公共卫生研究摘要 (2026-07-08)

共收录 58 篇研究文章

1. CSF Testing for Neuroinvasive West Nile Virus and Measures to Improve Guideline Adherence.

期刊: Neurology. Clinical practice 发表日期: 2026-Aug 链接: PubMed

摘要

Diagnosis of West Nile virus (WNV) neuroinvasive disease, an important cause of neurologic disability in endemic areas, requires appropriate testing given its often nonspecific presentation. Guidelines recommend CSF testing of WNV-specific immunoglobulin M (IgM) in all patients, with additional reverse transcription-polymerase chain reaction (RT-PCR) testing only in those who are unable to mount a humoral response due to significant immunosuppression. WNV testing is known to be underused, but real-world guideline adherence has not been described. We analyzed testing patterns for suspected neuroinvasive WNV in a retrospective analysis of 1,304 adult patients in a Boston hospital network who underwent CSF testing for WNV-specific IgM or WNV RNA using RT-PCR between 2016 and 2023. Both CSF IgM and RT-PCR were available to order during the duration of the study. Relevant clinical, laboratory, and demographic data were extracted from the electronic health record. The median age in our cohort was 63 years, and 46% of patients were female. Sole testing with CSF RT-PCR was performed in 73% of patients, and WNV testing guidelines were adhered to in only 25% of cases. Elevated CSF protein, CSF lymphocytic pleocytosis, admission to a neurology service, immunocompetence, race, and hospital site were significantly associated with improved adherence. WNV tests were positive in 26 patients, and patients whose CSF testing patterns adhered to guidelines were 12 times more likely to receive a WNV diagnosis. The existence of guidelines for appropriate diagnostic testing may not be sufficient to encourage appropriate CSF WNV IgM testing when the RT-PCR test, which is not recommended in immunocompetent patients, remains readily available for ordering. Differential guideline adherence based on institutional factors suggests that systems-level changes may play an important role in shaping provider behavior regarding appropriate use of diagnostic testing.

2. miR-187-3p as a Biomarker for Ischemic Stroke and the Therapeutic Target for Atherosclerosis via LOX-1 Inhibition.

期刊: FASEB journal : official publication of the Federation of American Societies for Experimental Biology 发表日期: 2026-Jul-15 链接: PubMed

摘要

As the primary receptor of oxidized low-density lipoprotein (ox-LDL), LOX-1 is a putative therapeutic target for atherosclerotic disorders including ischemic stroke (IS), whereas the regulatory mechanism of LOX-1 remains largely unknown in IS. We employed computational algorithms to screen candidate miRNAs, followed by integrative analysis of differentially expressed miRNA profiles derived from blood cells of 25 acute IS cases and 25 controls matched with age and gender. MiR-187-3p-mediated regulation of LOX-1 was confirmed by a dual-luciferase reporter assay and Western Blot in THP-1 derived macrophages. Elevated blood levels of miR-187-3p were observed both in IS patients and the atherosclerotic mice. In a case-control study enrolling 279 IS cases and 279 controls, we found that miR-187-3p level was significantly associated with the occurrence of IS (adjusted OR = 1.204; 95% CI: 1.086-1.335; p < 0.001). Similar results were replicated in another coronary heart disease case-control population. In vivo, systemic delivery of agomiR-187-3p significantly reduced atherosclerotic plaque burden alongside decreased plasma lipids and suppressed inflammation. In vitro, miR-187-3p over-expression attenuated foam cell formation induced by ox-LDL and down-regulated pro-inflammatory mediators in macrophages. Conversely, miR-187-3p inhibition exacerbated these effects, which were partially rescued by LOX-1 inhibitor BI-0115. This study establishes miR-187-3p as a novel epigenetic regulator of LOX-1 and provides critical evidence supporting its therapeutic potential for modulating IS progression.

3. Shared neurogenetic substrates of nonplanning impulsivity and procrastination.

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

Procrastination has a maladaptive impact on health and survival, yet it remains moderately heritable, presenting a biological paradox. Procrastination has been conceptualized as a byproduct of impulsivity, explaining its prevalence despite no discernible adaptive benefit. However, their shared neurobiological substrates have yet to be elucidated. Using a longitudinal twin cohort (N = 154), we show that nonplanning impulsivity (NPI) during late adolescence and early adulthood is prospectively associated with procrastination in later life. This effect was independently replicated in two cross-sectional cohorts (N = 327; N = 1,543). Twin modeling using an additive genetic and nonshared environmental (AE) framework, together with a meta-analysis of twin studies (N = 3,656 twin pairs), revealed significant shared genetic contributions (rg = 0.51). Beyond genetic overlap, neuroimaging meta-analysis (NeuroSynth meta-analysis for impulsivity: k = 198 studies, 5855 loci; mini meta-analysis for procrastination: k = 5 studies, 7 independent samples, Ncumulative = 893 participants), normative modeling (N = 37,407), and seed-based d mapping (SDM) converged on the left dorsolateral prefrontal cortex (DLPFC) as the region of maximal overlap between NPI and procrastination. The transcriptional profiles of the left DLPFC and impulsivity-associated genes exhibited functional convergence on regulation of biological and cellular processes. These genes showed brain-specific expression and associations with cortical metabolism, neurodegenerative disease, and developmental expression peaks, indicating a shared molecular basis for the neurogenetic architecture of procrastination. Together, our findings delineate a cross-scale characterization of the shared neurogenetic substrates linking NPI and procrastination, offering empirical evidence that elucidates the biological origins of procrastination.

4. Potential Drug-Drug Interactions With Nirmatrelvir/Ritonavir Among Long-Term Care Facility Residents.

期刊: Journal of the American Medical Directors Association 发表日期: 2026-Jul-07 链接: PubMed

摘要

Nirmatrelvir/ritonavir (Paxlovid) is an oral antiviral for COVID-19. Although effective, its use is complicated by clinically important potential drug-drug interactions (DDIs). Long-term care facility (LTCF) residents are especially vulnerable to both COVID-19 and the adverse effects of potential DDIs because of advanced age, multimorbidity, and polypharmacy. The objective of this study was to quantify the prevalence and duration of potential DDIs among US LTCF residents administered nirmatrelvir/ritonavir. We conducted a cohort study of LTCF residents using electronic medication administration record data from the Long-Term Care Data Cooperative linked to Medicare claims (January 2022-January 2025). Days of nirmatrelvir/ritonavir administration were identified, and concurrent exposure to 236 potentially interacting medications was assessed. A potential DDI was defined as same-day coadministration, reflecting concurrent exposure rather than clinical adverse effects. We estimated the prevalence of potential DDIs and the median duration of overlapping exposure. Among 48,260 LTCF residents treated with nirmatrelvir/ritonavir, the mean age was 78.8 years (SD, 10.9), 58% were female, and 76% were non-Hispanic White. Overall, 86% were exposed to at least 1 potential DDI. The most common potentially interacting medications were atorvastatin (28.1%; 95% confidence limits [CLs], 27.7-28.50), amlodipine (21.6%; 95% CLs, 21.2-21.9), and apixaban (15.9%; 95% CLs, 15.6-16.3). Median days of overlapping exposure ranged from 5 to 6 days. Potential DDIs most frequently involve medications requiring temporary withholding or dose adjustment rather than contraindication. The high prevalence of potential DDIs likely reflects the complexity of medication management in LTCFs, where antiviral use must be weighed against comorbidities and polypharmacy. Potential DDIs with nirmatrelvir/ritonavir were common among LTCF residents, though contraindicated ones were uncommon. These findings underscore the need for ongoing medication reviews and clinician and pharmacist oversight to ensure safe antiviral use in LTCFs.

5. Association between air temperature and COVID-19 emergency department visits in Ontario, Canada: A population-based case-crossover study.

期刊: International journal of hygiene and environmental health 发表日期: 2026-Jul-07 链接: PubMed

摘要

The impact of air temperature on COVID-19-related health outcomes, particularly in the context of extreme weather, remains underexplored. This time-stratified case-crossover study included 200,679 laboratory-confirmed COVID-19 emergency department (ED) visits in Ontario, Canada, from 2020 to 2023. Conditional logistic regression with distributed lag nonlinear models was used to assess the association of mean daily temperature with COVID-19 ED visits. Cumulative 0-5-day lag associations of cold and heat exposure were presented as odds ratios (ORs) with 95% confidence intervals (CIs) at the 1st and 99th percentiles of the temperature distribution, referenced to the minimum risk temperature (MRT). A non-linear, W-shaped relationship was observed between temperature and COVID-19 ED visits, with associations in extreme to very cold (-35.7°C to -21.6°C), cold (-14.1°C to -10.3°C), lightly cold to moderate (-10.2°C to 21.6°C), and warm to very hot (21.7°C to 29.2°C) temperature ranges (MRT: -17.2°C). Notably, heat exposure (24.6°C) showed stronger associations (OR: 1.53, 95% CI: 1.40-1.67) than cold exposure (-17.6°C, OR: 1.00, 95% CI: 0.996-1.005). Risk patterns varied across viral variants, with cold exposure associated with increased ED visits for Omicron and Wild variants, while heat exposure was linked to increased visits for Alpha, Delta, and Gamma variants. Associations were more pronounced for females, individuals aged <65 years, and those with a primary COVID-19 diagnosis. Short-term exposure to non-optimal temperatures significantly increases COVID-19-related emergency healthcare demand, with variant- and demographic-specific differences. Temperature-responsive public health strategies are needed to reduce the burden of COVID-19 and other infectious diseases as climate extremes intensify.

6. Unlocking the biotechnological potential of traditional fermented food microbiomes.

期刊: Current opinion in biotechnology 发表日期: 2026-Jul-07 链接: PubMed

摘要

Fermented foods are a globally important source of dietary microbes, cultural heritage, and functional diversity, yet current microbiome research captures only a narrow fraction of this richness. Public sequencing datasets are heavily skewed toward a limited set of regions and fermentation types, leaving vast areas of geographic, substrate, and process diversity underrepresented. This imbalance constrains the discovery of novel microbial species, enzymes, and biosynthetic capacities, and risks accelerating homogenization through standardized starter cultures. We argue that coordinated, ethically grounded global efforts integrating metagenomics, multi-omics, standardized metadata, and biobanking are urgently needed to document, preserve, and responsibly leverage fermented food microbial diversity for sustainable food systems and innovation.

7. The food additive microbial transglutaminase is a potential new environmental inducer of autoimmune diseases.

期刊: Current opinion in immunology 发表日期: 2026-Jul-07 链接: PubMed

摘要

Microbial transglutaminase (mTG) is a frequently used processed food additive, and the consumption of its cross-linked complexes is rapidly expanding. Despite numerous reports concerning its public safety, it is designated as a processing aid and classified as safe for use. mTG and/or its cross-linked complexes can compromise human health. They represent non-self peptides, resulting in non-immune-tolerable neoepitopes. They are proinflammatory, allergenic, immunogenic, pathogenic, human immune system suppressors, and potentially toxic, hence raising concerns for public health. mTG functionally mimics the endogenous transglutaminase and was recently identified as an inducer of celiac disease, potential primary biliary cholangitis, and neurodegenerative diseases. The present review describes the potential mechanisms and risky effects of mTG, highlighting its thermostability and broad pH activity range, its problematic, underregulated, genetically engineered origin, and public health concerns. The national food regulatory authorities are urged to reconsider mTG’s status, prioritizing public health protection over the mTG’s health-damaging consequences.

