公共卫生研究摘要 (2026-07-12)

共收录 57 篇研究文章

1. How can environmental fecal sampling support Echinococcus multilocularis surveillance in wild carnivores?

期刊: Food and waterborne parasitology 发表日期: 2026-Sep 链接: PubMed

摘要

Foxes (Vulpes vulpes) and raccoon dogs (Nyctereutes procyonoides) are natural definitive hosts of Echinococcus multilocularis. The aim of this study was to compare E. multilocularis findings from the necropsy analysis of hunted animals with those from environmental fecal samples. Between November 2023 and March 2025, 84 carcasses (58 foxes, 26 raccoon dogs) were provided by volunteer hunters located in the area of two municipalities of the island Rügen in North-Eastern Germany. Analysis using the sedimentation counting technique and real-time PCR resulted in a combined positive detection of E. multilocularis in 37.9% (95% Confidence interval [CI] 25.5-51.6%) of foxes and in 15.4% (95% CI 4.4-34.9%) of raccoon dogs. Between February and April 2025, during 13 excursions in the same two municipalities, two-person teams collected 365 environmental fecal samples, which were targeted to be from foxes and raccoon dogs. Species identification through species-specific real-time PCR revealed that the fecal samples were from foxes (56.2%), raccoon dogs (2.7%), domestic dogs or wolves (9.0%), domestic cats or wildcats (0.6%), raccoons (0.3%), and unknown species (26.0%). E. multilocularis DNA was detected by real-time PCR in 18.1% (95% CI 13.1-24.1%) of fox and in 10.0% (95% CI, 0.3-44.5%) of raccoon dog feces. The examination of environmental fecal samples for E. multilocularis appeared to be less sensitive compared to the analysis of necropsy samples from hunted foxes and raccoon dogs. The lower proportion of E. multilocularis DNA in environmental fecal samples may be due to adverse environmental factors, such as degradation by UV light or leaching from precipitation. Nevertheless, environmental fecal sample collection was less labor-intensive and time-consuming and was able to confirm the presence of E. multilocularis in both municipalities. Restricting the analysis to environmental fecal samples containing a minimal quantity of host DNA yielded a prevalence estimate closer to that obtained from necropsy.

2. Build fair machine learning models to predict adverse outcomes for heart failure patients with preserved ejection fraction and with reduced ejection fraction.

期刊: JAMIA open 发表日期: 2026-Aug 链接: PubMed

摘要

Develop and validate subtype-specific, fairness-aware machine learning (ML) models that integrate clinical and social determinants of health (SDoH) information to predict 6-month readmission or mortality after hospitalization among patients with HFpEF or HFrEF, and to evaluate the incremental contribution of SDoH, model explainability, and subgroup error disparities across demographic groups. We used University of Florida Health electronic health record (EHR) data (2016-2022) to identify adult heart failure (HF) hospitalizations and followed patients for 6 months for a composite outcome of readmission or mortality. Features included clinical characteristics, contextual SDoH (eg, neighborhood deprivation), and individual SDoH extracted from clinical notes via natural language processing (NLP). Logistic regression and XGBoost models were trained with random oversampling. Performance metrics included the C statistic, F1-score, and recall. Fairness was evaluated using false negative rate (FNR) parity across sex, race/ethnicity, and age band, and mitigation methods were applied (eg, Disparate Impact Remover, Adversarial Debiasing, and Calibrated Equalized Odds). Adding SDoH improved the C statistic for logistic regression in HFpEF (0.603 vs 0.586) and HFrEF (0.641 vs 0.637). SHapley Additive exPlanations (SHAP) highlighted sodium, financial constraint level, and emergency department visit count in HFpEF, and utilization measures and financial constraint level in HFrEF. FNR ratios indicated race/ethnicity disparities; HFpEF FNRBlack/FNRWhite was 0.7834 (0.8728 after Disparate Impact Remover), and HFrEF FNRHispanic/FNRWhite was 1.2217 (0.9880 after Adversarial Debiasing). SDoH integration and mitigation can modestly improve performance while reducing subgroup error disparities. Subtype-specific, fairness-aware ML models for HFpEF and HFrEF provided interpretable 6-month risk stratification and enabled subgroup fairness assessment. Integrating clinical and SDoH information added modest discrimination gains while strengthening interpretation and fairness assessment. These findings support further validation of explainable, equity-aware HF prediction models.

