公共卫生研究摘要 (2026-07-09)

共收录 62 篇研究文章

1. Stuck between a rock and an unnecessarily hard place-a qualitative interview study of experiences of psychiatric inpatient care among persons with severe dissociative states.

期刊: International journal of qualitative studies on health and well-being 发表日期: 2026-Dec-31 链接: PubMed

摘要

Persons with severe dissociative states constitute a vulnerable group in psychiatric inpatient care and are at risk of being misunderstood and mistreated. The aim was to describe experiences of psychiatric inpatient care among persons living with severe dissociative states. Sixteen persons with lived experience of severe dissociative states and previous contact with psychiatric inpatient care participated in semi-structured interviews that were analyzed using qualitative content analysis. This study is reported in accordance with the COREQ guidelines. Participants’ experiences are described in one theme, Stuck between a rock and an unnecessarily hard place, and three subthemes. At the mercy of others in a place intended to provide support, Distrusted and rejected in a place intended to allow existence and Lacking control in a place intended to be safe. The results suggest a gap in understanding of trauma dynamics in psychiatric inpatient care, implying a need for increased trauma awareness. Mental health nurses should lead the promotion of safe, person-centred and trauma-informed psychiatric inpatient care for persons with severe dissociative states, requiring authority, education, support, supervision and resources.

2. Long-Term Income and Productivity Losses in Individuals With Early-Onset Dementia: Evidence From 15 Years Preceding the Diagnosis.

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

摘要

Early-onset dementia (EOD), affecting individuals younger than 65 years, imposes a substantial socioeconomic burden. However, evidence on long-term income trajectories and productivity loss across EOD subtypes remains limited. The aim of this study was to evaluate income trajectories and societal productivity loss in individuals with different EOD subtypes. This retrospective, population-based longitudinal cohort study included all patients with EOD from Kuopio University Hospital and Oulu University Hospital referral area between January 2010 and December 2021. Diagnoses were re-validated through clinical data review. For each study case, 10 randomly selected matched controls were used. Demographics, education, and comorbidities were obtained from national registers. Annual gross income was retrieved from Statistics Finland tax records. The Human Capital Approach was used to calculate productivity losses, in effect by estimating the annual income difference relative to controls using a generalized estimating equation regression model, with panel data spanning 15 years before diagnosis and the year of diagnosis. The EOD cohort comprised 793 patients (50.4% women; mean age 59.6 years): 421 with Alzheimer disease (AD), 179 with frontotemporal dementia (FTD) spectrum disorders, 46 with α-synucleinopathies (α-SYNUs), and 147 with other EOD etiologies. Compared with 7,926 age-matched and sex-matched controls, patients with EOD showed substantial and progressively increasing productivity loss up to 15 years before diagnosis, with cumulative losses of €74,577 (46,423-102,732) per patient. In the AD group, productivity loss emerged 6 years before diagnosis (€2,767; 95% CI 18-5,515; p = 0.024) and reached €11,431 at diagnosis (95% CI 8,676-14,184; p < 0.001). In the FTD group, loss appeared 11 years before diagnosis (€4,799; 95% CI 433-9,166; p = 0.031) and increased to €16,116 at diagnosis (95% CI 11,671-20,561; p < 0.001). In the α-SYNU group, differences were variable and significant only at diagnosis (€11,284; 95% CI 2,574-19,993; p < 0.011). In the “other EOD” group (predominantly vascular and mixed dementias), productivity loss remained consistently high across the follow-up (e.g., €8,744 at diagnosis; p < 0.001). This large-scale longitudinal study demonstrates significant productivity loss up to 15 years before EOD diagnosis, with variation across dementia subtypes. Earlier recognition and targeted interventions are needed in the future to mitigate the substantial socioeconomic burden of EOD. This study is part of DEGE-RWD-research project (protocol registered to ClinicalTrials.gov: NCT06209515), coordinated by Neurocenter Finland.

3. Addressing the How of Implementation: A Hermeneutic Exploration of Implementing Virtual Kidney Care in a Remote, Rural Health Region.

期刊: Journal of evaluation in clinical practice 发表日期: 2026-Aug 链接: PubMed

摘要

Implementing evidence-informed healthcare services is typically approached as a structured, time-limited project, focused largely on what to do. Less well understood is how implementation actually unfolds in practice: the ways in which those involved navigate change and generate solutions in diverse community settings. Without understanding how implementation happens in unique contexts, implementation failure may remain poorly understood. The aim was to understand what it means for kidney care team providers, information technology staff, and patients to engage in implementing an evolving virtual kidney care service in a large, sparsely populated rural and remote region. We interviewed eight kidney care service providers, two information technology specialists, and 17 patients in northern British Columbia, Canada, for their experiences in implementing, delivering, and receiving virtual kidney care and how their practices changed with COVID-19. Through an inductive, reflexive process of analysis and hermeneutic interpretation, we identified patterns in how virtual kidney care was implemented. The analysis showed six hermeneutic principles of implementation at work in the everyday practices of the kidney care and information technology teams: acknowledging central concerns, creating new common understandings, collectively acting, surfacing tensions, being responsive to context, and engaging in ongoing dialogue. Rather than discrete, technical, and time-limited, we found implementation to be an ongoing, evolving, relational, generative, and iterative process that is inextricably connected to its context, and that never fully ends. Attending to the how revealed dimensions of implementation practice that are seldom visible in conventional implementation research. A hermeneutic sensibility, marked by openness, humility, and dialogue, with a commitment to understanding, responsiveness, and relationship-building, is key to implementation, especially in the ever-changing contexts of rural and remote areas. The findings point to the value of a hermeneutic approach in implementing, sustaining, and researching innovations in dynamic healthcare systems and rural settings.

4. Pilot Study and Evaluation of a Sleep Health Education Program for Early High School.

期刊: The Journal of school health 发表日期: 2026-Aug 链接: PubMed

摘要

Sleep education remains largely absent from high school health curricula, despite widespread insufficient sleep in adolescents. This pilot study evaluated Sleep Ninja for the Classroom, a curriculum-aligned sleep health education program for Australian high schools. Participants were teachers (N = 12) and students in Year 7-8 (N = 428). Using a single-arm pre-post design, all students received the three-lesson program during regular health classes. Student sleep knowledge and behaviors were assessed, and a program evaluation examined student- and teacher-rated acceptability, appropriateness, and feasibility. Improvements were observed in students’ sleep knowledge, satisfaction with current sleep pattern, frequency of daytime napping, earlier weekend rise time (mean = 25-min), and weeknight bedtime (mean = 6-min). No changes were found in other sleep behaviors. Students spending < 8 h in bed at program commencement showed the most significant changes in bedtimes (mean = 54-min earlier on weeknights and 39-min earlier on weekends). Acceptability was high, with most students reporting the program was relevant and engaging, and all teachers rating the program as appropriate and feasible to implement. Sleep Ninja for the Classroom is a brief, acceptable sleep education program that could be considered for inclusion in high school health curricula. This study provides preliminary evidence for an Australian curriculum-aligned sleep education program. Controlled studies are needed to evaluate longer-term outcomes and sustainable implementation.

5. Contextualizing the Dead Donor Rule in an Era of Voluntary Euthanasia.

期刊: The New England journal of medicine 发表日期: 2026-Jul-09 链接: PubMed

摘要

6. Ensartinib in Resected ALK-Positive Non-Small-Cell Lung Cancer.

期刊: The New England journal of medicine 发表日期: 2026-Jul-09 链接: PubMed

摘要

Anaplastic lymphoma kinase (ALK) inhibitors have emerged as promising agents for patients with resectable ALK-positive non-small-cell lung cancer (NSCLC). Whether ensartinib, a second-generation ALK inhibitor, is safe and effective in such patients is unknown. In this phase 3, double-blind, randomized trial involving patients with completely resected, ALK-positive stage IB to IIIB NSCLC after adjuvant chemotherapy, we randomly assigned patients in a 1:1 ratio to receive ensartinib at a dose of 225 mg once daily or placebo for 24 months. The primary end point was disease-free survival in patients with stage II to IIIB NSCLC. The key secondary end point was disease-free survival in the overall patient population. A total of 274 patients were randomly assigned to receive ensartinib or placebo (137 patients in each group). At 24 months, the percentage of patients with stage II to IIIB disease who were alive and disease-free was 86.4% in the ensartinib group and 53.5% in the placebo group (hazard ratio for disease recurrence or death, 0.20; 95% confidence interval [CI], 0.11 to 0.38; P<0.001). In the overall patient population, the percentage of patients who were alive and disease-free was 87.3% in the ensartinib group and 57.2% in the placebo group (hazard ratio, 0.20; 95% CI, 0.10 to 0.37; P<0.001). Overall survival data were immature. Adverse events of grade 3 or higher occurred in 35.8% of the patients who received ensartinib (most commonly rash) and in 18.2% of those who received placebo. Among patients with completely resected stage IB to IIIB ALK-positive NSCLC, the percentage of patients who were alive and disease-free at 24 months was significantly higher with ensartinib than with placebo. (Funded by Betta Pharmaceuticals; ELEVATE ClinicalTrials.gov number, NCT05341583.).

7. MRI-based gross tumor volume delineation in high-grade glioma using a deep convolutional neural network.

期刊: Applied radiation and isotopes : including data, instrumentation and methods for use in agriculture, industry and medicine 发表日期: 2026-Jul-08 链接: PubMed

摘要

In brain radiotherapy, accurate target volume delineation is a key step in treatment planning. However, manual contour delineation can be time-consuming, labor-intensive, and subject to inter-physician variability. Therefore, this study aimed to develop a deep learning (DL)-assisted, MRI-based auto-contouring model for gross tumor volume (GTV) delineation in radiotherapy for high-grade glioma (HGG). In addition to geometric evaluation, the dosimetric impact of using DL-based segmentations versus manually delineated contours for treatment planning was evaluated. A 2D ResU-Net deep convolutional neural network (CNN) was trained on 469 HGG patients from the Brain Tumor Segmentation (BraTS) datasets. Quantitative similarity metrics, including the Dice similarity coefficient (DSC) and Hausdorff distance (HD), were used for geometric evaluation. To evaluate the network’s performance, the algorithm was tested on an independent clinical dataset (n = 17 patients). An experienced radiation oncologist manually delineated GTVs on MRI scans of these 17 HGG patients as reference contours. Subsequently, CT-MRI rigid brain registrations were performed in treatment planning software. Quantitative similarity metrics, such as the DSC and HD, were used for geometric evaluation. Additionally, dose-volume parameters were analyzed. The ResU-Net achieved a DSC score of 90.0% with an HD of 1.53 mm on the clinical test dataset. There was no significant (P = 0.801) difference in the volumes of the structure of interest (i.e., GTV) between the manual and auto-segmented contours. No significant differences in dose-volume parameters were found between the auto-segmented and manual contours. A 2D deep CNN model was developed for MRI-based auto-segmentation of HGG. Our data demonstrated the feasibility of DL-assisted auto-contouring. While DL-based auto-contouring cannot replace clinical experts, it can serve as a valuable contouring assessment tool, especially in medical educational centers.

8. Symptom-Only Localization of Brainstem Ischemia Using Large Language Models Versus Neurologists in Diffusion-Weighted Imaging-Positive Cases: Retrospective Single-Center Study.

期刊: JMIR formative research 发表日期: 2026-Jul-08 链接: PubMed

摘要

Symptom-based localization of brainstem ischemia is challenging because of the anatomical complexity of the brainstem and the nonspecific overlap of clinical syndromes. Whether large language models (LLMs) can meaningfully assist in this task remains uncertain. This study aimed to compare the performance of several OpenAI LLMs and neurologists in localizing diffusion-weighted imaging (DWI)-confirmed brainstem ischemic lesions based on symptom descriptions alone. In this retrospective single-center study, 109 patients with DWI-confirmed acute brainstem ischemia were included. Three neurologists and 6 LLMs (GPT-5, GPT-4, GPT-4.1, GPT-4o, o3, and o3-pro) predicted lesion localization using a combined anatomical-lateral end point (left or right midbrain, pons, and medulla) based on symptom descriptions alone. Overall and regional accuracy, the Cohen κ, 6-class confusion matrices, and point-biserial correlations between symptom count and correct prediction were assessed. Because all raters evaluated the same cases, paired McNemar tests with Benjamini-Hochberg correction were used for pairwise performance comparisons. GPT-4 and GPT-4o achieved the highest overall accuracy (61/109, 56%; 95% CI 46.1%-65.5%). Agreement with the DWI reference standard remained limited across all raters, with the Cohen κ reaching a maximum of 0.291 for GPT-4o. Confusion matrices showed that higher performance was driven mainly by pontine cases, whereas misclassification remained frequent in mesencephalic and medullary lesions. Regional analyses outside the pons were imprecise because mesencephalic and medullary subgroups each contained only 16 cases. A higher number of documented symptoms was associated with correct prediction for GPT-4, GPT-5, GPT-o3, and 1 neurologist. Although some LLMs showed higher relative accuracy than the participating neurologists, absolute performance remained limited and clinically insufficient. These findings are best interpreted as an exploratory benchmark under constrained conditions: absolute performance remained modest, agreement beyond chance was limited, and performance outside pontine lesions was inconclusive.