8. ECCO Guidelines on Therapeutics in Ulcerative Colitis: Medical Treatment.

期刊: Journal of Crohn’s & colitis 发表日期: 2026-Jul-07 链接: PubMed

摘要

9. Resilience and Perceived Social Support as Predictors of Physical and Psychological Quality of Life: A Multicentric Study in Dementia Caregivers.

期刊: The Journal of psychology 发表日期: 2026-Jul-07 链接: PubMed

摘要

Family caregivers of people with dementia (PwD) face substantial caregiving demands and sustained stress, which increase the risk of adverse health outcomes. This study examined whether resilience and perceived social support (PSS) are associated with health-related quality of life (QoL) in family caregivers of PwD. In addition, mediation effects of main predictors through burden were computed to test directional pathways. A total of 317 family caregivers (mean age = 60.5 ± 14.5 years, 66.9% women) underwent a comprehensive interview measuring sociodemographic factors, burden (Zarit Burden Interview), resilience (Connor-Davidson Resilience Scale), PSS (Duke-UNC Social Support Questionnaire), and QoL dimensions, physical and psychological, (World Health Organization Quality of Life-Brief). The adjusted regression models showed that resilience significantly predicted both physical and psychological QoL, whereas PSS only predicted the psychological domain. The mediation analyses revealed a partial mediation effect of resilience through burden on QoL domains, whereas PSS showed a complete mediation effect on both domains. Finally, a moderated mediation analysis indicated that the indirect effect of resilience on QoL (through burden) was conditional on PSS levels. Thus, more substantial benefits of resilience were observed among caregivers reporting low to moderate PSS. These findings demonstrate that resilience operates through dual pathways (direct and via burden reduction), whereas PSS primarily alleviates burden. Both resources should be considered complementary targets for tailored interventions to improve QoL for family caregivers of PwD.

10. Polyhydroxybutyrate nanoparticles for encapsulating carvacrol: release in food simulants, antimicrobial applications and human health potential.

期刊: Journal of biomaterials science. Polymer edition 发表日期: 2026-Jul-07 链接: PubMed

摘要

Biological food contamination is a serious public health and economic problem worldwide. Antibiotics are commonly used to address this issue, but rising bacterial resistance has sparked interest in natural alternatives, such as carvacrol. Carvacrol (CAR), a bioactive compound in oregano and thyme essential oils, has demonstrated potent antimicrobial properties. However, its high volatility and environmental sensitivity limit direct application in food systems, requiring encapsulation strategies to enhance stability and controlled release. This study aimed to develop and characterize polyhydroxybutyrate nanoparticles (CAR-PHB-NPs) encapsulating carvacrol for enhanced stability, antimicrobial activity, and controlled release behavior. Nanoparticles were synthesized via nanoprecipitation, yielding hydrodynamic diameters of 200-250 nm, polydispersity index values of 0.220-0.327, and zeta potential values of -25 to -43 mV, ensuring colloidal stability. Storage tests confirmed refrigeration-maintained nanoparticle stability for over 247 days. Among the tested formulations, 25%CAR-0.2%PHB-NPs exhibited the highest encapsulation efficiency (15.56%). Release kinetics studies demonstrated prolonged release, particularly in non-polar solvent systems simulating moderate and lipid-rich matrices. The antimicrobial activity of CAR-PHB-NPs was confirmed against Staphylococcus aureus and Listeria monocytogenes, with inhibitory effects of 0.76 log (CFU/mL) and 0.56 log (CFU/mL), respectively. Additionally, cytotoxic assay in A549 human lung epithelial cells revealed a dose-dependent reduction in cell viability, moderate concentrations maintaining viability above 50%, suggesting balance between biocompatibility and functional anticancer activity. Overall, CAR-PHB-NPs demonstrated a promising role in food preservation and biomedical applications by ensuring sustained antimicrobial activity and controlled cytotoxic effects. Future research should optimize formulations, assess gastrointestinal absorption mechanisms, and explore targeted drug delivery applications.

11. Impact of COVID-19 Lockdown on Depressive and Behavioral Symptoms in US Nursing Home Residents.

期刊: Journal of the American Medical Directors Association 发表日期: 2026-Jul-07 链接: PubMed

摘要

To examine the short-term within-individual changes in residents’ depressive and behavioral symptoms following the March 2020 lockdown in US nursing homes. Retrospective cohort study. Nursing home residents in US nursing homes operating from 2019 to 2020. Residents in 2020 were considered exposed to the lockdown, and residents in 2019 were considered not exposed to the lockdown. Using the national Minimum Data Set 3.0, outcomes included changes in depressive symptoms (Patient Health Questionnaire [PHQ]-9 or PHQ-10-OV) and behavioral symptoms (Agitated and Reactive Behavior Scale), examined as continuous score changes and binary adverse severity changes between baseline and follow-up (PHQ-9: n2020 = 499,984, n2019 = 514,378; PHQ-10-OV: n2020 = 47,371, n2019 = 51,398; Agitated and Reactive Behavior Scale: n2020 = 628,332, n2019 = 641,403). Mixed-effects models with facility random intercepts estimated changes in symptom scores and generalized estimating equations with a log link to estimate the risk ratios of adverse severity changes. Statistical interactions between the lockdown and resident cognitive impairment, facility ownership, size, overall ratings, and staffing levels were examined. Sensitivity analyses were conducted among residents in states with state-level visitation bans. No clinically meaningful within-individual, short-term changes in depressive or behavioral symptom scores were observed. Associations did not meaningfully differ across resident cognitive impairment levels, facility characteristics, or states with visitation bans. For residents with minimal or mild depressive symptoms at baseline, those exposed to the lockdown were 22% and 39% more likely to experience worsening symptoms than those unexposed, whereas those with very severe behavioral symptoms at baseline were 7% less likely to show no improvement. These associations were slightly stronger in states with visitation bans. Findings should be interpreted with measurement sensitivity, residents’ lived experiences, and nursing home efforts to address social isolation in mind, underscoring the need for more responsive and timely assessments and for balanced approaches that consider both infection control and residents’ psychosocial well-being.

12. Evaluation of the Applicability of Synthetic Data in the Development of Colorectal Cancer Survival Prediction Models: External Validation of Advanced Machine Learning Models Based on National Cancer Data Center Data.

期刊: Journal of medical Internet research 发表日期: 2026-Jul-07 链接: PubMed

摘要

Limited data availability and privacy constraints hinder the development of robust survival prediction models for personalized treatment. Synthetic data offers a promising solution, preserving the statistical properties of real clinical data. This study aimed to quantitatively assess the feasibility of using synthetic data for survival prediction by evaluating model transfer performance to real-world hospital data, with a focus on model transfer strategies. We developed and validated colorectal cancer survival prediction models using the National Cancer Data Center (NCDC) synthetic data (30,683 patients from 3 Korean institutions) for pretraining and real hospital data (2170 patients from Hwasun Jeonnam University Hospital) for external validation. We evaluated 3 model transfer strategies-domain adaptation, zero-shot, and ensemble-using extreme gradient boosting (XGBoost) and light gradient boosting machine (LightGBM). In total, 48 model configurations were tested, defined by the combination of algorithms (LightGBM and XGBoost), sampling technique (no-sampling, random undersampling [RUS], and synthetic minority oversampling technique combined with edited nearest neighbors [SMOTEENN]), model type (baseline, domain adaptation, zero-shot, and ensemble), and optimization objective (area under the precision-recall curve [AUPRC] and F1). The outcome was 7-year overall survival, evaluated using the AUPRC and Brier scores. Performance was compared against a hospital-only baseline using absolute values and deltas (ΔAUPRC and ΔBrier). Differences and corresponding 95% CIs were estimated on the held-out test set using 2000 bootstrap samples. Zero-shot application reduced the AUPRC in most settings, and any marginal improvements observed in the remaining settings were not statistically significant. In contrast, the domain adaptation model improved AUPRC in 8/12 combinations, with 4 statistically significant gains; the best setting (XGBoost+RUS+F1 optimization) achieved AUPRC=0.5391 (Δ+0.1474; P<.001). The soft ensemble increased AUPRC in 7/12 combinations, with 3 statistically significant gains; the best setting (XGBoost+RUS+AUPRC optimization) achieved AUPRC=0.5060 (Δ+0.1258, P=.002). For calibration, Brier scores improved in most domain adaptation and ensemble combinations, with a substantial proportion reaching statistical significance. When domain adaptation using local hospital data was applied, the model pretrained on synthetic data exhibited similar performance to the hospital-only baseline across various settings. This study demonstrates the methodological utility of a model transfer approach using NCDC synthetic data in a setting with limited data sharing. At the same time, it clarifies that while synthetic data can serve as a complement to local clinical data, it is not a substitute for real-world clinical models.

13. Feasibility of Tailoring Artificial Intelligence-Assisted Ambient Scribes for Intensive Care Unit Rounds: Algorithm Development and Validation.

期刊: JMIR medical informatics 发表日期: 2026-Jul-07 链接: PubMed

摘要

The increasing documentation burden on physicians is a significant contributor to burnout and decreases in care quality. Artificial intelligence (AI) has been proposed as a solution to reduce documentation burden in clinical care, but there are very limited data on its use in the inpatient and intensive care unit (ICU) environments. This pilot study aimed to explore the feasibility of using AI-assisted ambient scribes to capture interprofessional ICU rounds and synthesize a singular document to improve documentation efficiency and clinician satisfaction during ICU rounds. In this paper, we showcase our findings from customizing prompts for large language models (LLMs) to generate and evaluate daily progress notes from transcripts of simulated ICU cases. This project is divided into 2 phases. In the first phase, a randomly selected transcript of an audio recording of a simulated ICU rounds case was used to iteratively evaluate and improve the prompts for the LLMs. Multiple models (n=5) were used in phase 1, and the best-performing model (M1, based on the highest accuracy) was selected for the next phase. In the subsequent phase, 5 cases were selected and evaluated using the refined prompt and 2 models: M1 from phase 1 and M6, a technological upgrade of M1. Accuracy and error percentages were used as primary metrics. Additionally, error severity and usability were assessed using the Harm scale (adapted for potential harm risk) from the Agency for Healthcare Research and Quality and the 9-item Physician Documentation Quality Instrument, respectively. Iterative improvements to the prompt increased accuracy and reduced errors during phase 1. In phase 2, M1 and M6 achieved accuracies of 69% and 80%, respectively (P=.04). Overall, errors of omission were most common (mean 15.5%, SEM 2.7%), followed by partial errors (mean 7.2%, SEM 0.92%) and then errors of commission (mean 2.6%, SEM 0.7%). The error severity of both models was low (µ=0.61 vs 0.53; P=.10), with most errors categorized as having potential for no harm to low harm. Both models performed well on the 9-item Physician Documentation Quality Instrument assessment, with the M6 model outperforming the M1 (35.8 vs 38.3; P=.06). Our findings demonstrate the feasibility of integrating AI-assisted scribes for ICU documentation. Both prompt improvements and technological advancements in LLMs are noted to be helpful. This study lays the groundwork for future research into AI applications in ICU settings, paving the way for broader improvements in health care documentation.

14. A nurse-led climate resilience program for older adults: A one-group pre/post pilot study and implications for nursing management.

