisciplinary team of experts in gynaecology, psychology, and representatives from patient advocacy groups. a sample of 473 Italian postmenopausal women (median age: 56 yrs; range 31-76 yrs), including 231 (48.8%) subjects with chronic conditions (48 with a past history of vulvodynia, 21 of endometriosis, and 15 of oncological diseases) completed the survey. There was a good understanding of the typical menopausal symptoms (90.3% hot flushes, 83.7% vaginal dryness). Weight gain was very commonly attributed to menopause (86.9%) as the most challenging symptom (59.4%). A negative view of menopause was reported by 30.6%, with an impact on relationships (26.4%), social life, and work (9.5% for both). The majority (96.8%) identified lifestyle changes as an effective non-pharmacological intervention for managing menopausal symptoms. Additionally, 26.2% reported that the use of nutraceuticals under medical advice could be effective. Psychological support was positively experienced by 19% and considered beneficial by 56.8%, in spite of direct experience. Providing evidence-based education on menopause is mandatory to foster individualised care. Primary prevention with lifestyle modification and some non-pharmacological interventions seems well-received.

56. Day-to-day links between negative affect, distress intolerance, and alcohol use.

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

摘要

Negative reinforcement models theorize that state negative affect should predict alcohol use; however, research examining the relationship between heightened negative affect and same-day drinking has produced equivocal results. Focusing on alcohol craving, a psychological mechanism that has clear implications on behavior, as an outcome may help elucidate this process. Further, it may be that an individual’s ability to tolerate distress associated with negative affect drives cravings for alcohol to alleviate such emotions. Thus, the goal of this study was to investigate the extent to which state-level distress intolerance mediates associations between negative affect and alcohol craving and use using a longitudinal daily diary design among a diverse, national sample of drinkers. One week of daily diary data from 82 participants (n = 530 observations) endorsing problematic past-year alcohol use were analyzed using a multilevel mediation model. Day-to-day fluctuations in negative affect were significantly associated with heightened distress intolerance and alcohol craving, but not consumption. Multilevel mediation analyses revealed that, controlling for participants’ average levels of negative affect and distress intolerance, day-to-day distress intolerance mediated the relation between negative affect and alcohol craving. Elevated state distress intolerance is a proximal risk factor for heightened alcohol craving among people with a range of alcohol use severity. This study underscores the importance of conceptualizing and assessing distress intolerance as a state-level construct. Findings also emphasize the need to focus on craving to better understand processes that drive alcohol use from a negative reinforcement model perspective. Individuals who have difficulty managing daily stress or negative emotions may experience stronger urges to drink alcohol. This study demonstrates that momentary intolerance of distress helps explain the link between negative emotions and alcohol craving. Interventions aimed at improving in-the-moment distress tolerance may help reduce alcohol cravings and, in turn, lower the risk of problematic drinking.

57. Characterizing sentiment and self-reported experiences with nonalcoholic beverages in the context of efforts to quit or cut down on drinking.

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

摘要

Nonalcoholic beverages (NABs), which emulate characteristics of alcoholic counterparts but contain little or no alcohol, have become increasingly popular. Though NABs might serve as alcohol substitutes for some, lowering the overall public health burden caused by alcohol consumption, NABs may create risks for other vulnerable populations, such as those in or attempting recovery from alcohol use disorder. Little research has investigated how people attempting to quit drinking use and talk about NABs. The present study characterized how NABs are discussed and experienced in the context of efforts to quit or reduce alcohol use within an online alcohol recovery forum. We conducted a qualitative content analysis of 200 NAB-related posts from the r/stopdrinking subreddit. Two coders independently annotated posts using a structured codebook. Of returned posts, 153 mentioned NABs and met criteria for inclusion. Most (86.8%) expressed either positive (35.3%) or neutral (52.2%) sentiment toward NABs, and over half (55.5%) stated abstinence as a current recovery goal. Posts mentioned: perceived benefits (46.4%), recommendations for NABs (32%), barriers to use (30%), requests for opinions about NABs (28.8%), warnings about NABs sometimes containing low amounts of alcohol (9.8%), consequences from drinking NABs (13.7%), and experiences mistakenly being served alcohol after ordering a NAB (6.5%). Results highlight largely positive sentiment and perceived benefits among posts in the r/stopdrinking subreddit. However, NABs may also present important risks, including mistakenly being served alcohol when ordering a NAB and as a risk pathway for returning to former levels of alcohol use.

58. Models of care for the management of alcohol use disorder in general hospital settings and transition to the community: a scoping review.