9. Smartphone-Based Ecological Momentary Assessment Among Community-Dwelling Older Adults: Observational Feasibility and Acceptability Study.

期刊: JMIR formative research 发表日期: 2026-Jul-08 链接: PubMed

摘要

Ecological momentary assessment (EMA) enables repeated, real-time measurement of emotional states, behaviors, and contextual exposures in individuals’ daily lives. Although EMA has been increasingly used in health and behavioral research, evidence regarding the feasibility, compliance, and acceptability of smartphone-based EMA among older adults in Asian settings remains limited. This study aimed to evaluate the feasibility, EMA compliance, usability, and acceptability of a 14-day smartphone-based EMA protocol among community-dwelling older adults in Singapore. The data came from the Ecological Momentary Assessment in Ageing study, a smartphone-based EMA study designed to assess mental well-being, lifestyle behaviors, and perceived neighborhood environment among older adults. Adults aged 65 years or older in Singapore were enrolled and asked to complete 5 EMA prompts per day over 14 consecutive days using a smartphone app. Each EMA prompt remained available for up to 5 hours after delivery. EMA prompts assessed momentary mental well-being, sleep, physical activity, screen time, and perceived neighborhood environment. Feasibility indicators included recruitment and retention rates. EMA compliance was assessed as the proportion of completed EMA prompts out of all scheduled prompts. Usability and acceptability were assessed using a poststudy survey. Between June 2025 and December 2025, a total of 186 individuals initially expressed interest in the study, of whom 139 (74.7%) scheduled an appointment, and 132 (95%) of the latter attended the appointment. Of those who attended, 98.5% (130/132) were enrolled. Participants had a mean age of 70.1 (SD 4.04) years; 65.4% (85/130) were female, 90.8% (118/130) were Chinese, and 65.4% (85/130) had postsecondary or university-level education. All enrolled participants completed the 14-day EMA protocol, resulting in 100% (130/130) retention. Across all participants, 99% (9007/9100) of the scheduled EMA prompts were completed. The poststudy usability survey was completed by 96.9% (126/130) of the participants. Among those who completed the poststudy usability survey, 88.1% (111/126) agreed or strongly agreed that the app was easy to use, 84.1% (106/126) agreed or strongly agreed that most people would learn to use it quickly, and 87.3% (110/126) preferred the app over face-to-face interviews. Overall, 91.3% (115/126) reported being satisfied or strongly satisfied with the app, and 100% (126/126) indicated willingness to be contacted for future research. A 14-day smartphone-based EMA protocol was highly feasible and acceptable among community-dwelling older adults in Singapore, with high retention and compliance and favorable usability ratings. These findings support the use of EMA methodologies in aging research within Asian contexts and suggest that older adults can successfully engage with repeated smartphone-based assessments when protocols are appropriately designed and supported.

10. Epidemiology and molecular evolution of norovirus GII.17 in the United States, 2021-2025.

期刊: The Journal of infectious diseases 发表日期: 2026-Jul-08 链接: PubMed

摘要

GII.4 noroviruses have been the leading cause of acute gastroenteritis outbreaks in the United States (U.S.) for the past decade. Recently, GII.17 viruses have emerged globally, raising concerns about changes in disease burden and potential replacement of GII.4 as the predominant strain. We characterized molecular and epidemiological features of U.S. GII.17 norovirus outbreaks from September 2021-August 2025 submitted to CaliciNet. Norovirus-positive outbreak samples were sequenced followed by RdRp and VP1 phylogenetic analyses. CaliciNet and National Outbreak Reporting System data were linked to compare GII.17 and GII.4 epidemiologic and clinical characteristics. Virus-like particles binding to gastric mucin and antibody blockade assays were conducted to assess antigenic variation among GII.17 variants. Among 1,412 outbreaks, GII.17 prevalence increased from 5.0% (2021-2022) to 74.8% (2024-2025). Compared with GII.4, GII.17 was more frequently reported with foodborne exposure (16.4% vs 9.6%), affected persons aged 10-49 years compared with other groups (31.1% vs 23.1%), and associated with slightly higher rates of vomiting (78.2% vs 72.2%), abdominal cramps (34.2% vs 30.1%), and fever (15.9% vs 10.9%). Phylogenetic analysis detected GII.17[P17] Romania-like (93.3%) followed by GII.17[P17] Kawasaki308-like strains (4.6%) and two novel tentative variants: Santa Clara (1.3%) and London (0.1%). Despite substitutions in key P2 antigenic sites, surrogate antibody neutralization remained conserved. These findings indicate a recent shift in norovirus genotype dominance in the U.S., likely driven by enhanced transmissibility or population susceptibility rather than increased virulence. Continued molecular surveillance is essential to monitor viral evolution and public health impact of norovirus.

11. Still Lost in Transition? A 20-Year Reflection on Cancer Survivorship Care.

期刊: Journal of clinical oncology : official journal of the American Society of Clinical Oncology 发表日期: 2026-Jul-08 链接: PubMed

摘要

12. Strategies to Reduce Gender Discrimination in Surgery: A Qualitative Study of Women Neurosurgeons and Cardiothoracic Surgeons.

期刊: Journal of surgical education 发表日期: 2026-Jul-08 链接: PubMed

摘要

Despite growing numbers of women entering medicine, female neurosurgeons and cardiothoracic surgeons continue to report persistent gender discrimination in their workplaces. While previous efforts to address these disparities have focused on individual-level interventions, less attention has been directed toward the cultural and structural dynamics that sustain inequity within these high-intensity surgical environments. This study explores female surgeons’ perspectives on how neurosurgery and cardiothoracic surgery might become more equitable and inclusive. This qualitative study involved semi-structured interviews with 18 female neurosurgeons and 4 cardiothoracic surgeons in North America. The grounded theory method of data collection and analysis was used. Analysis involved line-by-line coding and was inductive, with codes and categories emerging from participants’ narratives. Participants emphasized the need for a fundamental cultural shift within surgical practice. Six interrelated strategies were identified: (1) changing surgical training culture; (2) increasing female representation; (3) valuing surgeon differences; (4) supporting women through mentorship, advocacy, and sponsorship; (5) speaking up about bias and discrimination and pursuing legal action where necessary; and (6) implementing strategic policy changes and accountability mechanisms. Participants emphasized that policy reforms must be accompanied by cultural change and enforcement from leadership to produce meaningful impact. Female surgeons in neurosurgery and cardiothoracic surgery view gender inequity as embedded within the cultural and structural organization of surgical practice. Addressing these disparities requires coordinated reforms in training culture, representation, institutional policy, and accountability. Sustainable progress will depend on broader cultural transformation rather than isolated or symbolic interventions.

13. Perceived Sensitivity of Sensor-Based Digital Health Data: Qualitative Interview Study.

期刊: JMIR mHealth and uHealth 发表日期: 2026-Jul-08 链接: PubMed

摘要

Digital health tools are increasingly used in mental health care to passively collect patient data and analyze health status outside of clinical settings. While technologies such as digital phenotyping, affective computing, and computational behavioral analysis offer new insights into symptom manifestation in daily life, they generate large volumes of potentially sensitive data that raise significant data privacy concerns, requiring high levels of patient awareness and consent. Empirical research is lacking on stakeholder understandings toward the sensitivity of these data and expectations for data stewardship, perspectives that are critical for developing robust informed consent and data protection policies for digital health data use. This study aimed to explore key stakeholder perspectives on the sensitivity of computer perception (CP) data, trust in existing data protections, willingness to share CP data externally, and desire for transparency of CP data transactions outside of the clinical space. As part of a larger, multisite study, we conducted qualitative interviews (n=40) via Zoom (Zoom Communications, Inc) with 20 adolescents (aged 12-17 years) familiar with CP tools and their caregivers (n=20). Interviews consisted of a series of open-ended questions regarding stakeholders’ perspectives on privacy, data security, and the use and exchange of CP data. We developed a qualitative codebook to identify and label thematic patterns in responses to questions addressing the topics above, using thematic content analysis to identify themes inductively. Each interview was coded by merging work from at least two separate coders, and several team members contributed to qualitative analysis. Most adolescents and caregivers viewed CP data as highly sensitive and expressed a reluctance to share these data beyond their clinical teams. While many participants expressed trust in existing data protections to protect CP data, they often misunderstood or overestimated the extent of protections to safeguard CP data. Our findings underscore the critical need for clear and effective patient communication and education about the risks, benefits, and protections associated with CP data through informed consent protocols. To promote greater transparency, understanding, and trust, we recommend 5 strategies: educating patients about data protection; studying secondary data exchange and reidentification risks; strengthening transparency regulations; improving data traceability mechanisms, such as distributed ledger technologies, to enhance data traceability and auditability; and adopting dynamic consent models.

14. Resilience and Stress Among Health Care Workers Participating in the StressPal Frontline Program: Quasi-Experimental Pretest-Posttest Study.

期刊: JMIR formative research 发表日期: 2026-Jul-08 链接: PubMed

摘要

Health care workers continue to experience heightened levels of distress and burnout, which contribute to higher levels of job dissatisfaction, turnover intentions, presenteeism, and staffing shortages. The aim of this study was to examine how participation in the StressPal Frontline: Essential Resilience Self-Care and Burnout Prevention program influenced health care workers’ stress and resilience. The study also sought to identify specific measures of perceived stress and resilience that were most affected by participation in the program and to explore whether pre-and-post differences varied based on participant characteristics. The StressPal Frontline program is a digital resilience intervention specifically developed for health care workers to enhance psychological flexibility and stress resilience. The self-paced training program, designed for approximately a 6-week period, consists of brief modules, follow-up resources, and a peer engagement community. A pretest-posttest quasi-experimental design was used to assess the effectiveness of the StressPal Frontline program in reducing stress and building resilience among 76 health care workers who voluntarily joined and completed the program. Outcome measures included the Perceived Stress Scale and the Brief Resilience Scale to assess participants’ perceptions of stressful situations and their ability to bounce back from stress. Descriptive statistics, correlation analysis, paired-samples 2-tailed t test, and multiple regression analysis were conducted. The paired-samples t test was calculated at the scale level and item level to evaluate the statistical significance of pretest and posttest mean differences, and the Cohen d statistic was used as a measure of effect size. Statistical analysis for this study was conducted in Excel (Microsoft), SPSS (IBM Corp), and Jamovi (jamovi project). The results indicated a 1.53-point reduction in the Perceived Stress Scale score after participating in the StressPal Frontline program, suggesting a statistically significant decline in average perceived stress due to participation in the program (P=.004). The corresponding value of Cohen d was 0.34, suggesting a small-to-medium effect of the intervention, StressPal Frontline program, in reducing perceived stress. For the Brief Resilience Scale, pre-and-post difference was not significant at the scale level (P=.07); however, item-level analysis found significant increases in participants’ perception of their ability to bounce back quickly after hard times and handle difficult situations. No significant differences were found in outcome measures based on age, race, ethnicity, professional role, or practice setting. The StressPal Frontline program was associated with positive outcomes in reducing perceived stress. Our study also found no statistical differences in outcomes among participants of different age groups, races, ethnicities, occupations, genders, and practice settings. This is an important finding, as it indicates that the StressPal Frontline program may provide positive benefits for reducing stress across professions, settings, and individual characteristics. This program, along with other resources, could be implemented by health care organizations to support workers’ professional development, behavioral health, and well-being.

15. Conceptualization, Operationalization, and Measurement of Adherence to Patient-Facing Digital Health Applications: Protocol for a Scoping Review.