期刊: Nursing outlook 发表日期: 2026-Jul-07 链接: PubMed

摘要

Climate-related stressors increasingly threaten older adults’ psychological well-being, yet preliminary evidence guiding nurse-led, culturally situated community responses remains limited. To examine whether a brief nurse-led climate resilience program was associated with preliminary within-group changes over time in eco-anxiety, eco-guilt, ecological grief, and psychological empowerment among older adults, and to identify implications for nursing leadership and policy. This pilot one-group pretest-posttest study included 140 community-dwelling adults aged 60 years and older attending a club for older adults in Damanhur, Egypt. Standardized measures were completed at baseline and 3-month follow-up; findings were interpreted as preliminary because the design did not include a comparison group and could not support causal inference. At 3-month follow-up, within-group mean scores were lower for eco-anxiety (57.74-44.47; d = 1.07), ecological grief (16.75-12.98; d = 0.94), eco-guilt (20.91-17.09; d = 0.58), and psychological empowerment (24.11-19.74; d = 0.57; lower scores indicate greater empowerment). Exploratory mediation and moderation findings were treated as hypothesis-generating only. These findings suggest that a nurse-led climate resilience program may be feasible in community nursing settings serving older adults; however, controlled multisite studies are needed to assess effectiveness, clarify causal mechanisms, and establish generalizability. A brief nurse-led climate resilience program was associated with favorable preliminary within-group changes in climate-related emotional responses and psychological empowerment among older adults. Rigorous controlled research is needed before effectiveness can be concluded.

15. Reply to: "Beyond Average Grams: Aldehyde Dehydrogenase 2*2  and Alcohol-Induced Young-Onset Pancreatic Cancer" and "Uncontrolled Prediabetes Confounding in the Association Between Alcohol Consumption and Young-Onset Pancreatic Cancer".

期刊: Journal of clinical oncology : official journal of the American Society of Clinical Oncology 发表日期: 2026-Jul-07 链接: PubMed

摘要

16. AI Meets Attitudes: Cross-Sectional Quantitative Study of COVID-19 Vaccine Hesitancy in Alaska's Diverse Communities.

期刊: Journal of medical Internet research 发表日期: 2026-Jul-07 链接: PubMed

摘要

The global COVID-19 vaccine rollout faces challenges from persistent hesitancy, especially in rural and underserved regions. Alaska’s unique geographic, cultural, and infrastructural challenges create complex dynamics for vaccine uptake. This study uses machine learning on survey data to identify key sociodemographic and attitudinal predictors of hesitancy, informing targeted public health strategies. This study surveyed 720 Alaska adults, selected via targeted sampling to capture diverse COVID-19 vaccine attitudes across demographics and regions. A structured questionnaire assessed hesitancy through 17 indicators. We applied extreme gradient boosting, random forest, and K-nearest neighbors models for both regression and classification, and interpreted classification results via Shapley Additive Explanations values. Analysis of 720 respondents showed that in Alaska, 1.8% (13/720) of surveyed individuals completed the full primary vaccination series (doses 1-3) and received all 3 booster doses. A vaccination rate of 63.47% (at least 1 dose), with Pfizer preferred over Moderna. A total of 34% (238/720) of participants reported receiving the first dose of the COVID-19 vaccine, 43% (310/720) received the second dose, 18% (130/720) received a third dose, 22% (158/720) received the first booster, 13% (94/720) received the second booster, and only 4% (29/720) received a third booster. Geographic data revealed higher uptake in urban centers and variability in rural areas. Young adult males exhibited the highest hesitancy, while lesbian, gay, bisexual, and transgender individuals showed the lowest. Trust in the health care system was the strongest predictor, confirmed by machine learning analyses. Focusing on a geographically and demographically distinct US population, this study advances the scientific understanding of vaccine hesitancy while informing context-sensitive public health strategies. The findings offer actionable evidence to guide targeted communication, equitable outreach, and data-driven policy in Alaska and similarly underserved regions across the United States, underscoring the importance of culturally tailored, trust-centered interventions to promote vaccine uptake and health equity.

17. Beta-Alanine Supplementation Improves Isotonic Strength Endurance Performance Without Altering Psychological Responses During Drop-Set and Bi-Set Resistance Exercises in Resistance-Trained Individuals.

期刊: Journal of strength and conditioning research 发表日期: 2026-Jul-07 链接: PubMed

摘要

Colini, CL, Teixeira, EL, Andreato, LV, Marques, DC, Magnani Branco, BH, and de Salles Painelli, V. Beta-alanine supplementation improves isotonic strength endurance performance without altering psychological responses during drop-set and bi-set resistance exercises in resistance-trained individuals. J Strength Cond Res XX(X): 000-000, 2026-The ergogenic effects of beta-alanine (BA) supplementation are widely recognized, yet its effects on resistance exercises remain uncertain. It is possible that previous protocols were not sufficiently ‘acidotic,’ such as advanced drop-set and bi-set training systems. This study investigated whether BA supplementation improves isotonic strength endurance performance and psychological responses (perceived exertion, motivation, affect) during drop-set and bi-set protocols. In a double-blind parallel-group design, 22 young resistance-trained men and women were randomly assigned to either a BA group (6.4 g·day-1, n = 12) or a placebo (maltodextrin, n = 10). After familiarization with psychological scales, maximal strength (1-RM), and strength endurance tests, subjects’ total number of repetitions and psychological responses were recorded during drop-set (three sets at 80% 1-RM, with 3 successive 20% load reductions) and bi-set (three sets at 70% 1-RM, consisting of inclined bench press followed by flat bench press) protocols before and after a 4-week supplementation period. Outcomes were analyzed using mixed models for repeated measures (p < 0.05). The total number of repetitions increased with BA in the drop-set (+17.3%, effect size [ES] = 0.74, p = 0.007) and bi-set (+18.2%, ES = 0.98, p < 0.0001) protocols, but not with placebo (respectively, -0.98%, ES = -0.06, p = 0.988; and +5.6%, ES = 0.01, p = 0.406). Perceived exertion increased across sets during drop-set and bi-set protocols (both p < 0.0001), but without between-group differences (both p > 0.05). Other psychological responses were not influenced by set, group, or time (all p > 0.05). Four weeks of BA supplementation enhanced isotonic strength endurance performance in trained individuals performing drop-set and bi-set resistance protocols, without concurrent change in psychological responses.

18. Pre-Post Evaluation of a Sun Safety Social Media Campaign for Young Adults to Reduce Skin Cancer Risk.

期刊: JMIR dermatology 发表日期: 2026-Jul-07 链接: PubMed

摘要

Social media is a prevalent source of health information for young adults and offers a scalable platform for skin cancer prevention messaging, including sun safety. Despite high awareness among young adults that UV radiation is a potent carcinogen, both intentional and unintentional exposure remain common. Group-targeted and tailored digital campaigns may help counter protanning norms and strengthen protective behaviors to reduce long-term risk. This study aimed to evaluate the reach, engagement, and influence of a group-targeted and tailored Instagram-based sun safety campaign implemented as part of a university Skin Smart Campus (SSC) initiative. A pre-post design was used during the 2024-2025 academic year. The social media campaign evaluation was a focused analysis within a broader sun safety implementation initiative reported elsewhere. The analysis covered the trend-aligned Instagram campaign’s reach, engagement, awareness, aided thematic recall, following, and associations with sun safety behaviors. Surveys assessed demographics, sun safety behaviors, campaign awareness, and content recall. Instagram analytics quantified reach and engagement, and influence analyses included bivariate tests and logistic regression. Presurveys and postsurveys were obtained anonymously from 230 and 267 participants, respectively. A dedicated Instagram account and n=10 campus organizations shared campaign content, extending potential reach to 5711 campus followers. Weekly educational posts averaged 262 views and reached approximately 38 nonfollowers per post throughout the campaign. Postcampaign, SSC social media awareness was reported by 48.7% (130/267) of participants, compared to 24.1% (55/230) precampaign (χ²1=32.5; P<.001). There was significantly higher awareness among those with lighter skin types (93/164, 56.7%) compared to darker skin types (37/103, 35.9%; χ²1=10.9; P<.001). Followers were more likely to use on-campus sunscreen dispensers (χ²1=85.2; P<.001). Sunscreen use, protective clothing, and tanning bed risks were among the most frequently posted and recalled themes on Instagram, suggesting high salience (121/124, 97.6%; 111/124, 89.5%; and 106/124, 85.5%, respectively). Multivariable logistic regression revealed that participants with lighter skin tones (OR 2.33, 95% CI 1.19-4.56; P=.01), who followed the SSC Instagram account (OR 6.81, 95% CI 3.41-13.60; P<.001), and who used sunscreen dispensers (OR 7.78, 95% CI 3.82-15.84; P<.001) were significantly more likely to practice greater sun safety. A group-targeted, tailored social media campaign embedded in a broader campus initiative demonstrated meaningful reach, engagement, message recall, and impact among young adults. Pairing digital strategies with environmental ultraviolet radiation-reducing resources may enhance young adults’ sun safety behaviors. Future efforts should address differences in social media campaign awareness and strengthen messaging for groups that perceive themselves to be at lower risk for skin cancer.

19. Electrical discrimination of lysine methylation states at the single-molecule level.

期刊: Analytical sciences : the international journal of the Japan Society for Analytical Chemistry 发表日期: 2026-Jul-07 链接: PubMed

摘要

Lysine methylation is an important epigenetic modification that regulates chromatin structure and gene expression. However, it is still difficult to distinguish its methylated states without labels at the single-molecule level. In this study, we investigate the discrimination of lysine methylation states using single-molecule tunneling measurements with gold nano-gap electrodes. The conductance decreases stepwise as the number of methyl groups increases, even though density functional theory (DFT) shows that all molecules have almost the same HOMO energy levels. This result suggests that conductance is not determined only by the electronic structure, but also by how the molecule is arranged between the electrodes. Statistical analysis of current signals shows that high-conductance events become less frequent after methylation, indicating fewer strongly coupled configurations. The relationship between current and molecular length also supports that transport depends on variations in molecular configurations. Machine learning analysis achieved an F-score of 0.76 for distinguishing methylated from unmethylated lysine. In contrast, distinguishing between mono-, di-, and trimethylated forms gave a lower F-score of 0.49, reflecting overlap in the signals. These results suggest that single-molecule tunneling currents are sensitive to stepwise lysine methylation states through differences in transient molecular configurations. This work demonstrates the potential of single-molecule tunneling measurements for label-free analysis of epigenetic modifications.

20. Allogeneic hematopoietic cell transplantation with reduced-toxicity conditioning for X-linked hyper-IgM syndrome.

期刊: International journal of hematology 发表日期: 2026-Jul-07 链接: PubMed

摘要

X-linked hyper-IgM syndrome (XHIGM) is an inborn error of immunity caused by variants in the CD40LG gene, leading to disrupted T-cell function and impaired immunoglobulin class-switch recombination. Supportive care alone is linked to unfavorable outcomes, necessitating allogeneic hematopoietic cell transplantation (HCT) as a curative option. Although myeloablative conditioning is recommended for HCT, concerns remain regarding its toxicity. We reviewed ten patients with XHIGM who underwent HCT using reduced-toxicity conditioning (RTC) at our institution between 2010 and 2024. All patients underwent HCT by 5 years of age (range: 2-5 years; median: 3 years). Donor sources included unrelated bone marrow, unrelated cord blood, and haploidentical-related donors. Conditioning primarily consisted of fludarabine and busulfan (target area under the curve: 60-65 mg/L·h), with low-dose total body irradiation (TBI) administered in five patients. Two patients experienced graft failure, requiring a second transplantation, and one died from post-transplant complications. The remaining nine patients survived. The 5-year overall survival rate was 88.9%; the 5-year graft-versus-host disease-free, relapse-free, and second transplantation-free survival rate was 67.5%. The addition of low-dose TBI to fludarabine/busulfan was associated with favorable long-term donor chimerism, although this finding should be considered hypothesis-generating. RTC may represent a feasible conditioning strategy for XHIGM.