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

摘要

Early detection of alcohol use disorder (AUD) amongst people admitted to general hospitals offers an opportunity for early intervention and accesses to evidence-based care. However, current operational models for the management of AUD in these settings are poorly defined, limiting the ability to assess their impact on individual patient outcomes, treatment effectiveness, or healthcare system efficiency. This scoping review aims to identify and characterize existing models of AUD management within general hospitals. A scoping review approach was adopted, including relevant peer-reviewed publications between 1990 and 2025. Studies needed to report on ≥2 care components (systematic screening, brief interventions, medically assisted alcohol withdrawal, relapse prevention initiation, psychosocial interventions, transition to community, provision of training) to be included. Screening and data extraction were performed independently by at least reviewers. Fifty-one (n = 51) records were included, and four distinct models of care were identified (consultation liaison; screening, brief intervention, and referral to treatment; protocol implementation; supported diversion). Models varied in their clinical purpose, target population, and care delivery focus. Within each model, differences in aims, context, and implementation resulted in substantial heterogeneity. Consultation liaison models provided the most multifaceted care, with a specialist team providing clinical leadership, access to evidence-based interventions, transition to community services, and training of the wider workforce, but rarely described any wider systematic screening for AUD. A consistent observation across all identified models was the limited interface with mental health care, representing a critical gap in current AUD management within general hospitals.

59. Barriers and facilitators to healthcare utilization amongst people living with sickle cell disease in the United States: A scoping review.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Sickle cell disease (SCD) stands as one of the most prevalent genetic disorders in the United States (U.S.) that causes severe consequences such as organ damage and excruciating pain. Alarmingly, recent literature indicates a decline in the number of people living with SCD (PLWSCD) seeking professional care - hinting at an avoidance of the healthcare system. Therefore, this scoping review synthesizes the evidence regarding barriers and facilitators influencing healthcare utilization among PLWSCD within the U.S. To map the current literature on SCD management and provide a comprehensive overview of the current knowledge gaps regarding healthcare utilization for PLWSCD, a scoping review was conducted. A systematic search of articles reporting on the utilization of healthcare among PLWSCD in the U.S using seven data sources was conducted on March 24, 2023, without any restrictions on publication date and language. To capture any additional articles, the search was updated on March 4, 2024. Two reviewers independently assessed studies for inclusion, data extraction, and risk of bias (RoB). A total of 708 articles were screened; 70 met the study criteria. Results indicated that the four most common barriers were social (n = 25) interpersonal (n = 23), economic (n = 15), and institutional level factors (n = 11). The top four most common facilitators were technology (n = 9), education (n = 7), autonomy (n = 6), and a positive patient-provider relationship (n = 6). The most common forms of healthcare utilization were inpatient or hospital admissions (n = 19) and emergency department (ED) visits (n = 18). Evidence-based interventions (EBI) found to decrease healthcare avoidance included individualized pain plans (IPPs) (n = 4) and quality improvement (QI) strategies (n = 3). This scoping review identified complex multilevel barriers that impede healthcare utilization, and facilitators likely to promote healthcare utilization among PLWSCD in the U.S. Future research should prioritize developing and evaluating comprehensive, multi-level interventions that address identified barriers while leveraging facilitators to improve healthcare engagement and outcomes for this vulnerable population. Healthcare systems and health policies must urgently adopt and integrate evidence-based strategies to rebuild trust and ensure equitable, accessible care for PLWSCD.

60. Health-related quality of life and cost-of-illness in young people seeking peer support at @ease: A Dutch burden of disease study.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

The burden of mental health problems remains largely unexplored among vulnerable young people, especially those seeking peer support. Accessing peer support is often a first form of help-seeking, allowing early identification of signs of distress. The lost (mental) health and expenses of these young people upon presenting for peer support can be revealed through monitoring of health-related quality of life (HRQoL) and costs of mental healthcare and productivity loss, examined in this study among young people visiting the @ease peer-to-peer walk-in centres in the Netherlands. From @ease’s inception in January 2018 to mid-2024, a total of 940 answered questionnaires gathered through consecutive sampling contained minimally one required item. This bottom-up prevalence-based study focused on youth aged 12-30 who sought peer counselling at @ease. Burden of disease was estimated by: (1) HRQoL (EQ-5D-5L), and (2) Cost-of-illness through school absenteeism and mental healthcare use. Multiple imputation was used before conducting regression analyses, followed by non-parametric bootstrapping. This study expands upon an earlier publication that analysed data up to May 2019. HRQoL was impaired (M = 0.64, SD = 0.24) and significantly lower if living alone or having parents with mental health problems, and higher if having a higher level of social and occupational functioning. In the three months before presenting, 35.2% of young people had been absent from school (3 days on average, costing €358 per individual) and 33.4% had visited mental healthcare (2 visits on average, costing €234 per individual). Total cost-of-illness was €1,501,743 annually, and €2,318 per individual. Mental healthcare costs were higher for those born in the Netherlands and without occupation, and school absenteeism costs were higher outside the COVID-19 pandemic and if not born in the Netherlands. Found impairments and costs underscore the importance of investing in early-stage low-threshold services where substantial burden is already detectable, and of strengthening their capacity and links to stepped-care pathways to ensure timely support. Initiatives that help improve functioning and aid with challenging contexts may be advantageous in lowering the burden. Prospective (cost-)effectiveness studies are needed.