期刊: JMIR research protocols 发表日期: 2026-Jul-08 链接: PubMed

摘要

Medical adherence is traditionally defined as the extent to which a person’s behavior corresponds with agreed-upon recommendations from a health care provider. The rapid diffusion of patient-facing digital health applications (DHAs) challenges the direct applicability of this framework to software-mediated interventions. Unlike pharmacological treatments, DHAs automatically generate detailed usage data but lack a broadly accepted standard for determining which specific data points and usage patterns actually constitute “adequate” use across a broad variety of medical indications and population groups. In parallel, DHAs are becoming increasingly embedded in formal regulatory and reimbursement pathways. A notable example is Germany, where recent reforms plan to link at least 20% of reimbursement for Digitale Gesundheitsanwendungen-formally regulated and reimbursed DHAs-to performance-related indicators that implicitly operationalize adherence as a determinant of reimbursable performance. Despite this growing policy relevance, adherence in patient-facing DHAs remains conceptually fragmented and methodologically heterogeneous. This scoping review aims to map how adherence is conceptualized, operationalized, and measured in the context of patient-facing DHAs, and to explore whether these approaches differ between applications embedded within formal regulatory and/or reimbursement frameworks and those operating outside such settings. This scoping review follows the Joanna Briggs Institute methodology and will be reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. PubMed (MEDLINE), Scopus, and Web of Science will be searched for scientific literature published between 2020 and 2025, inclusive. Machine learning-assisted title and abstract screening will be performed using ASReview, following a sampling-based stopping criterion. Three independent reviewers will conduct screening and data extraction. Relevant gray literature will be identified through targeted searches. Database searches identified 15,403 records (5469 from PubMed/MEDLINE, 6198 from Scopus, and 3736 from Web of Science), which were reduced to 7052 unique records after automated deduplication using Zotero (Corporation for Digital Scholarship). The full results are intended to be submitted to a peer-reviewed journal by the end of 2026. Conducted as part of the DEKODE (Digital Health Adhärenz: Konzept und datenbasierte Evidenz) project funded by the German Federal Joint Committee’s Innovation Fund, this review contributes to the development of a conceptual and empirical adherence framework for patient-facing DHAs. Although DEKODE is primarily oriented toward the German Digitale Gesundheitsanwendungen context, this review applies no geographical restrictions, reflecting the value of establishing a broad evidence base before narrowing the focus to country-specific settings and rendering findings relevant for understanding DHA adherence in all geographies. By clarifying how adherence is currently conceptualized, operationalized, and measured, the review will promote more consistent and context-specific generation and interpretation of adherence-related evidence and support evidence-based policy discussions, international harmonization of evidence standards for DHAs, and health economic evaluations in digital health.

16. Systemic violence as an occupational hazard: Moral injury and nursing practice.

期刊: Nursing ethics 发表日期: 2026-Jul-08 链接: PubMed

摘要

This paper examines how sustained armed conflict operates as a primary occupational hazard that produces moral injury among nurses. It moves beyond burnout and moral distress frameworks to propose a justice-centered approach to nurse well-being in conflict settings. This discursive paper employs a critical interpretive synthesis (CIS) of peer-reviewed studies and humanitarian reports from 2020 to 2024, comparing documented conditions in Gaza with prevailing nursing well-being models. Sixty-eight sources were analyzed through iterative comparison of situational evidence and conceptual scholarship. Gaza served as a critical case to test the explanatory limits of dominant frameworks. Three systemic hazards shape nursing practice in Gaza: severe resource deprivation, direct violence against healthcare workers and facilities, and the collapse of health and civic infrastructure. Under these conditions, moral injury emerges as the dominant occupational harm. Nurses are compelled by external political and military forces to act in ways that violate core professional duties. Resilience and coping approaches fail where harm originates outside healthcare systems and where internal reform is not possible. In settings where healthcare is systematically targeted, political violence becomes a primary occupational hazard. A justice-centered framework is required, centered on protection of healthcare under international humanitarian law, accountability for violations, and global professional solidarity as core elements of nurse well-being. Occupational health becomes inseparable from protection, accountability, and justice. Models that assume stable healthcare systems cannot explain nurse suffering in conflict zones. Nursing policy and practice must expand occupational health frameworks to address structural and political conditions. Practical responses include protection mechanisms, documentation of violations, and evacuation pathways for healthcare workers under attack.

17. Guidelines on sexuality and intimacy in dementia: systematic review and intersectional analysis.

期刊: Aging & mental health 发表日期: 2026-Jul-08 链接: PubMed

摘要

Sexuality and intimacy are vital to the quality of life for people with dementia and should be incorporated into holistic dementia care guidelines. This systematic review aimed to (1) provide an overview of existing guidelines on sexuality and intimacy in dementia care and (2) analyse how these guidelines address intersectional needs within the dementia care triad. We reviewed guidelines that (1) focus on improving care for the entire dementia care triad, and (2) address sexuality and intimacy. The search was conducted in PubMed, CINAHL, Embase, PsycINFO, Cochrane Library, Google Scholar, and grey literature (Google search) in April 2024. 572 references were identified. 81 full texts were screened and 24 references were included. Nine references were included from scientific databases. The grey literature search located an additional 15 references. No guidelines specifically addressed people with dementia. Intersections of dementia with age, gender, and sexual orientation were most frequently discussed. Guidelines primarily target healthcare and social care professionals, while policy documents, clinical guidance, and professional development resources focus more on guidance for informal carers. Future research should adopt an intersectional approach to address the diverse needs of the entire dementia care triad, especially people with dementia themselves.

18. Promoting Health Behaviors Among Latina Caregivers of Children With Intellectual and Developmental Disabilities Through Goal Setting.

期刊: American journal of health promotion : AJHP 发表日期: 2026-Jul-08 链接: PubMed

摘要

PurposeThis study explored the types of health-related goals, the strategies employed, and challenges experienced by Latina caregivers of children with intellectual and developmental disabilities (IDD).DesignThis study focuses on exploratory data on goal setting obtained through qualitative observations and documentation of the intervention arm from a two-site RCT.Setting & SampleTwenty-six Latina caregivers were recruited and assigned to receive the intervention across 2 sites-Texas and Illinois.InterventionA 10-session culturally tailored health promotion intervention was delivered to participants by promotoras addressing caregivers’ wellness, physical activity, healthy eating, and navigating the environment and decision-making. Goal setting was incorporated throughout the intervention. Promotoras worked closely with participants to develop action plans and provided support as needed.MeasureTo analyze qualitative data, we used a deductive analytical approach based on transcript discussions and early data extraction. Qualitative data were categorized into types of goals, strategies used, subcategories, and barriers encountered.ResultsTwenty caregivers identified a total of 68 goals; 61.7% were achieved or in progress. Health promotion strategies included engaging in physical activity, changing nutrition/eating habits, participating in wellness activities, and using reminders. Caregivers experienced stress, feeling overwhelmed, and a lack of support.ConclusionThis study has some limitations, which are fully discussed. Despite the challenges they experienced, caregivers achieved or reported progress towards most of their goals.

19. Readability of Online Chronic Traumatic Encephalopathy (CTE) Information: Health Literacy Implications for Parents Navigating Youth Tackle Football Decisions.

期刊: Journal of community health 发表日期: 2026-Jul-08 链接: PubMed

摘要

Tackle football is the most participated youth sport in the U.S. with leagues beginning as early as age 5. Exposure to cumulative repetitive head impacts (RHI) over years of play is increasingly viewed as a major contributor to chronic traumatic encephalopathy (CTE), a progressive neurodegenerative disease documented in contact sport athletes. Amid growing awareness of CTE, parents may turn to online information to guide decisions about youth tackle football participation. This cross‑sectional study examined the readability of online CTE information. Using the search term, ‘CTE,’ 68 URLs providing non‑technical information were identified after applying exclusion criteria. Online software was used to generate metrics from six widely-used readability formulas. Grade-level readability scores were categorized as ≤ Grade 8, 9-12, and ≥ 13 and summarized using descriptive statistics; distributions were compared by URL designation using chi-square tests (P < 0.05). Web page publication/revision date and presence of references were recorded. Median readability scores ranged from high school to early college with few pages meeting the recommended ≤ Grade 8 reading level for the general population. Levels were similarly high across non-commercial (.org,.gov,.edu) and commercial (.com) domains. Nearly 40% lacked clear publication or revision dates; fewer than half (47.1%) included references. Commonly accessed online CTE resources exceed recommended reading levels. This digital barrier impairs parents’ functional health literacy and capacity for informed decision-making. As research on CTE and tackle football participation evolves, there is a need for plain‑language, clearly-sourced, updated online resources tailored to this decisional context.

20. Laparoscopic training in porcine models: a tool for continuous professional skill enhancement for paediatric surgeons.

期刊: Pediatric surgery international 发表日期: 2026-Jul-08 链接: PubMed

摘要

Laparoscopic training is an established component of minimally invasive surgery education, and involves different tools: virtual reality, training box and in vivo models. The use of porcine models is the most similar to human anatomy. Its role is well known during the residency program, but its specific impact on paediatric surgery consultants performance is poorly explored. Six consultant surgeons attempted a consecutive 4-h a week laparoscopic training on porcine models for a total of 12 weeks, focusing on refinement of fine dissection, intracorporeal suturing, and management of intraoperative complications. Participants underwent pre- and post-training (respectively Period A and B) assessment of surgical effectiveness by assessment of mean operative time, intraoperative and postoperative complications on three commonly performed procedures: inguinal hernia repair, varicocelectomy and laparoscopic orchiopexy. 210 procedures were analysed, 109 before and 101 after the training. We observed a significant overall reduction in operative time for all procedures (p = 0.007); more precisely, inguinal hernia repair and varicocelectomy showed a significant reduction in operative time (p = 0.028 and p = 0.04 respectively), while no significant reduction in operative time for laparoscopic orchidopexy was observed (p = 0.2668). Mean age at surgical intervention was significantly reduced in period B for herniorrhaphy. Laparoscopic training in porcine models could be considered an effective tool to improve skills of paediatric surgery consultants. Its use could allow the improvement of laparoscopic confidence and effectiveness also in surgeons with an already acquired learning curve, supporting the systematic and continuous integration of such programmes into the professional development.

21. Effectiveness of eHealth Interventions for Adolescents and Young Adults With Congenital Heart Disease: Systematic Review.

期刊: Journal of medical Internet research 发表日期: 2026-Jul-08 链接: PubMed

摘要

Adolescents and young adults (AYAs) with complex congenital heart disease (CHD) may benefit from eHealth interventions, particularly when early signs of deterioration or self-management challenges arise. eHealth can enhance self-management skills and communication with health care professionals (HCPs). However, systematic reviews examining eHealth interventions for this population remain limited and heterogeneous, indicating a need for a systematic review of the literature to guide the development, implementation, and evaluation of such interventions. In this systematic review, we aimed to synthesize the content, theoretical foundations, outcomes, and effectiveness of eHealth interventions targeting AYAs with complex CHD that involve interaction with HCPs. We conducted this systematic review in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. An a priori protocol was registered in PROSPERO (CRD42023400211). The review was reported according to the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), the PRISMA-S (PRISMA Literature Search Extension), and the SWiM (Synthesis Without Meta-Analysis) checklists. The final comprehensive bibliographic search was conducted on March 16, 2026, across MEDLINE ALL (Ovid), Embase (Ovid), APA PsycInfo (Ovid), ERIC (EBSCOhost), CINAHL (EBSCOhost), and the Web of Science Core Collection (Clarivate). Studies were eligible if they included AYAs aged 10-29 years diagnosed with CHD who received eHealth interventions delivered by HCPs regardless of care setting; measured effects of eHealth interventions using experimental or quasiexperimental designs; and were published in English or a Scandinavian language. The researchers assessed eligibility in pairs, risk of bias using the Revised Cochrane risk-of-bias tool for randomized trials (RoB 2) for randomized studies and the Risk of Bias in Non-Randomized Studies of Exposures (ROBINS-E) for nonrandomized studies, and extracted data. Overall risk of bias was high. Due to heterogeneity among the included studies, a narrative synthesis was conducted. We included 8 studies, with sample sizes ranging from 20 to 158, totaling 551 participants. Five studies reported improvements in the eHealth intervention groups, evaluating educational interventions to improve disease-specific knowledge, self-management, physical activity, psychosocial impact, and transition readiness in AYAs with CHD. However, the content, delivery mode and format, and target outcomes varied across studies. Seven studies lacked a theoretical foundation for the intervention. The evidence remains inconsistent and limited by heterogeneity, absence of theoretical foundations, risk of bias, and high dropout rates; further refinement is thus needed. Future research may benefit from theory-driven, user-centered, co-designed approaches with AYAs with CHD from the outset to enhance relevance, engagement, and long-term sustainability. Standardized outcome measures and long-term evaluations could clarify the long-term impact and implementation potential of eHealth interventions. This study emphasizes factors like tailoring content to medical complexity, integrating interactive interprofessional teams, and incorporating structured peer support in planning and developing eHealth intervention research in the future.

22. Acceptability, Feasibility, and Implementation Outcomes of a Family-Based Intervention for Black Men and Girls.

期刊: Health education & behavior : the official publication of the Society for Public Health Education 发表日期: 2026-Jul-08 链接: PubMed

摘要

Family-based interventions may reduce the risk of acquiring HIV and other sexually transmitted infections (STIs) among Black girls in the United States, but few have engaged Black male caregivers. We examined key implementation outcomes of IMAGE, IMARA for Black Male Caregivers, and Girls Empowerment, an adapted evidence-based intervention for Black girls (13-18 years old) and their male caregivers. We conducted a pilot test of IMAGE with 40 girl-male caregiver dyads, using a pre-post-test design at baseline and 1-month follow-up. We assessed four implementation outcomes: feasibility, acceptability, appropriateness, and fidelity. Descriptive statistics were used to evaluate the change from baseline to 1-month follow-up for girls and their male caregivers. Feasibility was strong; 87% of those approached agreed to participate, and 93% completed the intervention. Acceptability was also high, with more than 75% of girls and male caregivers reporting being extremely satisfied with IMAGE, and 76% of participants feeling there was an appropriate amount of time spent on the topics. Intervention fidelity, as rated by observers, was 98%. At 1-month follow-up, girls and male caregivers endorsed improvements in their relationship, namely closeness and communication. IMAGE is a promising program designed to protect and reduce transmission of HIV and STIs among Black girls. We found strong evidence of feasibility, acceptability, appropriateness, and fidelity; therefore, a fully powered randomized controlled trial is warranted.