21. 3D-printed foot orthoses with customized somatosensory stimulation knobs enhance balance and stability in older adults.

期刊: Assistive technology : the official journal of RESNA 发表日期: 2026-Jul-07 链接: PubMed

摘要

Age-related declines in plantar sensitivity contribute to balance deficits in older adults, motivating the use of somatosensory stimulation foot orthoses (SSFO) to enhance sensory input. This study evaluated the effects of 3D-printed SSFO with customized knob heights on postural control in older adults using computerized dynamic posturography. In a randomized, controlled, parallel-group study with a within-subjects component, 46 community-dwelling adults aged over 65 years were assigned to either a control group receiving flat foot orthoses (FFO) or an intervention group receiving both SSFO and placebo foot orthoses (PFO). SSFO and PFO were 3D-printed and individually customized. Postural stability and control were assessed using the Sensory Organization Test, Motor Control Test, and Adaptation Test. Compared to PFO, SSFO significantly improved equilibrium scores during eyes-open trials on a fixed support surface (p = 0.028). SSFO significantly increased weight symmetry compared to FFO (medium-magnitude-backward translation: p = 0.050) and PFO (large-magnitude-forward translation: p = 0.033), and response latency compared to FFO (medium-magnitude-backward translation: p = 0.033; large-magnitude-forward translation: p = 0.035). SSFO significantly reduced sway energy during toes-up perturbations compared to FFO (p = 0.018) and toes-down perturbations compared to PFO (p = 0.043). 3D-printed SSFO enhanced somatosensory feedback and improved postural stability but increased response latency. Further research is warranted to investigate SSFO’s broader clinical application.

22. Circadian Disruption in Nurses Working Night Shift: What We Know, What We Miss.

期刊: Workplace health & safety 发表日期: 2026-Jul-07 链接: PubMed

摘要

23. Family Functioning and Medication Self-Management in Rural Older Adults With Chronic Comorbidities: The Mediating Role of Self-Efficacy.

期刊: Journal of clinical nursing 发表日期: 2026-Jul-07 链接: PubMed

摘要

To examine the mediating role of self-efficacy for appropriate medication use in the relationship between family functioning and medication self-management among rural older adults with chronic comorbidities. Effective medication self-management is vital for rural older adults with chronic comorbidities. However, despite the recognized clinical importance of family functioning, self-efficacy for appropriate medication use and medication self-management, the relationships among these factors in this population remain underexplored. A cross-sectional design. Between June and July 2025, 539 rural older adults with chronic comorbidities were recruited from a county-level hospital in Henan Province, China using a convenience sampling method. Standardized instruments assessed demographic characteristics, family functioning, self-efficacy for appropriate medication use and medication self-management. PROCESS Model 4 tested the mediation effect. The median score for medication self-management was 61.0 (54.0, 70.0), and significant positive correlations were found among all three variables. Path analysis revealed that self-efficacy for appropriate medication use partially mediated the relationship between family functioning and medication self-management, with the direct and indirect effects accounting for 52.46% and 47.54% of the total effect, respectively. Medication self-management requires further improvement among rural older adults with chronic comorbidities. Self-efficacy for appropriate medication use serves as a partial mediator between family functioning and medication self-management. These findings support family-integrated nursing interventions, including family-centred education and collaborative medication planning, to strengthen family functioning, enhance patients’ self-efficacy and improve medication self-management in rural older adults. This study clarifies the mechanism linking family functioning to medication self-management in rural older adults, identifying self-efficacy as a mediator. This evidence supports interventions that enhance family support and patient confidence. Rural older adults with chronic comorbidities participated voluntarily in this study.

24. Assessing Civic Health Equity in Health Professions Education: Development of a Novel Metric Within the Planetary Health Report Card.

期刊: Health promotion practice 发表日期: 2026-Jul-07 链接: PubMed

摘要

Civic health equity is the principle that all people deserve a fair and just opportunity to participate in their communities and to have a voice in the systems that shape their lives. Yet despite its importance to population health, civic engagement remains inconsistently addressed in health professions education. Inequities in civic participation contribute to unequal political representation and policy responsiveness, disproportionately affecting historically marginalized communities, and limit the ability of future health professionals to engage with the structural and policy drivers of health. This paper describes the development and implementation of a civic health equity metric within the Planetary Health Report Card (PHRC), an international, student-led, faculty-supported initiative that evaluates how health professional schools integrate planetary health and social accountability into educational practice. First introduced in the 2026 PHRC assessment cycle, the metric was developed through iterative leadership discussions informed by existing frameworks. It assesses whether health professional curricula prepare students to understand civic participation and advocacy as mechanisms for addressing environmental and structural determinants of health. The metric is part of the PHRC curriculum domain and uses a standardized scoring system ranging from 0 to 3 points, with required qualitative justification from participating institutions. To promote feasibility and broad adoption, it is explicitly nonpartisan and educational in nature, aligning with 501(c)(3) requirements. By embedding civic health equity within an established assessment framework, this metric provides educators with a practical tool to identify curricular gaps, support equitable access to civic learning, and strengthen health promotion-oriented training.

25. [New perspectives in the management of dyslipidemia and the role of PCSK9 inhibitors].

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

摘要

Cardiovascular diseases continue to be the leading cause of morbidity and mortality worldwide. Reducing LDL cholesterol (LDL-c) is one of the fundamental pillars of cardiovascular prevention; however, a significant percentage of patients do not reach the recommended therapeutic targets with first-line treatment. PCSK9 inhibitors have demonstrated significant reductions in LDL-c and decreased cardiovascular events in high- and very high-risk patients. The 2025 update of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) guidelines for the management of dyslipidemias reinforces the concept of the earlier and the lower, the better, as well as the need for early combination therapies.

26. From diabetic foot to dementia: A neurovascular continuum linking systemic diabetic vasculopathy, cerebral small vessel disease, and glymphatic dysfunction.

期刊: Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie 发表日期: 2026-Jul-07 链接: PubMed

摘要

Diabetes mellitus, particularly type 2 diabetes mellitus (T2DM), is increasingly recognized as a major risk factor for cognitive decline and dementia. Epidemiological studies consistently demonstrate that individuals with diabetes exhibit a significantly elevated risk of both vascular cognitive impairment and Alzheimer’s disease [1,2]. Beyond hyperglycemia, systemic vascular dysfunction has emerged as a central mechanism underlying diabetes-related brain injury. Diabetes induces widespread vascular alterations, including endothelial dysfunction, arterial stiffening, oxidative stress, and chronic low-grade inflammation [3,4]. These processes affect both peripheral and cerebral circulation and may contribute to the development of cerebral small vessel disease (CSVD), a major substrate of cognitive decline [10-12]. Increased arterial stiffness may impair the Windkessel effect and facilitate the transmission of excessive pulsatile energy into fragile cerebral perforating arteries, thereby promoting microvascular injury and white matter damage [13-17]. In addition, diabetes-associated disruption of the neurovascular unit (NVU) may lead to blood-brain barrier dysfunction, neuroinflammation, and neuronal injury [20-30]. Impairment of the glymphatic system responsible for the clearance of metabolic waste products such as amyloid-β and tau may further contribute to neurodegenerative processes [31-41]. In this review, we propose a “systemic vascular continuum” linking peripheral diabetic vasculopathy, cerebral small vessel disease, neurovascular unit dysfunction, and glymphatic impairment. Within this framework, diabetic foot ulcer (DFU) is presented as a clinically visible peripheral phenotype and surrogate marker of advanced systemic vascular injury rather than a direct causal factor [5-9]. This integrative model provides a conceptual framework for understanding diabetes-associated cognitive impairment and highlights vascular-targeted preventive and therapeutic strategies as promising approaches for risk stratification and intervention.

27. Communication Breakdown in Patients With Alzheimer Disease: An Evolutionary Concept Analysis.

期刊: Professional case management 发表日期: 2026-Jul-07 链接: PubMed

摘要

Impaired communication is a common problem for many people with Alzheimer disease (AD), which results in behavioral disturbances and psychosocial distress. The current literature lacks a clear and unified conceptual definition of communication breakdown in AD, which limits its effective management. This article aims to clarify the concept of communication breakdown in patients with AD by identifying its attributes, antecedents, and consequences to propose a new operational definition of the concept. A systematic search was conducted on the databases such as Cochrane Database of Systematic Reviews, PsycINFO, Scopus, Medline, Social Sciences Index, and EMBASE between the years 2010 and 2026. Rodgers’ evolutionary framework of concept analysis (2000) was used as a guide for analyzing the communication breakdown concept. Four main attributes were extracted to describe and propose a coherent definition of communication breakdown in patients with AD that encompass cognitive and memory impairment, language impairment, failure of concentration and attention, and behavioral and emotional disorder. This concept analysis provides an operational and new definition that will improve knowledge of issues related to communication breakdown in AD, which can be used by family caregivers, case managers, and health care providers when preventing and managing communication problems in patients with AD.

28. Age at natural and surgical menopause and related factors: NHANES 2013-2023.

期刊: Menopause (New York, N.Y.) 发表日期: 2026-Jul-07 链接: PubMed

摘要

Premature and early menopause are public health issues that increase the risk for chronic conditions, including cardiovascular disease and osteoporosis. We aimed to estimate the average age at menopause and identify factors associated with age at menopause in a nationally representative sample of American women. We used a population-based cross-sectional study to investigate menopause timing in 15,322 women aged 15 years and older from the 2013 to 2023 National Health and Nutrition Examination Survey (NHANES). The outcomes were age at natural and surgical menopause (time-to-events) and menopause onset as multinomial categories (premature, early, typical, late). Life tables demonstrated a median age of natural menopause at 50 years, while survey-adjusted estimates suggested a weighted mean age of 49.5 years (95% confidence interval: 49.2-49.8). The prevalence estimates of premature and early natural menopause in postmenopausal women were 4.6% and 10.0%, respectively. Multivariate Cox proportional hazard models identified less education, smoking, and mild depression as factors associated with younger natural menopause onset, whereas obesity, high blood pressure, high cholesterol, and arthritis were significantly associated with younger age at surgical menopause. In postmenopausal women, less education, little sleep, diabetes, and mild depression demonstrated associations with increased odds for premature natural menopause. Differences between calculated associations and menopause timing reported in the literature are likely due to methodological and participant inclusion differences. The life table method demonstrates a similar estimate to the commonly reported value for natural menopause onset. Several modifiable factors may provide opportunities for intervention.

29. Yiqi Fumai Lyophilized Injection for Improving Exercise Tolerance in Chronic Heart Failure: Protocol for a Prospective Cohort Study.