3. Unsolicited Patient Complaints in Spine Surgery: An In-Depth Study of How and Why They Occur.

期刊: Neurosurgery practice 发表日期: 2026-Aug 链接: PubMed

摘要

The high-risk yet elective nature of spine surgery can often lead to patient complaints. Examining these complaints can improve care quality and experience. This multi-institutional study analyzed unsolicited patient complaints (UPCs) in spine surgery to: (1) compare mean complaints among spine surgeons, other surgeons, and nonsurgeon physicians; (2) categorize patient complaints; and (3) assess whether complaints were linked to surgeon-patient interactions. A multi-institutional cross-sectional study across 200 hospitals (2014-2017) analyzed deidentified UPCs regarding neurosurgery/orthopedic spine teams, categorizing complaints as surgeon- or nonsurgeon-related, focusing on communication, professionalism, complications, and hospital infrastructure. Descriptive and bivariate statistics were performed. Of 42 380 physicians, 525 were spine surgeons, averaging 7.2 ± 8.3 UPCs, significantly higher (P < .001) than nonspine surgeons (5.6 ± 6.3) and nonsurgeons (3.3 ± 5.4). Of 149 UPCs, 43% met multiple categories, 42% were not directly related to surgeon-patient interactions, and 58% occurred preoperatively. Reasons for complaints were as follows: Communication (64%): 63.2% stemmed from lack of communication rather than poor communication (36.8%). Attending surgeons accounted for 70.5% of communication issues. Lack of empathy was reported in 10.1%. Professionalism (26%): 86.8% were attributed to the attending surgeon. Postoperative complications (24%): Permanent deficits (4%) and dissatisfaction with outcomes (28.9%) were reported. Hospital infrastructure (14%): Cost/insurance-related issues (4.0%) were reported. People not offered surgery (12%): Reasons included the following: infrastructure/personnel (33.3%), risks-outweighing-benefits (27.8%), patient-related health reasons (11.1%), and perceived discrimination (5.6%). Clinic issues (12%): Dissatisfaction with not being seen by the surgeon (5.4%), long waiting times (6.0%), and appointment without previous imaging (1.3%) were reported. Among spine surgeons, 42% of complaints were unrelated to direct surgeon-patient interactions, and 58% occurred before any surgery was performed. Communication (64%) was the most common issue, with 70% being surgeon-related. Nonsurgeon-related complaints involved hospital infrastructure, not offering surgery, seeing advanced practice providers, and clinic inefficiencies. A collaborative effort of the healthcare team is crucial to address systemic issues and enhance care quality.

4. Comparative microbial ecology of seagrass and coral reef sediments in the Lakshadweep archipelago using high-throughput 16S rRNA sequencing.

期刊: 3 Biotech 发表日期: 2026-Aug 链接: PubMed

摘要

Seagrass and coral reef sediments from Minicoy Island were investigated to compare bacterial community composition and predicted functional potential using 16S rRNA gene (V3-V4) amplicon sequencing. Sequence data were processed in QIIME2 with Deblur-generated amplicon sequence variants and taxonomic classification against the SILVA database. Alpha and beta diversity analyses revealed high similarity in microbial community composition between seagrass and coral reef sediments, indicating strong ecological connectivity within the atoll environment. Proteobacteria, Bacteroidota, and Desulfobacterota were dominant across both habitats, while sulfate-reducing families such as Desulfobulbaceae and Desulfobacteraceae were relatively enriched in seagrass sediments. Correlation analysis showed that microbial diversity was positively associated with nutrient concentrations and turbidity, and negatively associated with temperature and particulate organic carbon. Functional prediction using PICRUSt2 and KEGG pathway annotation identified habitat-associated trends in transport- and signalling-related pathways, although these functional differences were interpreted cautiously due to the limitations of predictive approaches. Henceforth, the study provides a baseline assessment of benthic microbial communities in Lakshadweep ecosystems and highlights the need for geographically independent sampling and multi-omics approaches to validate functional and ecological inferences.