23. Comprehensive three-dimensional morphological changes of mandibular incisors and surrounding alveolar bone in patients with skeletal Class III malocclusion following surgery-first or conventional bimaxillary orthognathic surgery.

期刊: Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery 发表日期: 2026-Jul-08 链接: PubMed

摘要

This retrospective clinical and radiographic study aimed to quantitatively compare root resorption of mandibular incisors and surrounding alveolar bone remodeling in skeletal Class III malocclusion patients treated with surgery-first approach (SFA) or conventional orthognathic surgery (COS). Sixty-two eligible patients with skeletal Class III malocclusion treated with COS (n = 31) or SFA (n = 31) at our institution between January 2020 and December 2024 were included. CBCT scans were obtained at the following time points: before treatment (T0), completed presurgical orthodontic treatment (T1)-only for COS patients, and 1-2 weeks after postsurgical orthodontics completed and debonding (T2). Skeletal and dental parameters at diverse stages were determined by Dolphin Imaging software. Incisor roots were segmented into eight regions and their length and volume were measured by Mimics 21.0. Moreover, alveolar bone height surrounding the mandibular incisors was measured and compared at diverse stages. Root resorption and alveolar bone loss were found in the lower incisors after treatment irrespective of SFA or COS. SFA induced less root resorption and alveolar bone reduction as compared to COS. Moreover, root resorption was positively correlated with increased incisor inclination in SFA patients and alveolar bone loss was positively associated with increased incisor inclination among COS patients. Initial buccal alveolar bone height negatively associated with bone reduction after treatment in both groups. Taken together, our results indicate that SFA has advantages in reduced root resorption and alveolar bone loss in the mandibular incisors as compared to COS in skeletal Class III malocclusion, thus highlighting the need to monitor these changes in patients receiving combined orthognathic and orthodontic treatment.

24. Meningococcal B Vaccine to Prevent Neisseria gonorrhoeae Infection.

期刊: The New England journal of medicine 发表日期: 2026-Jul-08 链接: PubMed

摘要

No vaccines are currently licensed for the prevention of Neisseria gonorrhoeae infection. Observational studies suggest that the four-component meningococcal serogroup B vaccine (4CMenB) may reduce the risk of gonorrhea. In this multicenter, double-blind, randomized, placebo-controlled trial, we assigned, in a 1:1 ratio, men who have sex with men (MSM) to receive two doses of 4CMenB or placebo. All the participants had recently received a diagnosis of N. gonorrhoeae infection or infectious syphilis and either tested negative for human immunodeficiency virus (HIV) and were receiving HIV preexposure prophylaxis or were living with HIV. Screening for sexually transmitted infections, including N. gonorrhoeae nucleic acid amplification testing of samples obtained from urogenital, anorectal, and oropharyngeal sites, was performed quarterly for 2 years. The primary outcome was a first N. gonorrhoeae infection after the receipt of vaccine or placebo in the per-protocol population (participants who received both 4CMenB or placebo doses, attended at least two scheduled follow-up visits after the second dose, and did not meet any exclusion criterion pertinent to the assessment of efficacy). From July 2021 through May 2023, a total of 654 participants underwent randomization, of whom 587 were included in the primary analysis. The incidence of N. gonorrhoeae infection was 48.1 events per 100 person-years (160 events among 296 participants) in the 4CMenB group and 47.8 events per 100 person-years (155 events among 291 participants) in the placebo group (incidence rate ratio, 1.01; 95% confidence interval [CI], 0.80 to 1.26; P = 0.97), for a vaccine efficacy of -0.5% (95% CI, -26.2 to 19.9). Vaccine efficacy was 5.5% (95% CI, -56.0 to 42.8) for symptomatic infection, -6.4% (95% CI, -47.5 to 23.2) for asymptomatic infection, and -20.0% (95% CI, -90.2 to 23.9), -1.2% (95% CI, -33.0 to 23.0), and 2.6% (95% CI, -27.7 to 25.7) for urogenital, anorectal, and oropharyngeal infection, respectively. Serious adverse events occurred in 4.7% of the participants in the 4CMenB group and in 2.8% of those in the placebo group. 4CMenB did not result in a lower incidence of N. gonorrhoeae infection than placebo among MSM who were at high risk for gonorrhea. (Funded by the Australian National Health and Medical Research Council and GSK; GoGoVax ClinicalTrials.gov number, NCT04415424.).

25. Seroprevalence of Measles, Mumps, Rubella, and Varicella-Zoster Virus Antibodies-United States, 2017-March 2020.

期刊: The Journal of infectious diseases 发表日期: 2026-Jul-08 链接: PubMed

摘要

The most recent assessment of antibodies against measles, mumps, rubella, and varicella-zoster viruses (MeV, MuV, RuV, VZV) in the United States was conducted in 2009-2010. Regular assessments are essential to measure the impact of immunization programs, identify immunity gaps, and inform vaccination strategies. We report updated estimates of national seroprevalence. We used a CDC-developed immunoglobulin G multiplex bead assay to quantitatively detect antibodies against MeV, MuV, RuV, and VZV among participants aged 6-59 years in the 2017-March 2020 National Health and Nutrition Examination Survey. We estimated seroprevalence overall and by sociodemographic characteristics and assessed independent predictors of seropositivity using logistic regression models with weighted procedures for complex survey design. Overall seroprevalence was 95.2% (95% CI, 94.0%-96.3%) against MeV, 87.8% (95% CI, 86.5%-89.2%) against MuV, 95.6% (95% CI, 94.5%-96.5%) against RuV, and 97.2% (95% CI, 96.4%-98.0%) against VZV, and remained high across advancing age groups. Younger age and non-Hispanic Black race and ethnicity were independent predictors for MeV, MuV, and RuV seropositivity; sex, birthplace, and health insurance status were independent predictors for seropositivity for at least one of the viruses. Nationally, seroprevalence for MeV, MuV, RuV, and VZV antibodies remains high among persons aged 6-59 years and our findings indicate robust antibody responses are maintained decades after vaccination or natural infection. Maintaining high population immunity through vaccination is critical to prevent cases and outbreaks of all four vaccine-preventable diseases.

26. In situ vaccination, low-dose targeted radionuclide therapy, and immune checkpoint inhibition eradicate poorly immunogenic metastatic tumors in murine cancer models.

期刊: Cancer immunology research 发表日期: 2026-Jul-08 链接: PubMed

摘要

Focal radiotherapy can provide an in situ vaccine (ISV) effect that may prime adaptive antitumor immunity, which can be augmented by combination with intratumoral immune adjuvants and systemic immune checkpoint inhibition. However, propagation of an antitumor immune response is not consistently achieved in metastatic disease. Delivery of low-dose targeted radionuclide therapy (TRT) can promote clonal expansion and propagation of antitumor immune responses. Therefore, in this study, we combined dual immune checkpoint blockade (DCP; anti-PD-L1 and anti-CTLA-4) with ISV (focal radiotherapy with intratumoral injection of tumor-specific monoclonal antibody and IL2) to prime and low-dose TRT to propagate antitumor immunity. C57BL/6 mice were engrafted with a primary and secondary tumor, and intravenously injected with tumor cells to model advanced metastatic disease. Mice with poorly immunogenic, syngeneic MOC2 head and neck squamous cell carcinomas or B78 melanomas received monotherapy or double or triple combinations of: low-dose TRT; DCP; and primary tumor-targeted ISV. When compared to dual or monotherapies, TRT+DCP+ISV eradicated bulky well-established tumors, prevented development of lung metastases from circulating tumor cells, and extended survival (p< 0.01). TRT+DCP+ISV conferred tumor-specific immune memory, enabling uniform rejection of tumor re-engraftment. TRT+DCP+ISV activated innate and adaptive immune response in the primary and secondary tumors. Overall, these data highlight TRT+DCP+ISV as a promising approach to prime and propagate antitumor immunity and promote response to checkpoint inhibition.

27. Mast cell-derived IL-13 as a driver of Crohn disease-associated intestinal fibrosis.

期刊: Inflammatory bowel diseases 发表日期: 2026-Jul-08 链接: PubMed

摘要

Crohn disease is a chronic, immune-mediated disease that can lead to intestinal fibrosis, strictures, and bowel obstruction. The Src homology 2 domain-containing inositol polyphosphate 5’-phosphatase-deficient (SHIP-/-) mouse develops spontaneous Crohn disease-like ileal inflammation and fibrosis. Fibrosis depends on increased phosphatidylinositol 3-kinase p110δ activity downstream of interleukin 4 (IL-4) or IL-13. Because current anti-inflammatory treatments do not prevent or reverse fibrosis, we aimed to identify the key cytokine(s) and its cellular source(s). We blocked IL-4 or IL-13 in mice by use of neutralizing antibodies or genetic ablation. Intestinal inflammation and fibrosis were assessed by gross pathology, histopathology, collagen accumulation, muscle thickening, immune cell infiltration, and tissue IL-1β concentrations. IL13 and its cellular source in stricturing Crohn disease were examined using single-cell RNA sequencing and RNAscope. Mast cells and Il13 were also assessed in ileal cross-sections from SHIP+/+ and SHIP-/- mice. Blocking or genetic ablation of IL-13, but not IL-4, significantly reduced ileal fibrosis in mice, including collagen accumulation, smooth muscle thickening, vimentin + cells, and proliferating vimentin + cells. Blockade of IL-13 also reduced intestinal inflammation, including immune cell infiltration and ileal IL-1β concentrations. Single-cell RNA-sequencing analyses identified mast cells as the exclusive source of IL13 in stricturing Crohn disease. Human resection tissues confirmed increased mast cells in diseased small intestine and identified mast cells as the source of IL13. SHIP-/- mice similarly showed increased ileal mast cells that were also a source of IL13. IL-13 is critical for intestinal fibrosis in SHIP-deficient mice, and mast cells are a source of IL13 in Crohn disease-associated intestinal fibrosis.

28. European Association for the Study of Obesity-Defined Obesity Trajectories and Risk of Incident Cancer Among Middle-Aged and Older Chinese Adults.

期刊: Nutrition and cancer 发表日期: 2026-Jul-08 链接: PubMed

摘要

The European Association for the Study of Obesity (EASO) framework defines obesity by integrating adiposity measures with obesity-related clinical complications. Whether EASO-defined obesity and its longitudinal trajectories are associated with incident cancer remains unclear. This prospective cohort study used data from the China Health and Retirement Longitudinal Study from 2011 through 2020. Associations of baseline EASO-defined obesity and rule-based obesity trajectories with incident cancer were estimated using Cox proportional hazards models. Among 11,951 participants, 2,814 had EASO-defined obesity at baseline and 355 developed incident cancer. In the primary model, baseline EASO-defined obesity was associated with a higher risk of incident cancer (hazard ratio [HR], 1.43; 95% CI, 1.14-1.80). Among 6,448 participants with trajectory data, consistent obesity (HR, 1.83; 95% CI, 1.24-2.69) and fluctuating obesity (HR, 1.97; 95% CI, 1.09-3.55) were also associated with higher cancer risk. EASO-only obesity, defined as EASO-defined obesity without BMI-defined obesity, was associated with higher cancer risk compared with meeting neither obesity definition (HR, 1.41; 95% CI, 1.06-1.87). EASO-defined obesity and persistent or fluctuating obesity trajectories were associated with higher incident cancer risk. The EASO framework identified adults not classified as having obesity by BMI criteria who nevertheless had elevated cancer risk.

29. Tidal air exposure thresholds in seagrass survival: photodamage-antioxidant imbalance and anthocyanin accumulation associated with Enhalus acoroides zonation limits.