期刊: JMIR research protocols 发表日期: 2026-Jul-07 链接: PubMed

摘要

High mortality and prevalence rates are hallmarks of chronic heart failure (CHF). Patients frequently have a much lower quality of life as a result of diminished exercise tolerance. Chinese guidelines have recommended Yiqi Fumai lyophilized injection (YQFM) for the treatment of heart failure, although there is currently inadequate evidence to support its effectiveness in increasing exercise tolerance in these patients. The purpose of this cohort study is to examine the relationship between the improvement of exercise tolerance in patients with CHF and the addition of YQFM to guideline-directed medical therapy. In total, 216 hospitalized patients with CHF with New York Heart Association (NYHA) functional classes II-IV were to be enrolled in the prospective, observational cohort trial design. The participants were divided into a YQFM group (exposed group: n=144) and a non-YQFM group (nonexposed group: n=72) at a 2:1 ratio based on real clinical medication and patient preference. Standard guideline-directed medical therapy was administered to both groups; however, the YQFM group also got a 10-day YQFM exposure. The change in metabolic equivalents measured by the Veterans Specific Activity Questionnaire was the main outcome. The 6-minute walk distance, Kansas City Cardiomyopathy Questionnaire score, NYHA functional class, N-terminal pro-B-type natriuretic peptide levels, and echocardiographic parameters were among the secondary objectives. Traditional Chinese medicine syndrome scores and the frequency of hard clinical occurrences were the exploratory objectives. A linear mixed-effects model was used to examine repeated measurement data, and propensity score weighting was used to account for baseline confounding variables. The first patient was registered in June 2024, and all 216 patients had been recruited and followed up with by December 2025. Data cleaning and statistical analysis began in January 2026, with final results scheduled to be published in the autumn of 2026. This study, using a prospective cohort design, intends to offer high-quality, real-world evidence for the use of YQFM in cardiac rehabilitation for heart failure. This will aid in the optimization of preventative and treatment strategies for CHF that combine traditional Chinese and Western medicine, giving an objective basis for enhancing patients’ long-term quality of life.

30. Proactive Surveillance of Public Swimming Pools to Prevent Delayed Detection of Cryptosporidiosis Outbreaks.

期刊: The Journal of infectious diseases 发表日期: 2026-Jul-07 链接: PubMed

摘要

Swimming pool-related cryptosporidiosis outbreaks are a global issue disproportionately affecting young children. This study aimed to (1) quantify swimming pool outbreak detection timelines; (2) identify pathogen prevention and detection strategies from Australia, United Kingdom, United States, and World Health Organization guidelines for public swimming pools; and (3) review oocyst detection methods used in pool-related cryptosporidiosis investigations. Literature searches of peer-reviewed databases, public health publications, and relevant government guideline repositories were conducted. The interval between pool contamination, outbreak detection, and disinfection was estimated using an average response scenario. A comparative analysis of pool guidelines was performed based on Cryptosporidium prevention and testing strategies. Efficacy of proactive and reactive testing was estimated using oocyst detection yields from global studies. There was an average delay of 27 days between pool contamination and disinfection, contributing to the persistence of outbreaks in swimming pools. Cryptosporidium prevention strategies varied and were inconsistent across jurisdictions. Proactive surveillance was discouraged in many jurisdictions based on financial cost, methodological gaps, and sampling biases. Oocyst detection data showed a proactive approach provides surveillance and prevalence metrics in aquatic facilities. Reliance on notification-based outbreak identification and existing contamination prevention guidelines appear insufficient to prevent and reduce outbreaks in public swimming pools. Barriers to proactive surveillance can be addressed by monitoring high-risk settings using existing methods alongside current mandatory microbiological surveillance already occurring in swimming pools. Earlier detection of contamination events would significantly reduce pool-associated cryptosporidiosis outbreaks locally and globally, and reduce the burden of gastroenteric disease in young children.

31. Environmental controls on soil nematode composition and network complexity across a restoration chronosequence in a mining-affected alpine grassland on the Qinghai-Tibet Plateau.

期刊: Journal of environmental management 发表日期: 2026-Jul-07 链接: PubMed

摘要

Soil nematodes are widely used indicators of soil ecosystem condition. However, their responses to ecological restoration are often assessed solely through diversity metrics, which may overlook important changes in community organization and species interactions. Here, we examined how soil nematode community composition, α-diversity, and co-occurrence network complexity responded to a mining restoration chronosequence in an alpine grassland on the Qinghai-Tibet Plateau, encompassing short-term restoration, long-term restoration, and native vegetation. Across restoration stages, nematode α-diversity indices (Shannon, Chao1, and Pielou’s evenness) showed no significant differences, whereas community composition and trophic structure shifted markedly, particularly in the relative abundances of bacterivorous and predatory nematodes. In contrast to the stability of α-diversity, co-occurrence network complexity varied substantially, with long-term restoration sites exhibiting higher connectivity, clustering coefficient, and interaction density than short-term restoration and native vegetation. Environmental analyses revealed that soil properties explained the largest proportion of variation in community composition. Soil pH and phosphorus availability emerged as key predictors of both community composition and network complexity. Path modeling further indicated that chromium exerted strong indirect effects by regulating soil physicochemical conditions and plant belowground biomass, thereby influencing both community composition and network topology. Overall, our findings demonstrate that α-diversity alone provides limited sensitivity for detecting ecological recovery, whereas network structural attributes capture environmentally driven reorganization of belowground communities. Integrating nematode network analysis with environmental modeling offers a more sensitive framework for evaluating soil health and restoration outcomes in mining-disturbed alpine ecosystems.

32. Emerging Contaminants in Treated Wastewater Reuse under Water Scarcity: A Hidden Risk in the Middle East, North Africa, and Türkiye.

期刊: Environmental science & technology 发表日期: 2026-Jul-07 链接: PubMed

摘要

33. Occupational quality of life during the menopause transition: a cross-sectional study of women faculty and staff at three universities in the United States.

期刊: Menopause (New York, N.Y.) 发表日期: 2026-Jul-07 链接: PubMed

摘要

In the absence of menopause-friendly workplaces, the menopause transition may negatively impact women’s occupational quality of life (OQoL). There is little research on women’s experiences of menopause in university workplaces in the United States. From January to May 2025, 391 women faculty and staff aged 40-55 at three universities completed a cross-sectional self-report survey. Using multivariable linear regressions controlling for university clustering and sociodemographics, we tested if self-reported menopause stage was associated with the Utian Quality of Life sub-scale for OQoL, and, among women in perimenopause or postmenopause, we tested if the presence of 12 symptoms (eg, hot flashes, irritability, exhaustion, pain) occurring at work were associated with OQoL and an item measuring how much “perimenopause or menopause impacted productivity” at work (0 = no effect to 10 = completely prevented activities). Of 263 women in perimenopause or postmenopause, 95% had at least one recent symptom at work, most commonly physical/mental exhaustion (68%) and feeling tired at work due to sleep problems (67%). About 90% reported that perimenopause or menopause impacted productivity, with 13% having substantial disruptions (≥7). Menopause stage was not associated with OQoL. Among women in perimenopause or postmenopause, all else held constant, a greater number of symptoms and joint/muscle pain were associated with lower OQoL, and 9 of 12 symptoms and a greater number of symptoms were associated with menopause-related disruptions to workplace productivity. Workplace interventions may be needed to reduce the interference of symptoms with OQoL during the menopause transition.

34. Signal versus Diagnosis: From Burnout Risk Screening to Care.

期刊: Evaluation & the health professions 发表日期: 2026-Jul-07 链接: PubMed

摘要

35. Commuter-related ocular symptoms and eyewash intervention in an urban setting: a non-randomized interventional study in Bandung, Indonesia. The first report of the Bandung eyewash study.

期刊: Environmental science and pollution research international 发表日期: 2026-Jul-07 链接: PubMed

摘要

Air pollution associated with rapid urbanization has become a critical public health challenge in Southeast Asian cities. Bandung, Indonesia, is situated in a basin, a topographical feature that facilitates the stagnation of pollutants. Although exposure to air pollutants triggers mucosal symptoms in the eyes and nose, the impact of individual background factors-such as transportation mode and work environment-and the efficacy of eyewash interventions remain insufficiently understood. This study aimed to elucidate the effects of background factors, including transportation mode (motorcycle vs. car) and work environment (outdoor vs. indoor), on subjective ocular and nasal symptoms among commuters in Bandung, and to evaluate the clinical efficacy of an eyewash intervention. This was an investigator-initiated, single-center, participant- and assessor-blinded, parallel-group, non-randomized controlled trial. Thirty commuters in Bandung (mean age 33.7 ± 9.6 years; 21 males, 9 females; 15 motorcycle commuters, 15 car commuters) were enrolled. Subjective ocular (8 items) and nasal (4 items) symptoms were assessed. Baseline scores were compared after stratification by transportation mode and work environment. Subsequently, an intervention using a commercially available eyewash solution was performed, and pre- and post-intervention changes in symptoms were statistically analyzed. Univariate analysis and multiple linear regression analysis were conducted using the total clinical scores for eye and nose as dependent variables and background factors (sex, age, work environment, smoking habit, commute duration, and transportation mode) as independent variables to identify independent predictors of symptoms. Multiple regression analysis revealed that motorcycle use was the sole independent and significant predictor of increased ocular symptom scores (p < 0.01). Furthermore, outdoor workers exhibited significantly higher baseline ocular symptoms compared to indoor workers (p = 0.01). Following the eyewash intervention, total clinical scores for both ocular and nasal symptoms improved significantly in both motorcycle and car commuters (all p < 0.05). Particulate matter was detected in the post-intervention eyewash solution of all participants. Motorcycle commuting was associated with higher ocular symptom burden in this small urban cohort. Eyewashing was associated with short-term improvement in subjective ocular and nasal discomfort. These findings suggest that eyewashing may serve as a supplementary personal care measure for symptom relief in individuals exposed to urban air pollution; however, further studies with larger, controlled designs are required to confirm its effectiveness and clinical utility.

36. The role of organochlorine pesticides as environmental factors in Alzheimer's disease in human studies: A systematic review and meta-analysis.

期刊: Journal of Alzheimer’s disease : JAD 发表日期: 2026-Jul-07 链接: PubMed

摘要

BackgroundAlzheimer’s disease (AD) is a prevalent neurodegenerative disorder among the elderly, influenced by both genetic and environmental factors. Organochlorine pesticides (OCPs) have recently been identified as potential environmental risk factors due to their bioaccumulation in adipose tissue and neurotoxic properties.ObjectiveThis systematic review aimed to examine the human evidence regarding exposure to OCPs and the risk of AD. The results of the meta-analysis showed that exposure to pesticides is significantly associated with an increased risk of AD.MethodsA comprehensive search was performed across major scientific databases, including PubMed/MEDLINE, Scopus, Web of Science, the Cochrane Library, and Embase.ResultsPooled estimates (random effects meta-analysis) of the four eligible studies showed a significant positive association between exposure to OCPs and the risk of AD (OR = 2.19; 95% CI: 1.40-3.42). These findings indicate that exposure to OCPs may significantly increase the risk of AD. The substantial heterogeneity among studies (I2 = 84.58%) may partly reflect differences in exposure assessment approaches, such as biomonitoring-based measurements compared with occupational or geographically inferred exposure assessments.ConclusionsThese findings highlight the importance of controlling occupational and environmental exposures to pesticides in preventing neurodegenerative outcomes. The findings suggest that chronic exposure to lipophilic pesticides, particularly persistent chlorinated compounds, may contribute to neurodegenerative processes implicated in the pathophysiology of AD. Therefore, more studies with similar designs and more precise exposure measurements are needed to confirm the results and reduce the heterogeneity.

37. Habituation to Elevated Glucose Levels in Type 1 Diabetes: Function and Well-Being in Guideline-Based Versus Typical Glycemic Range.