5. BanglaRiceLeaf: A benchmark dataset for automated rice leaf disease detection and health classification in Bangladesh.

期刊: Data in brief 发表日期: 2026-Aug 链接: PubMed

摘要

Rice leaf diseases pose a major challenge to crop health and agricultural productivity, particularly when timely and accurate diagnosis is required under natural field conditions. The development of automated disease recognition systems depends heavily on the availability of large, well-annotated image datasets. However, many existing rice leaf disease datasets are limited in terms of environmental variability, disease representation, and real-field imaging conditions. To address this gap, this paper presents BanglaRiceLeaf, an original rice leaf image dataset collected and curated by the authors from the experimental fields of the Bangladesh Rice Research Institute (BRRI), Gazipur, Bangladesh, between July 2023 and July 2024. The dataset contains 4152 images belonging to five classes: Bacterial Leaf Blight, Bacterial Leaf Streak, Sheath Blight, Leaf Blast, and Healthy Leaf. The images were acquired from two rice varieties, BR11 and BRRI dhan34, under natural field conditions across varying illumination environments in order to reflect practical disease recognition scenarios. All images were manually annotated by trained annotators under expert supervision. The dataset is systematically organized and publicly released to support reproducible research in rice disease classification. In addition to dataset presentation, benchmark experiments using Xception, NASNetMobile, and InceptionV3 are provided to demonstrate its applicability for deep learning-based disease recognition. BanglaRiceLeaf is expected to serve as a useful resource for plant disease analysis, comparative model evaluation, and future research in precision agriculture and agricultural computer vision.

6. Implementing a Multi-Ancestry Polygenic Risk Score for Coronary Heart Disease in a Diverse Cohort.

期刊: Genetics in medicine : official journal of the American College of Medical Genetics 发表日期: 2026-Jul-11 链接: PubMed

摘要

We describe a prospective cohort study (NCT05277116) conducted in phase IV of the electronic MEdical Records and GEnomics (eMERGE) Network to implement a multi-ancestry polygenic risk score for coronary heart disease (PRSCHD: PGS004696) and assess outcomes after return of results (RoR). PRSCHD was considered alongside family history (FamHxCHD), monogenic risk from familial hypercholesterolemia (FH), and clinical risk factors, to return CHD risk as part of a Genome Informed Risk Assessment (GIRA) report. Participants with high PRSCHD (top 5th percentile) or FH received their results from study personnel, while participants with FamHxCHD were informed by mail/email. Results were placed in the electronic health record and communicated to the primary care provider. The primary outcome of initiation/intensification of lipid lowering therapy within 12 months after RoR is compared between participants with PRSCHD ≥95th percentile and those with PRSCHD 90th-94th percentile, using a regression discontinuity design. Secondary outcomes include ordering of screening tests, a new CHD diagnosis, and lifestyle changes. By April 2025, 20,421 adults were enrolled: mean age 50±15 years (range 18-75 years), 68% female, 50% belonging to health disparity groups, and 40% non-White by self-report. Prevalence of CHD, FamHxCHD, high PRSCHD and FH was 4.0%, 10.2%, 4.3% and 0.7%, respectively; 14.3% had at least one of the three CHD genetic risk factors and CHD risk estimates were highest in those who self-reported as Black. The prevalence of increased genetic risk for CHD was high and at least one of the three genetic risk factors for CHD was present in 14.2% of the cohort. Analyses are underway to assess outcomes after PRSCHD implementation in the context of FamHxCHD, FH, and clinical risk, across the age spectrum in a diverse cohort.