期刊: Marine pollution bulletin 发表日期: 2026-Jul-08 链接: PubMed

摘要

Seagrass meadows are ecologically vital yet increasingly threatened marine ecosystems. Identifying the mechanisms that determine their spatial distribution, particularly in shallow coastal zones, is essential for effective conservation and management. In this study, we investigate the physiological and molecular mechanisms underlying seagrass zonation in Enhalus acoroides using field surveys, controlled experiments, and multi-omics analyses. Our findings demonstrate that seagrass distribution is constrained to areas experiencing ≤4 h of daily air exposure, beyond which plant viability sharply declines. While shoot density remained relatively stable, leaf length was negatively correlated with air exposure. While high-light exposure led to transient photoinhibition, seagrass photosynthetic efficiency (FV/FM) recovered under submersion. Furthermore, laboratory experiments revealed that air exposure beyond 4 h resulted in irreversible physiological damage. Transcriptome and metabolome analyses revealed systemic downregulation of photosynthesis-related genes in shallow populations, along with activation of antioxidant defenses (e.g., APX) and accumulation of stress-related metabolites (e.g., cyanidin-3-O-glucoside increased 5.8-fold via CHS1 upregulation). These results suggest that photodamage-antioxidant imbalance and anthocyanin accumulation may contribute to the zonation limits of E. acoroides. Our study proposes ≤4 h of tidal air exposure as a threshold for seagrass conservation and identifies CHS1 expression and cyanidin accumulation as potential molecular biomarkers for monitoring ecosystem health. By integrating physiological thresholds with molecular diagnostics, this research provides a foundation for adaptive conservation and restoration strategies in seagrass ecosystems under accelerating marine environmental change.

30. Dysregulation of Human ClpP Using Small Molecules with Piperazine-Based Scaffold for Diffuse Intrinsic Pontine Glioma Therapy Validated by Patient-Derived Tumor Organoids.

期刊: Journal of medicinal chemistry 发表日期: 2026-Jul-08 链接: PubMed

摘要

Diffuse intrinsic pontine glioma (DIPG) is a dismal pediatric brainstem tumor with a median survival of approximately 12 months and no curative treatments. ONC201, the most clinically characterized small-molecule, selectively activates human caseinolytic protease P (hClpP). Guided by X-ray structure of the hClpP:ONC201 complex, piperazine-based derivatives were designed and identified compound 26 (DA29) as a lead. Structural studies confirmed its binding to the enzyme hydrophobic allosteric pocket, a finding consistent with its strong proteolytic activation. Permeability under dynamic flow conditions suggested the ability of 26 (DA29) to cross cellular barriers, indicating potential brain tumor penetration. Mechanistically, 26 (DA29) activates hClpP, displaces hClpX from the hClpXP complex, induces mitochondrial dysfunction and ROS accumulation, and exerts cytotoxic effects in patient-derived DIPG cells and organoids. Notably, unlike ONC201, it does not interact with D2/D3 dopamine receptors. Overall, these findings establish a new structural framework for hClpP-targeted therapies and support further development of 26 (DA29) for DIPG treatment.

31. Concordance Between MR Safety Guidance Documents on Conditions for a Safe MR Environment.

期刊: Journal of magnetic resonance imaging : JMRI 发表日期: 2026-Jul-08 链接: PubMed

摘要

Environmental conditions established at facility design, construction, updates, and/or procurement of specialized equipment are the foundation of safe MR practice. Establishing an institutional MR safety program must take into consideration the conditions of the MR environment, and staff training should be tailored to its features. To identify the concordance on conditions for a safe MR environment among a variety of widely known national guidance documents. Analysis of guidance documents. Not applicable. Not specific to field strength. Information was extracted from national MR safety guidance documents about the expected conditions in a safe MR environment, and categorized among (1) facility design, (2) MR equipment selection, and (3) peripheral equipment. Commonalities and differences were identified. Descriptive statistics. Six publicly available national guidance documents for MR safety were obtained, from countries with relatively high density of MR systems (between 9 and 38 MR systems per million inhabitants): Australia, New Zealand, Sweden, Switzerland, UK, and USA. Full or partial concordance was observed among many measures related to facility design (21/25 conditions), MR equipment features (7/9 conditions), and peripheral equipment (10/13 conditions). This work identified the common and divergent recommendations on facilities and equipment from a variety of guidance documents from national sources. Highlighting common (and uncommon) features recommended by guidance can help users identify weaknesses in their MR environment. This could inform jurisdictions/countries without official guidance and serve in the development of future guidance documents or MR safety training materials. 5. 1. Human magnetic resonance imaging presents hazards to both patients and staff due to the use of magnetic fields to image the human body. The risks associated with these hazards are reduced through careful device engineering, facility design, staff expertise, institutional policies, and clinical procedures. Healthcare institutions rely on expert guidance to inform the necessary safety measures. In this work, six recognized national‐level guidance documents were analyzed to extract and compare the information related to facility design and equipment selection that establish the environment for safe practice of in vivo magnetic resonance.

32. RETRACTED: Sathish et al. Influence of Compression Molding Process Parameters in Mechanical and Tribological Behavior of Hybrid Polymer Matrix Composites. Polymers 2021, 13, 4195.

期刊: Polymers 发表日期: 2026-Jul-08 链接: PubMed

摘要

The Journal retracts the article “Influence of Compression Molding Process Parameters in Mechanical and Tribological Behavior of Hybrid Polymer Matrix Composites” […].

33. Tracing nutrient and cadmium accumulation in wheat from vegetative growth to grain filling: source dependencies and grain transcriptional programmes.

期刊: Journal of experimental botany 发表日期: 2026-Jul-08 链接: PubMed

摘要

Wheat is a major global food crop, and the content of essential minerals and toxic elements in the grains is crucial for human nutrition and health. However, their accumulation dynamics across developmental stages and their allocation mechanisms during grain filling remain poorly understood. Here, we systematically investigated the accumulation of essential minerals and toxic elements in field-grown wheat throughout its growth cycle and integrated source contribution analysis with temporal grain transcriptomics during grain filling. Shoot accumulation of Fe, Mn, Cu, Zn, and Cd followed a characteristic slow-fast-slow pattern, peaking at the jointing stage. Element allocation strategies were strongly influenced by phloem mobility: Cu and Zn were primarily remobilized from vegetative organs (>55% contribution), whereas Fe, Mn, and Cd were mainly derived from direct root uptake (>70%). During grain filling, ten elements exhibited three distinct temporal patterns: early accumulation (Ca), mid-phase accumulation (Mg, S, P, K, Mn, Cu, Zn, Cd) synchronized with dry matter, and continuous accumulation (Fe). Organ-level analysis further indicated that the flag leaf and node I acted primarily as transfer and regulatory hubs rather than major direct sources for grain loading. Temporal transcriptomic analysis of developing grains identified early and sustained gene expression patterns corresponding to these phased accumulation dynamics, suggesting stage-specific regulation of element import, redistribution, buffering, and deposition. Together, these results support a two-level interpretation of wheat grain mineral accumulation under the field conditions examined, in which whole-plant source dynamics interact with grain-associated handling processes. This study provides a mechanistically informed insights that may guide future efforts to improve grain mineral nutrition and reduce Cd accumulation through integrated breeding and agronomic strategies.

34. In Situ Single-Cell Raman Isotope Analysis Quantifies Cell-to-Cell Metabolic Heterogeneity within Individual Cable Bacteria Filaments in Sediments.

期刊: Environmental science & technology 发表日期: 2026-Jul-08 链接: PubMed

摘要

Cable bacteria are multicellular, electrogenic filamentous microorganisms that oxidize sulfide in anoxic sediments while reducing oxygen near the surface, driving crucial redox transformations in aquatic environments. However, the metabolic diversity and growth dynamics of individual cells within a single filament remain poorly understood. Here, we developed an in situ single-cell Raman microspectroscopy method coupled with dual stable isotope (2H/13C) labeling to quantify cell-to-cell metabolic heterogeneity within individual cable bacteria filaments in intact sediment microcosms. Quantitative analysis of the diagnostic Ni-S Raman bands enabled unambiguous identification of cable bacteria among coexisting non-cable filamentous microbes. Combined D2O and 13C tracers revealed prevalent metabolic activity but pronounced variation in anabolic growth: approximately 48% of suboxic-zone cells displayed concurrent 2H and 13C incorporation, indicative of biomass synthesis, whereas the remaining ∼52% incorporated only deuterium, reflecting maintenance metabolism. Oxic-zone cells exhibited consistent 2H incorporation but negligible 13C labeling, signifying active energy metabolism yet minimal anabolic growth. Suboxic cells within the same filaments showed heterogeneous growth, with actively growing cells directly interspersed with cells performing only maintenance metabolism. These results provide the first quantitative in situ evidence of metabolic heterogeneity among cells across oxic and suboxic zones as well as within the suboxic zone itself in individual cable bacteria filaments.

35. Safeguarding medical empathy and cultivating compassion in contemporary medicine.

期刊: Internal medicine journal 发表日期: 2026-Jul-08 链接: PubMed

摘要

Empathy and compassion are both fundamental to patient-centred care, enhancing satisfaction, adherence and outcomes while improving clinician well-being. However, certain aspects of medical culture may put these emotional qualities at risk. The preclinical-to-clinical transition exposes students to hierarchical structures, time constraints and performance expectations prioritising technical competence over interpersonal skills. Negative role modelling, rushed consultations and inadequate emotional support normalise emotional detachment. The COVID-19 pandemic intensified burnout and moral injury, while societal desensitisation through social media compounds these effects. Although medical humanities programmes show promise, meaningful change requires addressing both curricula and clinical environments through structured reflection, compassion-focused training and recognising empathy fatigue as an occupational hazard, reaffirming medicine’s ethical foundations.

36. Psychological Impact of Caregiving When Navigating Language Barriers in Health Care: A Scoping Review.

期刊: Journal of the American Geriatrics Society 发表日期: 2026-Jul-08 链接: PubMed

摘要

Family caregivers provide essential support to older adults, yet those caring for individuals who face language discordance may experience added challenges affecting their psychological well-being. To synthesize the existing literature on the psychological impact of caregiving in contexts of language discordance, focusing on stress, anxiety, depression, burnout, and coping strategies. A scoping review was conducted across six electronic databases from 2000 to 2025 to identify studies examining caregivers of culturally and linguistically diverse individuals in healthcare and community settings. Quantitative and qualitative study characteristics were summarized via frequencies, and qualitative studies were additionally analyzed using content analysis. Preliminary results were reviewed with patient and family partners to inform discussion, interpretation, and implications for optimizing caregiver supports. A total of 7590 citations were retrieved, with 53 full text reviews. Ten studies were included, primarily composed of qualitative studies. Key themes include the emotional and cognitive burden of acting as interpreters, advocates, and system navigators; filial obligations, gendered expectations, and stigma on caregiving experiences; and the protective role of language-concordant or ethno-specific services. Language-discordant caregiving was closely tied to cultural norms. Fragmented and unilingual healthcare systems, unmet service needs, and system-level barriers increased caregiver distress, whereas culturally tailored supports and coping strategies provided mitigation. Caregivers supporting individuals who face language barriers experience significant psychological strain. Routine screening for caregiver burden, integration of professional interpreters, and expanded access to multilingual and culturally appropriate supports are recommended. Future research should employ quantitative and mixed-method designs to quantify psychological impact, investigate the intersection of language, gender, and other aspects of identity, and evaluate interventions that reduce caregiver burden. Addressing both linguistic and cultural dimensions is essential for improving caregiver well-being and promoting equitable healthcare delivery.

37. Determinants of risk factor target attainment after myocardial infarction: the Perfect-CR study.

期刊: European journal of cardiovascular nursing 发表日期: 2026-Jul-08 链接: PubMed

摘要

How individual components of cardiac rehabilitation (CR) programmes predict attainment of risk factor targets after myocardial infarction (MI), and their predictive strength relative to patient characteristics, remain unclear. We aimed to identify organizational and patient-level predictors of risk factor target attainment at 1-year post-MI. Organizational structure and processes followed at all 78 CR centres in Sweden were surveyed and merged with patient-level registry data (n = 6755). Predictors of attaining low-density lipoprotein-cholesterol (LDL-C) and blood pressure (BP) targets and smoking abstinence were identified using orthogonal partial least squares discriminant analysis, generating variables of importance for the projection (VIP) values. Variables with VIP > 0.8 were considered meaningful. The strongest predictors for attaining LDL-C and BP targets included availability of psychosocial management, medication adjustment protocols for nurses, continuity in nurse-patient contact, extended opening hours and adequate facilities, and having a medical director at the CR centre. The strongest patient-level predictors of attaining LDL-C and/or BP targets included low baseline LDL-C and having no history of hypertension, respectively, and the patient having participated in exercise-based CR. For smoking abstinence, the strongest organizational predictors were availability of psychosocial management, having a medical director, prescribing nicotine replacement therapy and varenicline, and self-reported team spirit. Patient-level predictors included having participated in exercise-based CR and group education. We identified multiple CR organizational predictors of attaining key risk factor targets after MI. These results may influence the future design of comprehensive CR programmes.