期刊: Diabetes care 发表日期: 2026-Jul-07 链接: PubMed

摘要

Chronic hyperglycemia may shift physiological and perceptual thresholds upward, such that guideline-defined glucose targets feel aversive. We compared time in range (TIR) (70-180 mg/dL) with time in personal range (TIPR) (mean glucose ± 50 mg/dL) to determine whether daily symptoms, functioning, and diabetes-specific outcomes align more closely with guideline-based versus personal glucose ranges. Adults with type 1 diabetes completed 14 days of blinded continuous glucose monitoring (CGM), with ecological momentary assessments (EMAs) and mobile cognitive testing six times daily. For each 3-h interval preceding an EMA prompt, we calculated the percentage of time in guideline-defined and personal ranges. We estimated within-person correlations and regression models evaluating the incremental predictive effects of TIPR over TIR. Analyses were repeated stratified by personal (unblinded) CGM use. Analyses included 161 participants (mean ± SD 41.1 ± 14.8 years old; 55% female; 41% Hispanic, 30% non-Hispanic White, 14% non-Hispanic Black). Compared with TIR, TIPR was more consistently associated with improved pain, fatigue, activity demands, and perceptual speed, whereas TIR was more strongly associated with better diabetes-specific self-evaluations (diabetes distress and self-care). Glucose metrics showed minimal associations with stress and negative affect, and TIPR showed modest associations with positive affect. In models including both predictors, TIPR explained unique variance beyond TIR for several outcomes. Associations between glucose metrics and diabetes-specific outcomes were stronger among CGM users than nonusers. Personal glucose ranges capture aspects of lived experience not fully reflected by guideline targets, supporting TIPR as a complementary metric for psychosocially informed, person-centered care.

38. Psychometric validation of the Spanish SDM-20: an occupational health screening tool for assessing workplace mobbing.

期刊: International journal of occupational medicine and environmental health 发表日期: 2026-Jul-06 链接: PubMed

摘要

The aim of this study was to psychometrically validate the Spanish version of the Polish SDM-20 questionnaire (Skala Doświadczania Mobbingu) as a screening instrument for assessing workplace mobbing in occupational health settings. A cross-sectional online survey was conducted among 753 Spanish employees (65.5% women, age: 18-66 years). The factorial structure of the SDM-20 was examined using confirmatory factor analysis (CFA). Internal reliability was assessed using Cronbach’s α and McDonald’s ω coefficients. Convergent and divergent validity were evaluated through correlations with workplace bullying (Negative Acts Questionnaire - Revised - NAQ-R), burnout (Maslach Burnout Inventory - General Survey - MBI-GS9), and organizational climate measures. Confirmatory factor analysis supported the original 3-factor model, encompassing person-related mobbing, work-related mobbing, and health-related harm, and demonstrated satisfactory model fit. All subscales showed high internal reliability. Strong positive correlations with workplace bullying and burnout measures supported convergent validity, whereas negative associations with organizational climate indicators provided evidence of divergent validity. The results confirm the structural stability and construct validity of the Spanish SDM-20. The Spanish version of the SDM-20 is a reliable and valid instrument for screening workplace mobbing in occupational health contexts. By integrating behavioral exposure with a psychometrically assessed harm component, the instrument enables differentiation between exposure and clinically relevant victimization. Its brevity and robust psychometric properties support its application in occupational health surveillance and early risk detection. Int J Occup Med Environ Health. 2026;39(3).

39. Nicotinamide-derived tumor-targeting carbon dots for Cancer Photothermal therapy.

期刊: Journal of colloid and interface science 发表日期: 2026-Jul-04 链接: PubMed

摘要

The lack of tumor-specific targeting remains a major bottleneck in photothermal therapy. Here, we exploit the natural affinity of nicotinamide (NAM) for Ki67, a tumor proliferation marker, to design a targeted photothermal nanomaterial. NAM-derived carbon dots (NAM-CDs) were synthesized via a one-step solvothermal method, in which the carbon core serves as a scaffold for the multivalent presentation of NAM moieties. Dynamic molecular docking simulations revealed that NAM-CDs exhibited a markedly enhanced binding affinity toward Ki67, with binding energy of -7.7 kcal/molcompared with -3.8 kcal/mol for free NAM. These results indicate that the multivalent display of NAM not only preserves but also amplifies its intrinsic Ki67-targeting capability. To further optimize the photophysical properties of NAM-CDs, the synthesis temperature was systematically tuned. At 180 °C, the resulting NAM-CDs developed a pyridine-rich surface characterized by maximized pyrrolic-N content and enhanced amide bond formation, facilitating efficient energy transfer from the carbon core to surface states. This optimized electronic structure synergistically enhanced both red fluorescence emission and photothermal conversion efficiency. The pyridine-rich NAM-CDs exhibited excellent biocompatibility, specific nuclear retention through Ki67-mediated interactions in cancer cells, and potent photothermal tumor ablation upon 660 nm laser irradiation in vivo, achieving complete tumor regression without recurrence over a 30-day observation period. By harnessing the inherent Ki67 affinity of NAM, this work provides a facile strategy for imparting tumor-targeting capability to photothermal agents, opening a new avenue for proliferation-marker-directed cancer therapy.

40. Using a self-efficacy framework in the management of inducible laryngeal obstruction (ILO): A tutorial with illustrative case scenarios.

期刊: Journal of communication disorders 发表日期: 2026-Jul-04 链接: PubMed

摘要

Self-efficacy (SE), a concept from health promotion, is known to be associated with numerous positive health outcomes but has not been formally described for the management of individuals with inducible laryngeal obstruction (ILO). The purpose of this article is to describe how a SE framework can be used to promote optimal outcomes for individuals with ILO. The SE framework uses a variety of methods to enhance self-management and achieve therapeutic goals. Key elements include mastery experiences, vicarious experience, verbal persuasion, and an understanding of physiological and affective states, all of which are relevant to the optimal treatment of ILO. Data from our clinic support the use of a SE approach and two case scenarios are presented which illustrate its use in clinical practice. In a study of adults with ILO treated at our institution, there were significant associations between feelings of control of symptoms, activity limitations, and psychological symptoms. These findings highlight the utility of using the concept of control as a way of goal-setting at diagnosis, tracking progress in therapy, and as a metric of treatment success. At our institution, simple numeric rating scales provide a useful means of assessing control and are used for the management of ILO at every visit. SE is a powerful predictor of behavior change and has been widely used to successfully treat a wide variety of medical conditions. Further investigation of the application of this framework to the treatment of ILO is recommended. As a result of this activity, readers will: 1. Describe the findings from previous research and the measures that have been used to document improvement after ILO treatment. 2. Define the concept of self-efficacy and its component parts and summarize its previous use in the literature. 3. Apply that model to the field of rehabilitation, with particular reference to a comprehensive treatment model for ILO as a way of promoting optimal outcomes.

41. The HFpEF-ABA score predicts adverse cardiac remodelling and incident heart failure: a UK biobank study.

期刊: ESC heart failure 发表日期: 2026-Jul-04 链接: PubMed

摘要

The HFpEF-ABA score (age, body mass index, atrial fibrillation) was originally derived to diagnose heart failure with preserved ejection fraction (HFpEF) in symptomatic patients. However, its utility as a preventive screening tool to identify preclinical risk in unselected community populations remains unvalidated.To validate the HFpEF-ABA score in a large community-based cohort free of heart failure and structural heart disease, utilizing a dual validation approach combining cardiac magnetic resonance phenotyping and long-term outcome prediction. We analysed 416 374 UK Biobank participants without baseline heart failure. Participants were stratified by HFpEF-ABA score into low, intermediate, and high risk. We assessed biological validity in a subcohort of 65 293 participants utilizing cardiac magnetic resonance, and clinical validity via prospective adjudication of heart failure hospitalization over a median follow-up of 14.9 years. Structurally, elevated scores identified characteristic patterns of adverse cardiac remodelling in individuals at high risk for incident heart failure despite the absence of a clinical diagnosis: high-risk individuals exhibited profound left atrial dysfunction (LA ejection fraction 55.48% vs. 61.92%, P < .001) and distinct concentric ventricular remodelling compared with low-risk participants. Clinically, this structural substrate translated into a 6.4-fold excess risk of incident heart failure hospitalization (hazard ratio [HR] 6.44, 95% confidence interval [CI] 5.86-7.08, P < .001) and a 3.5-fold increased risk of the composite outcome (P < .001). The score demonstrated robust discrimination, outperforming its individual components. The HFpEF-ABA score demonstrates significant prognostic value for identifying individuals at high risk for incident heart failure and is associated with adverse cardiac remodelling and subclinical cardiac changes. These findings support repositioning the score from a diagnostic aid to a population-level screening instrument, supporting earlier identification of high-risk individuals before overt clinical heart failure develops.

42. Depressive symptoms in mid-pregnancy are associated with DNA methylation marks in the placenta.

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

摘要

Maternal depressive symptoms during pregnancy are associated with a range of adverse neurodevelopmental outcomes in offspring. DNA methylation, influenced by both genetic and environmental factors, has been identified as a potential mechanism mediating these associations. Because the placenta serves as an interface between mother and fetus, epigenetic marks in this tissue may provide insights into how the intrauterine environment influences child outcomes. The present study aimed to determine whether maternal Edinburgh Postnatal Depression Scale (EPDS) scores in mid-pregnancy (20 + 6 to 30 + 0 gestational weeks) are associated with placental DNA methylation marks and whether these marks differ from those associated with EPDS scores in early pregnancy. In this descriptive analysis, the DNA methylomes of placental samples collected at birth from 91 women in the FinnBrain cohort were analyzed using reduced representation bisulfite sequencing. The association of EPDS with DNA methylation of each CpG site was examined using the PQLseq. A total of 1345 CpG sites in 381 genes were identified with FDR ≤0.05, suggesting a potential association with mid-pregnancy EPDS scores. The most significant methylation marks were found in the following genes: PTPRO, RPTOR, TBX1, SLC7A4, FBRSL1, and ADAMTS17. When accounting for early pregnancy EPDS scores, 272 methylation marks remained significant. The genes were functionally enriched in biological pathways such as cell adhesion, nervous system development, and anatomical structure development. Compared with methylation marks associated with early pregnancy EPDS scores, similar methylation marks were found in 29 distinct genic regions. Further studies are needed to determine whether these methylation marks mediate the effects of maternal depressive symptoms on the fetus.

43. The effects of cold temperature on the development, microbiome, and transcriptome of the sea anemone Nematostella vectensis.

期刊: Comparative biochemistry and physiology. Part D, Genomics & proteomics 发表日期: 2026-Jul-02 链接: PubMed

摘要

Thermal conditions impact essentially all aspects of the physiology for ectotherms. While the effects of high temperatures have been widely studied, cold temperature effects on aquatic invertebrates and their microbial communities have been poorly characterized. To determine the diverse effects of exposure to cold temperatures, we assessed acute and long-term impacts of ecologically relevant low temperatures on the development, microbiome, and gene expression of the sea anemone Nematostella vectensis. Two hours post fertilization, embryos were exposed to temperatures from 4°C to 35°C and development rate to the juvenile stage was quantified. We found temperature impacts the development rate of embryos, where lower temperatures extended development time and resulted in mortality below 10°C. For both microbiome and host transcriptomic responses, anemones were held at 20°C, 10°C, and 0°C and compared at 24 hours and 7 days. Extended exposures to colder temperatures caused restructuring of the host-associated microbiome, with the loss of common taxonomic groups from the class Bacteroidia and Bacilli. Lastly, cold stress induced significant changes in gene expression, which were more pronounced at the 10°C than 0°C but showed little change over time in each temperature. Interestingly, expression of genes associated with innate immunity were among the most differentially expressed genes including heat shock proteins and innate immune genes providing a potential host-imposed mechanism to explain the shift in the microbiome. Overall, cold temperatures have broad effects on many facets of this sea anemone and its microbial community and indicate the importance of cold temperature events when characterizing how ectotherms acclimate to thermal variation.