38. Characterization of the Term "Wandering" in Dementia-Related Research: A Scoping Review.

期刊: Occupational therapy in health care 发表日期: 2026-Jul-08 链接: PubMed

摘要

“Wandering”, commonly associated with dementia, is inconsistently defined in the literature. This scoping review examined definitions of wandering among persons living with dementia. We conducted a scoping review following Arksey and O’Malley’s framework using seven databases with keywords “dementia,” “wandering,” and “terminology.” Articles of any year or study design were eligible if they referenced wandering in the context of dementia. Of 1,888 articles identified, 116 met the inclusion criteria. Publications defining the term wandering increased over the last three decades, representing seven categories: aimless walking, normal routine walking for pleasure, elopement, critical wandering, disorientation in spatial navigation, combined definitions, and other. A shared, person-centered definition that includes the perspectives of persons living with dementia would promote an acceptable understanding. As “wandering” carries stigma, its use varies across countries, resulting in inconsistent approaches for research and practice.

39. Smartphone-assisted ratiometric fluorescent sensor CQDs@Eu-MOF for the visualization and quantitative detection of Hg2+ and norfloxacin.

期刊: Food chemistry 发表日期: 2026-Jul-06 链接: PubMed

摘要

The precise monitoring of Hg2+ and norfloxacin (NOR) residues is essential for ensuring food safety and environmental health. This study describes the fabrication of a dual-emissive CQDs@Eu-UiO-66 hybrid, synthesized via the in-situ encapsulation of carbon quantum dots (CQDs) within a Eu3+-doped UiO-66 framework. By leveraging the blue emission of CQDs and the red emission of Eu3+, this ratiometric platform facilitates the ultrasensitive, discrete detection of Hg2+ and NOR, yielding LODs of 2.08 nM and 48.96 nM, respectively. Mechanistic investigations reveal that Hg2+ quenching proceeds via photoinduced electron transfer (PET), while NOR detection is driven by the inner filter effect (IFE) and electrostatic association. The sensor demonstrates high matrix resilience in complex samples, including lake water, milk, and chicken. Furthermore, integrating a smartphone-based RGB interface enables a transition toward portable, digitized on-site quantification. This platform aligns with regulatory standards, offering a robust solution for rapid food safety monitoring in resource-limited settings.

40. Frailty transitions and incident stroke in older adults: A comparative longitudinal cohort study between China and the UK.

期刊: Archives of gerontology and geriatrics 发表日期: 2026-Jul-04 链接: PubMed

摘要

To examine the association between frailty status, its dynamic changes, and the risk of incident stroke among older adults in China and England. A total of 19,723 participants (CHARLS: n = 9048; ELSA: n = 10,675) were included in the baseline analysis. Among them, 14,682 participants (CHARLS: n = 6419; ELSA: n = 8236) with complete data for both baseline and the second survey (2-year interval) were included in the analysis of frailty transitions. Frailty was assessed using a 28-item frailty index (FI) and categorized as robust (FI ≤0.10), pre-frail (0.10<FI<0.25), or frail (FI ≥0.25). Changes in frailty status were determined between baseline and the second survey. The primary outcome was incident stroke, ascertained by self-reported physician diagnosis. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CIs), adjusting for sociodemographic and lifestyle factors. Baseline frailty was associated with an increased risk of stroke in both cohorts. Participants whose frailty progressed from robust to pre-frail or frail had a significantly higher stroke risk, while those who recovered from frail to robust or pre-frail showed a reduced risk. Additionally, higher cumulative FI was strongly associated with increased stroke incidence, with a significant dose-response relationship (all trend P-values < 0.0001). Sensitivity analyses using alternative FI thresholds yielded consistent results. Frailty status and its dynamic changes are significant predictors of stroke in older adults. Monitoring frailty transitions may help identify individuals at high risk of stroke and inform early intervention strategies.

41. The dynamic influence of exercise on emotional state among people with a history of mood disorder.

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

摘要

Planned or motivated physical activity (exercise) is amenable to direct modification and has been inversely linked to major depression (MDD), suggesting its potential to support recovery in bipolar disorder (BD). However, it is unclear how quickly exercise may impact emotion. We characterized the association of exercise with subsequent emotional state within hours in persons with a history of mood disorders. Euthymic participants aged 11-85 years, diagnosed with BD (n = 110), MDD (n = 157), anxiety without mood disorder (n = 96), or no disorder (n = 96), self-reported their emotional state (sad, anxious, activated, energetic) scaled 1-7 and whether they were exercising four times per day for two weeks via ecological momentary assessment. We characterized the implicit impact of exercise on subsequent emotion within-person and at the group level using dynamic structural equation modeling. Among those with a major mood disorder (BD or MDD), exercise was associated with a strong reduction in subsequent anxiety (-1.706 (95% Credible Interval -2.296, -1.048)), overall and in males and females. However, exercise was not associated with subsequent changes in sad, activated, or energetic feelings. Exercise-emotion dynamics did not differ significantly between individuals with BD compared to MDD, Anxiety without Mood, or no disorder. However, there was variation at the individual within-person level in BD subtypes. Exercise appears to drive beneficial impact on emotional state within hours in persons with BD or MDD-particularly by lowering anxiety. Independent replication and clinical trials are needed to draw conclusions about specificity by mood disorder subtype.

42. Can immediate weight bearing be achieved following a first metatarsocuneiform arthrodesis with a locking plantar plate and compression screw? A case series evaluating the early safety results in 72 consecutive patients.

期刊: Foot (Edinburgh, Scotland) 发表日期: 2026-Jul-01 链接: PubMed

摘要

The literature for a first metatarsocuneiform joint (MCJ) arthrodesis procedure and an early weight bearing post-operative regime (<2 weeks) has been systematically reviewed [1,2]. The concern regarding an increased risk of non-union with early weight bearing has largely been anecdotal. This is a single surgeon retrospective review assessing the union rates achieved following a Lapidus (1st tarsometatarsal joint) arthrodesis in the treatment of Hallux valgus using an anatomically contoured plantar plate and applying an early weight-bearing regime. A retrospective study of consecutive patients who underwent this surgical technique between June 2019 and January 2025 were reviewed. Patients were evaluated at 8 weeks post operation for weight bearing x rays and returned for final clinical review at 6 months post operation. Clinical outcomes were validated through the Manchester-Oxford Foot Questionnaire (MOXFQ) and patient satisfaction (PSQ10) survey. Union of the arthrodesis and complications were reported. A total of 72 patients (60 female and 12 male) with a mean age of 60.60 (range 29 - 75) were analysed. The mean MOXFQ score improved across all domains. All three domains demonstrated highly significant post-operative improvement (p < 0.001 for all). Mean reductions were 26.2 points for Walking Standing (95% CI: 18.6-35.0; Cohen’s d = 0.93), 25.6 points for Pain (95% CI: 18.7-32.9; Cohen’s d = 1.03), and 37.5 points for Social Interaction (Cohen’s d = 1.66). Effect sizes ranged from large to very large, indicating clinically meaningful improvements. There were no reported non-unions or plate failures. Fixation removal was required in 1 patient (1.5%). Ninety percent of patients were back to normal supportive footwear by 8 weeks. This study has demonstrated the low complication rates and acceptable safety profile of an immediate weight bearing post-operative regime following a first MCJ arthrodesis procedure with a single locking plantar plate fixation modality. It provides a larger cohort of patients to support the benefits of plantar plate fixation highlighted in other supporting systematic reviews for a first tarsometatarsal joint arthrodesis. [2] LEVEL OF EVIDENCE: IV.

43. Multi-cohort evidence for impaired microbial support of the methionine cycle in children with autism spectrum disorder.

期刊: Psychiatry research 发表日期: 2026-Jul-01 链接: PubMed

摘要

The contribution of gut microbiota to outcomes of autism spectrum disorders (ASD) has been increasingly appreciated in recent years. With the accumulating evidence on ASD-driven alterations of the gut microbiota, heterogeneities arise across different reports. To account for variabilities in gut microbiota, clinical representations of ASD and data processing approaches, as well as limitations in sample sizes among the existing gut microbiota studies for ASD, the present multi-cohort analysis applied a standard bioinformatic and statistical pipeline on the publicly available gut metagenomic sequencing data for 674 samples, including 326 TD and 348 ASD individuals, collected from eight studies across three main geographical regions. Throughout the analysis, we identified taxonomic profiles of the gut microbiota exhibited more pronounced dysbiosis associated with ASD and between-study variations compared to functional profiles. Differentially abundant taxonomic and pathway markers were identified and validated for their consistent response to ASD across different studies. Co-occurring deficits in microbial pathways for salvaging adenosylcobalamin and S-adenosyl-L-methionine and biosynthesis of methionine in children with ASD point to a reduced microbial support for the host methionine cycle. Species from Faecalibacterium, Bacteroides, Blautia and Bifidobacterium were identified as microbial contributors to ASD-deficient microbial pathways, particularly those related to the methionine cycle. Therefore, the generalisable ASD-deficient contributors to the methionine cycle, such as Blautia wexlerae, Bacteroides stercoris and Streptococcus thermophilus, could be further investigated for their role in therapeutic applications for ASD.

44. Influence of collection site on cerebrospinal fluid test results in horses with equine protozoal myeloencephalitis.

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

摘要

Cerebrospinal fluid (CSF) analysis is a critical component in the diagnosis of equine protozoal myeloencephalitis (EPM). Test results obtained may differ based on different collection sites. Compare results of EPM-specific diagnostic tests obtained from different collections sites in EPM-affected and non-EPM affected horses. Twenty control and 7 EPM-affected horses. Prospective observational study. CSF was collected from the lumbosacral (LS) and cranial sites (atlantooccipital or C1-2) in 27 horses and EPM-specific diagnostic tests were performed. Data were summarized by collection site and disease status. Results were compared by Wilcoxon signed rank test in the non-EPM and EPM-affected cohorts. The EPM-specific diagnostic test results (anti-Sarcocystis neurona CSF antibody titer, serum/CSF titer ratios, and S. neurona antibody index [AI]) in non-EPM affected horses did not differ based on collection site. In EPM-affected horses the median [interquartile range] CSF anti-S. neurona antibody titers were higher in samples from the LS site compared with fluid collected from the cranial sites (160 [1240] vs. 80 [600]; Wald test statistic, 21.0; P = .03) and the median serum/CSF titer ratio was also lower in fluid collected from the LS site (25 [46.8] vs 50 [93.7]; Wald test statistic, 0; P = .03). Median AI values did not differ based on CSF collection site. Results of EPM diagnostic tests on CSF may differ based on collection site and lead to misdiagnosis. The AI appears to be less affected by collection site than antibody titers or the serum/CSF titer ratio.

45. Neutrophilic inflammatory enteropathy in 27 dogs: a retrospective descriptive study.

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

摘要

Dogs with chronic inflammatory enteropathy (CIE) are common in companion animal practice. Neutrophilic inflammatory enteropathy (NIE) is a subtype of CIE that is uncommonly reported, posing a dilemma in terms of etiology, treatment, and prognosis. To describe historical, clinical, clinicopathological, imaging findings, treatment, and survival in dogs with histologically confirmed NIE. Twenty-seven client-owned dogs with NIE. Retrospective interrogation of the hospital database between January 2015 and January 2025 identified dogs with NIE based on histological reports. Cases were regraded using modified WSAVA guidelines and classified into the minor (mild inflammation) or major (moderate or severe inflammation) groups. Twenty-seven dogs were identified, with 8 and 19 dogs in the minor and major groups, respectively. The mean age was 7.7 ± 3.5 (95% CI, 6.4-9.1) years. The most common presenting signs were diarrhea (n = 21/27; 78%), vomiting (n = 21/27; 78%), weight loss (n = 20/27; 74%), hyporexia/anorexia (n = 13/27; 48%), and melena (n = 7/27; 26%). Clinicopathological abnormalities included neutrophilia (n = 12/27, 44%), hypoalbuminemia (n = 14/27, 52%), hypoglobulinemia (n = 23/27, 85%), hypocholesterolemia (n = 11/27; 41%), total hypocalcemia (n = 11/27; 41%), and hypocobalaminemia (n = 14/24; 58%). Twenty-four (89%) dogs (6 minor and 18 major) survived to discharge, with an overall median survival time of 267 (95% CI, 0-569) days, with no statistically significant difference between the major and minor groups. Peripheral neutrophilia was associated with an increased hazard of death (4.43; 95% CI, 1.16-16.99; P = .03) on univariate analysis and a significantly shorter median survival time. Neutrophilic inflammatory enteropathy is potentially associated with poor survival. Peripheral neutrophilia might indicate a poorer prognosis.

46. Participant Heterogeneity in the Prostate Cancer Biobank of the NRG: An Obstacle to Broadening the Reach of Precision Oncology.

期刊: JCO precision oncology 发表日期: 2026-Jul 链接: PubMed

摘要

Precision medicine has revolutionized oncology; however, tumor biomarkers are not reflective of the heterogeneous cancer population. We evaluated NRG Oncology prostate cancer (PCa) clinical trials for demographic differences among patients with optional biospecimen collection (BC) consent and biospecimen submission (BSub). Data from 19 NRG PCa clinical trials closed before 2015 were analyzed. Patients who consented to BC and completed BSub were evaluated by race, ethnicity, median income, area deprivation index (ADI; categorized as highest v lowest three quartiles), age at enrollment, site, and year of enrollment. T/chi-square tests were used for continuous/categorical variables, respectively, followed by logistic regression. Of the 15,648 randomized patients eligible for BC, 11,796 (75%) had specimens submitted. In all, 4,598 (82.2%) of 5,597 eligible patients consented for optional BC in nine clinical trials with a separate BC consent process (consent rates by race/ethnicity: 74.1% Black, 72.8% Hispanic/Latino, 83.8% White). A smaller proportion of Black and Hispanic/Latino patients consented to optional BC compared with those who did not (12.1% v 19.5% Black, P < .0001; 3.5% v 5.8% Hispanic, P = .0006). In univariable logistic regression models, high ADI (more socioeconomic disadvantage) was associated with a decreased likelihood for optional BC consent (odds ratio [OR], 0.67 [95% CI, 0.55 to 0.82]; P = .02), but not a decreased likelihood for BSub (OR, 0.74 [95% CI, 0.53 to 1.04]; P = .08). Multivariable models demonstrated that Black/Hispanic/Latino patients were less likely to consent to optional BC, and Black patients were less likely to have BSub (P < .05 for all). White/non-Hispanic patients and those with less socioeconomic disadvantage were more likely to consent to optional BC, whereas Black patients were less likely to have BSub. Targeted solutions are needed to improve biorepository representation so that precision medicine approaches better reflect the cancer population.

47. Development and Validation of a Computational Histology Artificial Intelligence-Powered Biomarker in Metastatic Hormone-Sensitive Prostate Cancer on Randomized Phase III Trials.

期刊: JCO precision oncology 发表日期: 2026-Jul 链接: PubMed

摘要

Metastatic hormone-sensitive prostate cancer (mHSPC) is a heterogeneous disease state with multiple treatment options. Biomarkers are needed for risk stratification and to guide treatment intensification or deintensification. We used a computational histology artificial intelligence-based platform (CHAI) to develop and validate a digital image-only prognostic biomarker in mHSPC with participant-level data from two prospective, phase III randomized controlled trials. The CHAI platform extracted quantitative histomorphologic features from whole-slide images of hematoxylin and eosin-stained diagnostic specimens. Data from CHAARTED were used to construct a signature of features associated with overall survival (OS). A continuous risk score was dichotomized into favorable- and unfavorable-risk groups. The performance of the locked model was assessed in ENZAMET as an independent validation cohort using Kaplan-Meier methods and multivariable Cox proportional hazards models. Institutional review board approval was obtained for each participating data set. Given all patient information was deidentified, the study was considered institutional review board-exempt and consent waived. Overall, 1,191 participants were included: 507 in development (CHAARTED) and 684 in validation (ENZAMET). In the validation cohort, CHAI unfavorable-risk participants had worse OS (hazard ratio [HR], 2.6 [95% CI, 2.0 to 3.4]; P < .001) and progression-free survival (PFS; HR, 2.2 [95% CI, 1.7 to 2.7]; P < .001). Five-year OS was 39% for unfavorable-risk versus 69% for favorable-risk participants. In adjusting for clinical variables, the biomarker remained prognostic for OS and PFS (P < .001). Among those who received doublet (androgen-deprivation therapy [ADT] plus androgen receptor pathway inhibitor [ARPI]) versus triplet systemic therapy (ADT plus docetaxel plus ARPI), there was a significant interaction between biomarker and treatment intensification for OS (P = .003) and PFS (P < .001), suggesting that patients at higher risk may benefit more from triplet therapy. We developed and validated an image-only AI-based biomarker associated with clinical outcomes and potential benefit from treatment escalation in mHSPC independent of conventional clinicopathologic risk factors.

48. Acoustic burden in the emergency department: A latent operational Hazard.

期刊: The American journal of emergency medicine 发表日期: 2026-Jul-01 链接: PubMed

摘要

Hospital noise significantly impacts patient and clinician experience. Emergency departments (EDs) face unique acoustic challenges due to high patient volume, rapid turnover, equipment generated sound, and complex communication needs. This pilot study quantifies the severity of ambient noise patterns in an ED by comparing measured noise levels to recognized safety thresholds, while evaluating concurrent communication-related safety events to inform future communication interventions. A descriptive analysis of noise measurements was conducted across a tertiary hospital ED. Three sound metrics were measured, including LAeq, equivalent continuous sound level; LAFmax, maximum fast time-weighted sound level; and LCPeak, maximum C-weighted sound level. Measurements were collected from May-September 2025 (n = 47) during ≥5-min sampling sessions across morning and afternoon time periods. Results were summarized descriptively and compared to WHO, OSHA, and NIOSH guidelines. Additionally, patient safety reports (n = 676) were extracted from the institutional reporting system, PressGaney SafetyNet. The reports were then reviewed for inclusion based on their relevancy to ED communication, then further classified and temporally binned. Mean noise levels exceeded all referenced safety thresholds. Afternoon periods showed the highest noise levels (LAeq: 69.6 dB(A), LAFmax: 91.6 dB (A)), exceeding WHO guidelines by 29.6 dB(A) and NIOSH guidelines by 6.6 dB(A); while morning periods were relatively quieter (LAeq: 65.9 dB(A), LAFmax: 88.4 dB(A)), exceeding WHO guidelines by 25.9 and NIOSH guidelines by 3.4 dB(A). Among 676 safety events, 35 were identified as intra-department miscommunication events (5.2%). These miscommunication events occurred most frequently during afternoon periods (42.86%), which were previously identified as the louder of the two time periods. ED noise levels exceed recognized safety guidelines across both time periods. Furthermore, increased occurrence of intra-departmental miscommunication events during peak noise level time periods suggests that elevated noise levels may contribute to patient safety risk. The unique challenges of ED operations create sustained acoustic burden that likely requires multifaceted mitigation strategies, including unified communication pathways beyond communication-focused interventions alone.

49. Cohort Profile: The Nanjing Chronic Disease Cohort.

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

摘要

50. Europe must learn from America's assault on science.

期刊: European journal of public health 发表日期: 2026-Jun-10 链接: PubMed

摘要

51. SARS-CoV-2 testing uptake and its determinants in six ethnic groups living in Amsterdam, the Netherlands: a registry-based study within the HELIUS cohort.

期刊: European journal of public health 发表日期: 2026-Jun-10 链接: PubMed

摘要

Diagnostic testing was key in preventing transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the pre-vaccination era of the coronavirus disease 2019 pandemic. This study compared SARS-CoV-2 polymerase chain reaction (PCR) testing uptake and its determinants across six ethnic groups in Amsterdam, the Netherlands. We analyzed data from the population-based Healthy Life in an Urban Setting cohort linked to SARS-CoV-2 testing registry data from the Public Health Service of Amsterdam. Testing uptake was defined as completing at least one SARS-CoV-2 PCR test before 6 September 2021. We examined the association between ethnicity and testing uptake, and assessed determinants of testing uptake per ethnic group, using logistic regression while correcting for ethnic-specific age and sex distributions in Amsterdam. We included 19 006 participants (median age 53 years; 57% female). Testing uptake ranged from 25.3% (95% confidence interval (CI) = 23.1%-27.5%) in the Ghanaian to 52.2% (95% CI = 50.3%-54.1%) in the Turkish group. Individuals of Turkish origin [adjusted odds ratio (aOR) = 1.12, 95% CI = 1.01-1.23] were more likely, while those of African Surinamese (aOR = 0.88, 95% CI = 0.79-0.97) and particularly Ghanaian (aOR = 0.35, 95% CI = 0.30-0.40) origin less likely to be tested compared to those of Dutch origin. Younger age and perceived work or home-related stress were associated with testing uptake across most ethnic groups. Other determinants were specific to certain groups. SARS-CoV-2 testing uptake varied slightly across most ethnic groups in Amsterdam with the highest uptake among individuals of Turkish origin but was remarkably lower among individuals of Ghanaian origin. Given the diversity of identified determinants, testing strategies should be tailored to the needs of specific groups.

52. A functional framework in patient fibroblasts informs ATP7A variant pathogenicity and identifies p.Q990P as a novel cause of distal motor neuropathy.

期刊: Human molecular genetics 发表日期: 2026-Jun-06 链接: PubMed

摘要

ATP7A is a P-type ATPase copper transporter and a central component of the intracellular network to maintain copper (Cu) homeostasis, trafficking between the trans-Golgi network (TGN) and the cell periphery in response to intracellular Cu levels. Pathogenic ATP7A variants cause Menkes disease (MNK), occipital horn syndrome (OHS) and X-linked distal hereditary motor neuropathy (HMNX), with the clinical severity inversely related to residual ATP7A function. In MNK and OHS, variants result in loss of ATP7A function due to absent (MNK) or markedly reduced (OHS) protein levels, leading to abolished ATP7A trafficking and/or impaired Cu transport capacity. HMNX-associated variants are thought to retain partial Cu transport activity, although functional data remain limited. To date, three missense variants (p.T994I, p.P1386S, p.A991D) are established causes of HMNX, but the number of ATP7A variants reported in patients with a distal motor neuropathy phenotype is increasing, creating a need for functional assessment of variants of uncertain significance (VUS). We have developed a functional framework for evaluating HMNX-associated ATP7A variants. Using three patient fibroblast lines carrying the confirmed variants, we demonstrate reduced ATP7A TGN localization under low-Cu conditions and impaired capacity of these cell lines to maintain intracellular Cu levels. By applying these assays to five VUS (p.R703H, p.Y760C, p.A768G, p.Q990P, p.M1311V) identified in individuals from unsolved peripheral neuropathy families, we identify p.Q990P as a novel ATP7A variant in a patient with progressive peripheral motor neuropathy. This approach enables comparison of Cu trafficking and handling across ATP7A alleles, providing a functional framework to support diagnostic variant classification.

53. Temporal effects of educational interventions on fit and knowledge retention of N95 filtering facepiece respirator under rest and exertion.

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

摘要

Proper use of N95 filtering facepiece respirators is critical for respiratory protection in healthcare settings. Effective protection depends not only on respirator selection but also on adequate training and proper fit. Although text-based, video-based, and person-guided training approaches are commonly used, evidence comparing their effectiveness and the durability of training effects on quantitative fit performance and respirator-related knowledge remains limited, particularly among medical and nursing students. This study aimed to evaluate the effects of different training approaches on knowledge acquisition and respirator fit over time. This prospective study enrolled 42 participants who were randomly assigned to 3 training groups. Fit factor values were assessed using quantitative fit testing to evaluate changes in respirator fit over time, including immediately after training, at 2 wk, and at 3 mo. A questionnaire assessed participants’ respirator-related knowledge and procedural competence in donning and doffing. In addition, a treadmill was used to standardize walking speeds of 1.5 and 3.0 miles/h to introduce controlled levels of physical activity. The mean age of participants was 20.3 ± 2.2 yrs. Only 11.9% had prior experience with N95 respirators, and none had received formal training. The mean questionnaire accuracy increased significantly from 46.0 ± 11.9% at baseline to 65.9 ± 13.5% immediately after training (P < 0.01), but declined over time to 59.2 ± 15.3% at 2 wk (P < 0.05) and 54.9 ± 13.4% at 3 mo (P < 0.01). However, no significant differences were observed among training groups when analyzed by domain (knowledge and respirator-wearing practices). Median fit factor increased from 28 ((interquartile range, IQR) 7 to 99) at baseline to 143.5 (IQR 73.5 to 232.8) immediately after training, then declined to 130 (IQR 70 to 158) at 2 wk and 126 (IQR 92 to 195) at 3 mo (P < 0.001). Notably, the fit factor in the video- and guided-training groups remained significantly higher than that of the text group even after 3 mo (P = 0.029). Moreover, fit factor declined while respiratory rate and heart rate increased during treadmill walking rate at speeds of 1.5 and 3 miles/h (P < 0.001). Educational interventions both improve knowledge and respirator fit; however, these effects diminish over time, indicating the need for periodic reinforcement. Video-based and person-guided training offer superior retention of respirator fit performance at 3 mo compared to text-based instruction. Physical exertion may compromise respirator fit, emphasizing the need for awareness of potential fit limitations during clinical activities.