44. The South Had The Lowest Rates Of Hospice And Palliative Medicine-Certified Providers In The US, 2024.

期刊: Health affairs (Project Hope) 发表日期: 2026-Jul 链接: PubMed

摘要

To improve access to care for serious illness, policy makers need evidence on how workforce capacity aligns with the need for palliative care. This study evaluated the palliative care workforce and policy environments at the state level, using a new data source: the 2024 Center to Advance Palliative Care’s comprehensive Serious Illness Scorecard. We describe variation in the palliative care workforce relative to serious illness deaths across states and by five policy types related to serious illness: serious illness task forces, continuing medical education (CME), pediatric Medicaid waivers, adult payment policies, and Medicaid expansion. States varied from 2.91 to 19.86 hospice and palliative medicine-certified providers per 1,000 serious illness deaths, and seven states in the South census region had the lowest rates. CME for serious illness care and Medicaid expansion were significantly associated with higher rates. Between-state variation raises concerns about whether the workforce is sufficient to meet needs for people with serious illness in some southern states.

45. Access To Community Pharmacies Associated With Reduced Racial And Ethnic Disparities In Use Of Prescription Drugs, 2010-19.

期刊: Health affairs (Project Hope) 发表日期: 2026-Jul 链接: PubMed

摘要

Racial and ethnic disparities in access to medicines persist across the US. Community pharmacies serve as critical access points for prescription drugs, yet their availability varies widely, potentially contributing to health disparities. We estimated the share of the population living within ten minutes of a community pharmacy across counties, by race and ethnicity, during the period 2010-23. We linked these measures to race and ethnicity-specific, state-level estimates of age- and prevalence-standardized medication use for twenty-seven health condition categories through 2019. A 1 percent increase in people living within ten minutes of a community pharmacy at the state level was associated with 0.7 percent higher use of medications per prevalent case. This association was strongest for Asian/Pacific Islander, Black, and Hispanic populations. In addition, a 1 percent increase in ten-minute community pharmacy access was associated with a 0.52 percent decrease in racial and ethnic disparities in medication use. These findings suggest that uneven community pharmacy access may exacerbate racial and ethnic disparities in medication use. Policy makers seeking to improve medication access should consider targeted interventions to preserve or expand pharmacy availability for underserved communities.

46. Workforce Projections For Physicians, Nurse Practitioners, And Physician Associates.

期刊: Health affairs (Project Hope) 发表日期: 2026-Jul 链接: PubMed

摘要

Ensuring an adequate supply of clinicians is a critical policy concern. In our forecast, physician supply growth remains consistent with prior forecasts, at 1 percent annually, but the numbers of nurse practitioners and physician associates, respectively, are projected to increase 11 percent and 5.6 percent annually through 2030. The surge in nurse practitioner graduates, especially, has implications for onboarding, team-based care, and policies.

47. Perceived physical exertion in senior workers performing heavy manual tasks.

期刊: Annals of work exposures and health 发表日期: 2026-Jun-03 链接: PubMed

摘要

With an aging workforce and longer working lives, staying in physically demanding occupations is increasingly challenging, and the factors influencing perceived exertion are still poorly understood. Also, self-rated exertion may not correlate strongly with physiological measurements of physical strain at work, such as heart rate. Our study aimed to describe the physical strain experienced by senior workers in manual occupations using Borg’s Rating of Perceived Exertion (RPE) scale and to explore associations between personal variables such as heart rate during work, age, physical fitness, and RPE ratings. We recruited workers aged 50 yr or older in manual occupations and collected data using questionnaires, physical examinations, field heart rate monitoring, and RPE ratings during work. Field heart rate monitoring was conducted using a chest band with a pulse sensor that transmitted data to a mobile application, and the first 6 h of recordings were used in subsequent analyses. Subjects were asked to simultaneously complete a diary at the end of each shift, rating the overall physical exertion for that day using the RPE scale, ranging from 6 (rest) to 20 (maximal physical exertion). Correlation between variables was determined using Spearman’s rank correlation coefficient (r). A linear mixed model was used to investigate associations between personal variables and RPE ratings. The sample consisted of 126 subjects, aged 50 to 67 yr, of whom 76 (60.3%) were females. The participants were employed as construction workers, kitchen workers, cleaners, or assistant nurses. They rated perceived physical exertion on the RPE scale once daily in one to three workdays, resulting in a total of 250 workdays. The mean (SD) RPE rating was 12.1 (2.1). When stratified by sex, the mean (SD) RPE rating was 12.1 (2.2) among females and 12.0 (1.8) among males (P = 0.669). When stratified by occupational group, the mean (SD) was 11.9 (1.9) for construction workers, 12.1 (2.0) for kitchen workers, 12.4 (1.6) for cleaners, and 11.8 (2.8) for assistant nurses (P = 0.139 to 0.815). In total, 298 heart rate (HR) recordings were obtained during work with a mean (SD) HR of 89.4 (11.4) beats/min (range 54 to 125). There was a significant bivariate correlation between the RPE ratings and mean HR for the entire study population (r = 0.14; P = 0.025) as well as in the group of construction workers (r = 0.23; P = 0.042), but not for any other occupational groups (r = 0.04 to 0.25; P = 0.096 to 0.752). In the linear mixed model, using the RPE ratings as the dependent variable, the statistically significant (P < 0.05) estimated coefficients (SE) were as follows: mean heart rate (beats/min), 0.03 (0.01); very poor sleep quality, 3.38 (0.93); and high psychological stress, 2.62 (0.71). Age, body mass index, theoretical maximum oxygen consumption, and chronic pain ratings were not significantly associated with the RPE ratings. We conclude that senior workers in manual occupations reported that their work was somewhat hard in terms of physical exertion. Our study also indicates associations between mean heart rate, sleep quality, psychological stress, and RPE ratings.

48. Examining Cost Differences in Malignant Brain and Central Nervous System Tumor Treatment Across US Military Health System Care Settings.

期刊: Journal of healthcare management / American College of Healthcare Executives 发表日期: 链接: PubMed

摘要

The objectives of this study were to determine whether the cost of care for malignant brain and other central nervous system tumors (MBT) in the US Military Health System differs between the Department of War-operated direct care (DC) network and the affiliated civilian-operated private sector care (PSC) network, as well as to identify the treatment types (i.e., surgery, radiation therapy, chemotherapy) driving any observed cost differences. Linked cancer registry and administrative-claims data from the Military Cancer Epidemiology database-including 574 patients ages 18-64 diagnosed with MBT between 2003 and 2014-were used to describe and compare patient characteristics and costs in 2022 US dollars associated with primary treatment in each setting. Because of the skewed distribution of cost data, the possibility that the effect of the care setting may have varied for patients with different levels of total cost, and to allow greater flexibility in modeling associations between independent variables and cost, nonparametric and semiparametric methods were used for the primary aims of this study. First, we used Wilcoxon-Mann-Whitney tests and Hodges-Lehmann difference estimator 95% confidence intervals (CIs) to compare DC and PSC median total cost and individual treatment type cost per patient. Next, we used quantile regression to compare DC and PSC costs at five levels between the 10th and 90th percentiles of total cost and individual treatment type cost per patient, while controlling for administrative, demographic, health, and tumor characteristics. Most patients were male (69%), younger than 29 years (28%), or older than 50 years (30%). Glioblastomas were the most commonly diagnosed tumor type (38%). Overall, 270 patients (47%) were treated in DC and 304 (53%) were treated in PSC. The median unadjusted total cost of treatment per patient was significantly higher for PSC at $87,652 compared to DC at $55,361 (Hodges-Lehmann difference estimator 95% CI [-49,544,-10,086], p < .001). While median unadjusted surgery costs were similar, radiation therapy and chemotherapy costs were significantly higher in PSC than in DC. After controlling for confounders, total cost per patient was significantly higher in PSC compared to DC for patients near the median, 75th, and 90th percentiles of the cost distribution, with the additional total cost per patient associated with PSC increasing from $31,443 (95% CI [4,216,58,669], p = .024) near the median to $305,200 (95% CI [211,412,398,897], p < .001) at the 90th percentile. After controlling for confounders, radiation therapy was significantly more costly for patients at each quantile in PSC compared to DC, while surgery costs were similar for patients in PSC and DC at each quantile of the cost distribution. The decision to internally deliver care or outsource services for complex and costly diagnoses such as MBT involves multiple strategic considerations, including treatment costs. Using data from the universal-access Military Health System, this study demonstrated that providing care within system-owned and operated facilities may be more cost-efficient than outsourcing care to affiliates, especially for patients whose treatment costs are above the median.

49. Prior Authorization In Medicare Advantage: Beneficiary Exposure And Plan Disenrollment In 2021.

期刊: Health affairs (Project Hope) 发表日期: 2026-Jul 链接: PubMed

摘要

Medicare Advantage plans use prior authorization to manage health care use. In recent years, these practices have come under intense scrutiny from policy makers. Using beneficiary enrollment data and contract-level prior authorization data from 2021, we documented three facts about prior authorization in Medicare Advantage. First, beneficiaries who live in different areas of the country enrolled in contracts with widely varying prior authorization rates. Second, Hispanic, Asian, Black or African American, and dual-eligible beneficiaries were disproportionately likely to enroll in plans with high prior authorization rates. Third, beneficiaries enrolled in contracts with higher prior authorization rates were more likely to disenroll from their contract-moving either to another Medicare Advantage contract or to traditional Medicare-than beneficiaries in contracts with lower prior authorization rates. Beneficiaries exposed to the highest quartile of prior authorization rates were 4.7 percentage points more likely to disenroll than beneficiaries exposed to the lowest quartile, a 44 percent difference. Higher disenrollment may suggest that beneficiaries are dissatisfied with plans that have higher prior authorization rates. Reducing overall rates of prior authorization could improve beneficiary retention in the Medicare Advantage program.

50. Broad Roles of Endoplasmic Reticulum Stress Sensors Activated by Diverse Pathophysiological Stimuli.

期刊: Frontiers in bioscience (Landmark edition) 发表日期: 2026-Jun-25 链接: PubMed

摘要

The endoplasmic reticulum (ER) stress response is a critical cellular program that maintains proteostasis and membrane homeostasis through the activation of the ER stress sensor proteins inositol-requiring enzyme 1 (IRE1), protein kinase R-like ER kinase (PERK), activating transcription factor 6 (ATF6), and old astrocyte specifically induced substance (OASIS) family proteins. These sensors, canonically understood as transducers of the unfolded protein response (UPR), respond to the accumulation of misfolded proteins in the ER lumen as a result of ER luminal Ca2+ depletion, defective disulfide bond formation, dysregulated glycosylation, or inhibition of ER-associated degradation. However, recent conceptual advances have reshaped understanding of these classical mechanisms, by revealing multiple non-canonical pathways that operate independently of luminal proteotoxicity. Emerging evidence highlights the roles of ER stress sensors in integrating diverse stimuli, including the integrated stress response, lipid bilayer stress, mitochondria-ER contact, and the DNA damage response. Herein, we discuss how these ER stress sensors function as multidimensional signaling hubs for proteotoxic, metabolic, and genomic stresses, and consequently modulate pathophysiological cellular outcomes. Finally, we examine current knowledge regarding both canonical and non-canonical modes of ER stress sensor activation, and we discuss how these mechanisms expand the functional scope of ER stress signaling in physiological regulation and diseases.

51. Recurrent urinary tract infections in older adults: A systematic review of current challenges and emerging therapeutic strategies.