54. Breaking Barriers in Obesity Care - Scaling a Primary Care Weight Management Program Statewide.

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

摘要

Obesity disproportionally impacts North Carolina, with rates exceeding national obesity rates, especially in rural areas. Lack of access to obesity care has been identified as a barrier to treatment nationally, excessively impacting those most vulnerable to the risks and consequences of obesity. UNC Health piloted a primary care-based weight management program in 2019, and this article details the program’s subsequent scaling across a statewide footprint to address the problem for both adult and pediatric populations. The program leverages American Board of Obesity Medicine specialty-certified primary care clinicians. It focuses on brief nutritional counseling and prescription of both first-generation anti-obesity medications and glucagon-like peptide-1 medications. Between 2019 and 2025 the program successfully scaled across North Carolina, growing from 3 physicians in 3 counties in 2019 to 17 clinicians in 9 counties in 2025, with each providing a half to a full day per week of their clinical time purely dedicated to weight management. Between these dedicated clinic sessions and weight management patients seen during their usual primary care sessions, the physicians cumulatively cared for more than 3000 patients. While scaling across a broad statewide footprint, the program has continued to deliver clinical success while being financially sustainable for the health system. More than one half of patients who attend at least four visits achieve 5% weight loss, and more than one third achieve 10% weight loss. This program successfully eliminates barriers and provides effective, accessible, and evidence-based weight management care to patients disproportionately impacted by the obesity epidemic.

55. Benchmarking with Patient Outcomes - Unmasked Surgeon Comparisons within a Learning Community for Continuous Improvement.

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

摘要

Patient-reported outcome measures (PROMs) are increasingly applied in clinical practice to improve quality of care and patient outcomes. To date, however, little is known about their use for peer comparisons of performance between clinicians, which the authors refer to as benchmarking. In this study of cataract surgeons, benchmarking was implemented through a stepwise approach: (1) Before benchmarking, each surgeon could not access their performance data or compare it with that of their peers; (2) once benchmarking began, all surgeons’ identities and individual results became visible to their peers. This benchmarking design was intended to create a learning community free from judgment or stigmatization, drawing each surgeon into a collaborative dynamic of continuous improvement. The authors hypothesized that surgeons within such a benchmarking community would be encouraged to modify their surgical indications, improve their patients’ average outcomes, and reduce the volume of procedures without meaningful patient benefit. Between 2021 and 2025, the authors analyzed a benchmarking community of cataract surgeons practicing at four institutions in France. The benchmarking model included voluntary participation, patient involvement, improvement cycles, and respect for patient-surgeon autonomy in clinical decision-making. Dashboards allowed surgeons to compare their PROMs, clinician-reported outcome measures (CROMs), and case-mix-adjusted results. Access to the benchmarking dashboard was supplemented through noncoercive, nonpunitive quarterly meetings with peers to discuss individual and community results, enabling improvement cycles. The authors analyzed data from over 2600 patients with complete PROM and CROM data and found that five times more surgeons modified the surgical indications they used during benchmarking than before benchmarking - 10 of 24 (42%) versus 2 of 24 (8%). The authors also found that only surgeons who actively consulted the benchmarking dashboard modified their surgical indications. Among those who modified their surgical indications during benchmarking, the average postsurgery health gain score of their patients increased by 22% (from 28.7 before to 35.1 after modifying the indications), and the rate of patients without meaningful benefit decreased by 34% (from 19% to 13%). The differences were similar when compared with performance before benchmarking, which yielded a 21% increase in average health gain scores and a 35% decrease in the proportion of patients below the meaningful outcome threshold. These findings support the potential of unmasked peer benchmarking to improve patient outcomes, reduce unnecessary procedures, and advance value-based surgical care.

56. The Increasing Community Access to Testing, Treatment, and Response Program - A Model for Future Public Health Emergency Response.

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

摘要

Rapid distribution of diagnostic testing and countermeasures in community settings is a persistent challenge during pandemics. During the coronavirus disease 2019 (Covid-19) public health emergency, the Increasing Community Access to Testing, Treatment, and Response program at the U.S. Centers for Disease Control and Prevention provided free Covid-19 testing through retail pharmacies. The program enabled timely diagnosis for uninsured individuals and maintained a robust pharmacy network with the capacity to serve the entire U.S. population. This public-private partnership model can be employed for future public health emergency response, surveillance, research, and prevention.

57. Delivering High-Value Musculoskeletal Care - A Virtual Care Solution That Preserves In-Person Physical Therapy Volume.

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

摘要

Managing musculoskeletal conditions presents significant challenges, including high health care expenses from various medical interventions. These challenges are magnified when pain becomes chronic in nature. Early access to conservative measures, such as physical therapy or occupational therapy, can reduce downstream health care costs and use. Because accessibility and cost to the patient can be barriers to engaging in noninvasive services, virtual musculoskeletal care may be effective in decreasing the barriers to participation in rehabilitation services. Through a pilot study with its own insured population, Emplify Health by Bellin implemented a third-party virtual platform to help Bellin and its patients navigate these barriers. The integration of the virtual musculoskeletal care solution did not reduce in-person visits per beneficiary but added to the overall number of combined visits - virtual and in person. It is plausible that the addition of the third-party virtual musculoskeletal care service enabled participation for individuals who would not otherwise attend in-person therapy because of their own concerns about timely or convenient access to care or other obstacles. Further studies are needed to assess if the integration of a virtual musculoskeletal care option decreases downstream health care costs and use.

58. Using the RE-AIM framework to evaluate the implementation of a clinical workflow designed to identify, refer, and connect insufficiently active patients to health coaching.

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

摘要

Primary care is well-positioned to connect patients to physical activity (PA) interventions but is underutilized. To describe the implementation of a clinical workflow designed to identify, refer, and connect insufficiently active patients to health coaching (HC). From June 2023 to March 2025, a physical inactivity screening and referral workflow was implemented in six primary care clinics within a large university healthcare system. Guided by the RE-AIM framework, descriptive analyses focused on the number and proportion of patients who (i) were screened for inactivity, (ii) were identified as insufficiently active, (iii) expressed interest in HC, (iv) were referred to HC, and (v) were connected to HC. We also assessed provider uptake, evaluated workflow modifications, and computed measures of central tendency and dispersion during the final year. Monthly, a mean (SD) of 1771 (153) patients were screened. Of these, 1013 (102), or 57.1%, were insufficiently active. A median of 288 patients (29%) expressed interest in HC, of which 243 (89%) were referred. A median of 20 patients (10% of those referred) were connected to HC monthly. Among providers with patients requesting a referral, 86% referred. Workflow changes were followed by shifts in metrics, while variability remained low during the final year of evaluation. This workflow identifies and refers many insufficiently active patients to HC. However, there is a gap between patient HC referral and connection to support. Identifying and implementing strategies to overcome barriers and improve patient connection rates is a critical next step. Regular physical activity helps to prevent many long-term conditions, such as heart disease, diabetes, certain cancers, and poor mental health. Despite its importance, physical activity is not adequately promoted in primary care. Given its extensive reach, primary care is an ideal setting to help patients become more active. This study described the implementation of a new clinical process designed to identify, refer, and connect inactive patients to health coaching programs. Over nearly two years, new or returning patients attending their annual physical exam were screened for physical inactivity. Approximately 1700 patients were screened each month, and more than half were found to be insufficiently active. Roughly one-third of these patients reported interest in getting connected to a health coaching program, and nearly 90% of these patients were referred by their provider. However, only 10% of referred patients enrolled. Changes to the process appeared to have large impacts, and most outcomes remained stable over time. Overall, we showed that this clinical workflow can effectively identify and refer inactive patients to supportive resources within primary care, but further improvements are needed to maximize patient use of these resources. Future work should investigate and address modifiable barriers that prevent inactive patients from connecting with supportive programs.

59. Strategies for tackling fake news in healthcare: a complex approach from a nursing perspective.

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

摘要

To unveil strategies for tackling fake news in the context of health and nursing from nursing professionals’ perspective. This qualitative research, whose theoretical and methodological frameworks were, respectively, Complexity Theory and Grounded Theory, involved 25 nursing professionals from a public hospital and a Family Clinic in the city of Rio de Janeiro. Semi-structured interviews were conducted between 2021 and 2023. The meanings revealed by nursing professionals considered the complexity of tackling fake news, highlighting that the dissemination of this information occurs through multiple channels and is embedded in social, political, and technological dynamics. The results indicated the importance of developing institutional fact-checking mechanisms and promoting educational campaigns as strategies to minimize the impacts of fake news on healthcare. The study’s complex perspective indicates that tackling fake news in health and nursing requires multidimensional approaches that combine education, regulation, and the valuing of science in the construction of reliable knowledge.

60. Knowledge, attitudes, and practices regarding type 2 diabetes and associated factors among rural adolescents in Indonesia: A cross-sectional study.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Type 2 diabetes (T2D) is an increasingly important public health concern in Indonesia and is increasingly affecting adolescents at a growing rate due to lifestyle transitions and limited awareness. Evidence regarding adolescents’ knowledge, attitudes, and practices (KAP) toward T2D in rural settings remains limited. This study assessed KAP levels related to T2D, identified sociodemographic factors associated with KAP outcomes, and examined interrelationships among KAP domains among rural Indonesian adolescents. A cross-sectional study was conducted from September 2024 to February 2025 among 1,546 senior high school students in Kampar Regency, Riau Province. Participants were selected using multistage cluster sampling. Data were collected using a validated KAP questionnaire (Cronbach’s α = 0.725). Descriptive and inferential statistics, including Mann-Whitney U tests, Kruskal-Wallis tests, Spearman’s rank correlations, and multiple linear regression analyses, were used to examine KAP outcomes and associated factors. Participants demonstrated limited knowledge regarding T2D, particularly related to risk factors, symptoms, and complications. Although attitudes toward diabetes prevention were generally positive, preventive practices remained suboptimal, especially regarding physical activity. Female gender, peri-urban school location, higher academic rank, extracurricular participation, and prior exposure to diabetes information were associated with higher KAP scores. Knowledge was moderately associated with attitude but only weakly associated with preventive practices. Rural adolescents demonstrated limited diabetes-related knowledge and suboptimal preventive behaviors despite generally positive attitudes toward T2D prevention. Several sociodemographic and school-related factors were associated with KAP outcomes. However, the weak relationship between knowledge and practice highlights a persistent gap between awareness and preventive behavior. School-based, peer-led, and after-school interventions that integrate education with behavioral reinforcement may strengthen diabetes prevention efforts among rural adolescents.

61. Women workers' rights and managers' point of view: a qualitative approach to maternity leave and breastfeeding.

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

摘要

This study aimed to learn managers’ points of view on maternity leave and breastfeeding and find promotion, protection, and support strategies for breastfeeding in the work environment. This qualitative study, using Laurence Bardin’s content analysis, was conducted with eight managers in 2023 in Uberlândia, Minas Gerais State, Brazil. We used a semi-structured script with questions about how managers organized women workers’ activities before they took their maternity leaves and after their return to work and questions about managers’ points of view about breastfeeding and maternity leave. Answers were analyzed using NVivo. We established three big topics from the content of the interviews, namely: (1) managers’ point of view regarding the duration of maternity leave and breastfeeding; (2) rights, incentives, and work conditions; and (3) the organization of the work environment during maternity leave. We verified compliance with the 4-month maternity leave provided for in the Brazilian Consolidation of Labor Laws, highlighting the disagreement of leave duration and the health recommendation for exclusive breastfeeding of up to six months. We also found that managers’ lack of awareness about government programs encourage companies to support breastfeeding by tax reduction benefits and extended maternity leaves. Managers’ point of view and personal experiences permeate knowledge about laws protecting female workers. The pro-breastfeeding strategy only involved complying with the maternity leave duration provided by law, which indicates the need for greater investments in awareness-raising actions for managers regarding the review of the concept of maternal protection.

62. Linguistic markers of emotional reactivity and their association with anxiety, depression, and stress among emergency call takers and dispatchers.

期刊: PloS one 发表日期: 2026 链接: PubMed

摘要

Emergency call takers and dispatchers (ECDs) are routinely exposed to emotionally intense and highly stressful events, placing them at elevated risk for mental health challenges. Despite their critical role in emergency response, ECDs remain underrepresented in occupational mental health research, and it is unclear why some adapt more effectively than others under chronic stress. Cognitive appraisal theory suggests that differences in emotional reactivity-how individuals evaluate stimuli in terms of arousal and valence-may contribute to this variation. To test this, a sample of ECDs provided open-ended narratives of a stressful work-related event and completed the Depression, Anxiety, and Stress Scale (DASS-21). Narratives were analyzed using natural language processing to quantify emotional reactivity through the usage of high and low arousal language, and positively and negatively valenced language. Analyses revealed that greater use of negatively valenced language significantly predicted higher depression and anxiety, whereas positively valenced and arousal language did not. Stress symptoms were not significantly predicted by any linguistic markers of emotional reactivity. Follow-up analyses showed that individuals with moderate or higher depression and anxiety used significantly more negatively valenced language than those below threshold. These findings suggest that negatively valenced language serves as a robust marker of psychological distress among ECDs, even when narratives are elicited in contexts that naturally evoke negative emotion. Results highlight the potential of language-based tools for early, unobtrusive detection of distress, offering scalable approaches to promote resilience and support well-being in this critical workforce.