期刊: Acta pharmaceutica (Zagreb, Croatia) 发表日期: 2026-Jun-01 链接: PubMed

摘要

As global life expectancy continues to rise, urinary tract infections (UTIs) have become an increasing concern in older adults. The higher prevalence in this population is attributed to anatomical and physiological changes of the urinary tract, hormonal imbalances, immunosenescence, and the presence of comorbidities. These factors, combined with a distinct microbiological profile and rising antimicrobial resistance, create significant clinical challenges in diagnosis and treatment. We conducted a systematic review of clinical trials and observational studies on the epidemiology, pathogenesis, diagnosis, and management of recurrent urinary tract infections (rUTIs) in older adults. The prevalence of rUTIs increases with age, disproportionately affecting women, with 53 % of those over 55 years experiencing recurrences within one year. Healthcare-associated UTIs (HAUTIs) account for 20-30 % of nosocomial infections, primarily impacting older adults. The host microbiome seemed crucial in UTI pathogenesis, with Escherichia coli being the leading causative agent due to its ability to adhere, colonise, and evade the immune response. In elderly patients, atypical presentations - such as delirium, functional decline, or nonspecific abdominal symptoms - complicate diagnosis, underscoring the critical need to differentiate symptomatic infections from asymptomatic bacteriuria (ASB) to prevent misdiagnosis and overtreatment. Effective management requires accurate diagnosis, appropriate antibiotic selection, and careful monitoring of adverse effects, especially in patients with comorbidities. Emerging therapies, including faecal microbiota transplantation, bacteriophages, probiotics, and proanthocyanidins, offer promising adjuncts. While long-term antibiotic prophylaxis is effective, it increases the risk of bacterial resistance, particularly in catheterised patients. Behavioural modifications, such as increased fluid intake, aid pathogen clearance, and topical estrogen therapy in postmenopausal women provides additional preventive benefit. Managing recurrent UTIs in ageing populations requires addressing microbiological, diagnostic, and antimicrobial resistance challenges. Despite resistance levels, the first-line treatment, nitrofurantoin, remains a viable therapeutic option, particularly in developed countries. An integrated approach combining individualised care, healthcare provider training, and rational antimicrobial use is essential to improving patient outcomes and quality of life. Future strategies should focus on novel antimicrobials targeting bacterial virulence factors, vaccines against uropathogens, and advanced diagnostic technologies.

52. Synergistic effect of piperine combined with luteolin on anti-non-small cell lung cancer activity in vitro and in LLC tumour-bearing mice: Mechanistic insights from network pharmacology and molecular docking.

期刊: Acta pharmaceutica (Zagreb, Croatia) 发表日期: 2026-Jun-01 链接: PubMed

摘要

Piperine had synergistic effects with other natural products in treating lung cancer. The synergistic effects of piperine combined with luteolin on anti-non-small cell lung cancer activity and their mechanism of action are studied using network pharmacology and molecular docking. Cell viability, wound-healing, colony-formation, cell-apoptosis, and cell-cycle tests on A549 cells were used to detect the in vitro synergistic effects. Tumour growth and hematoxylin and eosin (HE) staining were used to verify the synergistic effects in Lewis lung carcinoma (LLC) tumour-bearing mice. Their combination indexes ranged from 0.3 to 0.8 across different concentrations, and the combination of 175.3 µmol L-1 piperine and 87.32 µmol L-1 luteolin showed synergistic inhibition of A549 cell viability. Moreover, the combination induced a higher apoptosis rate (75.60 %) than luteolin (24.56 %) or piperine (17.53 %). It arrested more cells in the G0/G1 phase than luteolin or piperine did. The combination achieved a tumour inhibition rate of 75.28 %, with lower tumour density and more obvious apoptosis. Network pharmacology identified AKT1, EGFR, SRC, and MMP9 as core targets regulating the PI3K/AKT pathway. Multi-software molecular docking confirmed binding of both compounds to these targets, with MMP9 as the common primary target. In conclusion, piperine and luteolin acted synergistically against non-small cell lung cancer.

53. Commentary on Exploring Environmental Sustainability in Mohs Micrographic.

期刊: Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] 发表日期: 2026-Apr-22 链接: PubMed

摘要

54. Beyond the Counter: The Community Pharmacist of the Future.

期刊: NEJM catalyst innovations in care delivery 发表日期: 2026-Feb 链接: PubMed

摘要

Fifteen years ago, a community pharmacist’s role in the United States was dispensing medication. Five years ago, it expanded to include administering routine vaccines. Fifteen years from now, the authors posit that it will include minor acute illness evaluation and treatment, chronic disease prevention, and complex disease management, including medication prescribing and administration. This evolution, which just began recently in the United States but is well under way in many other countries, would help to relieve pressure on primary care, control costs, improve outcomes, and increase access to essential services, particularly in rural communities. It will require policy reforms and investments in key enablers, including workforce development, integration and interoperability with the rest of the health ecosystem, and systems and structures to ensure safe, high-quality care. Ultimately, this expansion of the role of the community pharmacist will align care more closely with locations that are convenient to patients and leverage relationships already imbued with trust. The authors describe the structural changes needed to accomplish this transformation.

55. Epidemiological characteristics of amebiasis in Japan from 2001 to 2022.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Amebiasis cases in Japan are reported to the government according to the Infectious Diseases Control Law. Previous studies have shown significant reductions in total case numbers after 2018 and during the COVID-19 pandemic. This study aimed to clarify the recent trends of amebiasis cases in Japan, including during the pandemic period, with details on places of infection, using government surveillance data from January 1, 2001, to December 31, 2022. Change of time trends were modeled through piecewise mixed-effect regression model with knots set at 2018 and 2020. Year-to-year differences in case numbers were statistically assessed using Poisson regression model. And descriptive analyses of amebiasis cases reported in Japan by sex, age class, and prefecture (from 2001 to 2022) were conducted. Piecewise time trends of male-domestic cases showed increasing trend by 59.5 cases per year (p < 0.0001) before 2008. The trend slowed but still increased during 2008-2018, showing annual increase of 15.2 cases per year (p = 0.0014). A sharp decline occurred during 2018-2020, with cases decreasing by 219.0 cases per year (p < 0.0001). After 2020, the trend did not show statistically significant change (-16.9 cases per year, p = 0.6532). Poisson regression confirmed significant reductions in total and domestic cases between 2017-2018 and 2019-2020, while imported cases declined significantly only between 2019 and 2020. Male cases predominated, with most male cases in their 40s and 50s. Most cases of amebiasis have been reported in metropolitan areas. These results suggest that the decreased case numbers during the COVID-19 pandemic were due to not only the travel ban, but less socioeconomic activity. Furthermore, the epidemiology of amebiasis is similar to that of HIV infection in Japan, but the case numbers of amebiasis have not yet increased through 2022, showing a different trend from HIV infection and syphilis, the reason of which is unclear and needs further investigation.

56. The CARE Model: A Framework for Artificial Intelligence Integration in Chronic Disease Management.

期刊: Journal of healthcare management / American College of Healthcare Executives 发表日期: 链接: PubMed

摘要

Chronic diseases are long-lasting health conditions that require continual management and coordination across multiple levels of care. The persistent nature of these diseases strains healthcare systems due to fragmented delivery, inefficiency, and provider burnout. This research introduces the CARE Model (Chronic care AI for Redesign and Empowerment) as a comprehensive framework to integrate artificial intelligence (AI) across clinical, operational, and patient domains for chronic care management. The model consists of four pillars: coordination, analysis, redesign, and empowerment. Together, these components demonstrate how AI can enhance decision-making, foster communication among healthcare professionals, and improve outcomes for patients with long-term and complex conditions. The treatment of chronic obstructive pulmonary disease (COPD) serves as a case example, demonstrating how AI coordination can drive predictive analytics to prevent exacerbations, reduce readmissions, and empower self-management for patients. The CARE Model ultimately provides healthcare leaders with a blueprint for AI technology-enabled transformation in care delivery.

57. Prognostic significance of nutritional status for neurological and functional recovery after cervical spinal cord injury.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Cervical spinal cord injury (SCI) often results in severe motor and sensory deficits, leading to substantial impairment in activities of daily living. Malnutrition is common after SCI and may adversely affect recovery; however, the association between early nutritional status and subsequent neurological and functional recovery remains unclear. This study examined the association between early nutritional status and neurological and functional recovery after acute traumatic cervical SCI. Ninety-one patients admitted within 72 hours of injury and followed for at least 6 months were retrospectively analyzed. Neurological function was assessed using the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) total motor score, and functional independence was evaluated using the Spinal Cord Independence Measure version Ⅲ (SCIM Ⅲ). Nutritional status after SCI was assessed using the Prognostic Nutritional Index (PNI), Geriatric Nutritional Risk Index (GNRI), and Controlling Nutritional Status (CONUT) score. Recovery rates were calculated as the proportion of the maximum possible improvement achieved between 4 weeks and 6 months after SCI. Patients with higher PNI at 4 weeks after SCI showed greater neurological and functional recovery. Mean ISNCSCI total motor score recovery rates were 43.89%, 28.08%, and 18.7% in the good, normal, and poor PNI groups, respectively (p for trend = 0.0005), with corresponding SCIM III recovery rates of 40.65%, 26.1%, and 22.41% (p for trend = 0.0072). GNRI and CONUT scores were also associated with ISNCSCI total motor score recovery; however, PNI showed the strongest predictive performance (p = 0.0031). In multivariable linear regression analyses adjusting for age, sex, and baseline neurological and functional status, PNI remained independently associated with ISNCSCI total motor score recovery (β = 0.857 per 1-point increase, 95% CI 0.011-1.703, p = 0.0471). These findings indicate that early nutritional status, particularly as assessed by the PNI, is independently associated with neurological recovery after cervical SCI and may be useful for early prognostic assessment.

58. Secondary Traumatic Stress of Interpreters Working in Psychotherapy: Protective, Risk and Interpreter-Specific Factors.

期刊: Clinical psychology & psychotherapy 发表日期: 2026 链接: PubMed

摘要

Interpreters working in psychotherapy are frequently exposed to emotionally demanding situations and may develop secondary traumatic stress. However, quantitative research has largely focused on community interpreters, highlighting the need for data on symptom levels and associated risk factors among interpreters in psychotherapeutic settings. Sixty-three eligible interpreters were included. Secondary traumatization, psychological distress, resources, competence, occupational distress, empathy, as well as interpreter-specific aspects such as flight experience and identification with the patient’s cultural background were assessed using validated instruments. Data were analyzed using correlations and hierarchical multiple regression to examine general and interpreter-specific risk factors. 14.29% of participants scored above the clinical cutoff for secondary traumatic stress. In a hierarchical regression model predicting secondary traumatic stress (STS), the final model explained a substantial proportion of variance (adjusted R2 = 0.52). In Step 3, interpreter-specific factors contributed significantly to the model (ΔR2 = 0.25, F_change (2,48) = 14.10, p < 0.001), with flight experience showing a significant negative association with STS (β = -0.54, 95% CI [-0.97, -0.16]) and identification with the patient’s cultural background showing a significant positive association (β = 0.27, 95% CI [0.05, 0.47]). Interpreters with personal flight experience and strong identification with the client’s cultural background appear particularly vulnerable to secondary traumatic stress. Psychological distress, resources, competence, occupational distress, and empathy did not influence secondary traumatic stress. This suggests that support such as supervision and training should focus more specifically on interpreters’ personal experiences and cultural match.