7. Comment on "Altered Pharmacokinetics and Delayed Sputum Conversion in Tuberculosis Patients Co-Infected With HIV".

期刊: Tropical medicine & international health : TM & IH 发表日期: 2026-Jul-11 链接: PubMed

摘要

8. Behavioral Predictors of Safe Diving Practices Among Aquaculture Workers: An Occupational Health Perspective.

期刊: Journal of agromedicine 发表日期: 2026-Jul-11 链接: PubMed

摘要

This study develops and validates a scale designed to measure safe diving culture among aquaculture divers. It also examines occupational health and safety behaviors by considering the individual, environmental, and organizational factors that influence safe diving practices. The study followed a methodological design combining descriptive analysis and scale development. Participants were professional aquaculture divers working in fish farming facilities in Türkiye (n = 613). Data was collected through an online survey. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and structural equation modeling (SEM) were conducted in AMOS, and all items were rated on a 5-point Likert scale. According to the EFA results, four factors accounted for 57.7% of the total variance: pre-dive planning and safety awareness, safe behavior during the dive, equipment and environmental safety, and post-dive risk management with behavioral attention. CFA supported this four-factor structure with excellent fit indices (χ2/df = 1.165; CFI = .988; TLI = .986; RMSEA = .026). Internal consistency values were high (α = .851-.877). SEM further confirmed the expected relationships among the subscales, indicating that diving safety reflects not only technical knowledge but also behavioral attitudes and organizational safety climate. The “Safety Behavior Scale for Aquaculture Divers” offers a sound psychometric tool for evaluating behavioral safety culture in aquaculture diving. The scale provides a structured tool for assessing self-reported safe diving behaviors among aquaculture divers. By addressing diving behavior through multiple dimensions, the study provides a meaningful contribution to occupational health literature.

9. Validation of the Multiplex PCR Assays for Detection of Salmonella spp. and Cronobacter sakazakii on Stainless Steel and Sealed Concrete Surfaces Compared with FDA-BAM Reference Methods.

期刊: Journal of AOAC International 发表日期: 2026-Jul-10 链接: PubMed

摘要

Rapid laboratory detection methods need to be tested against reference methods to confirm their efficiency and suitability. In an unpaired study, the IEH Salmonella-Cronobacter spp. and Cronobacter sakazakii-Salmonella Multiplex PCR Assays’ performance was compared with the FDA-BAM reference methods Chapter 5 for Salmonella and Chapter 29 for Cronobacter sakazakii detection on stainless-steel (SS) and sealed concrete (SC) surfaces. Seeking a shorter enrichment time for the candidate method, the Salmonella-Cronobacter broth enrichments for 18, 20, 22, and 24 h at 35 °C were analyzed with the IEH Multiplex PCR Assays. Two pathogen cocktails were prepared: one including S. Typhimurium ATCC 19585, S. Senftenberg 775W, and S. Enteritidis PT30, and a second one including C. sakazakii MEI 27583, C. sakazakii ATCC 29544, and C. sakazakii ATCC 29004. The Salmonella and C. sakazakii cocktails were independently inoculated onto separate SS and SC following the AOAC guidelines. Additionally, a competing microorganism was added at a concentration 10-100-times higher than that of the pathogens. The candidate method yielded zero false negatives and zero false positives, with 100% sensitivity and 100% specificity for both SS and SC surfaces, regardless of the inoculation level (high, low, and uninoculated) and the enrichment time (i.e. 18, 20, 22, and 24 h for Salmonella, and 20, 22, and 24 h for C. sakazakii). The candidate method successfully detected both target microorganisms on both surface types with a minimum enrichment of 20 h. Statistical analysis using the probability of detection (POD) confirmed the equivalency between the candidate method and the reference methods at either inoculation level or enrichment time (P > 0.05). The IEH Salmonella-Cronobacter spp. and Cronobacter sakazakii-Salmonella Multiplex PCR Assays demonstrated performance comparable to the FDA-BAM reference methods for the detection of Salmonella and C. sakazakii on SS and SC, with a significantly shorter turnaround time.

10. Advances and challenges in the mechanistic understanding of beta-cell dysfunction in gestational diabetes mellitus.

期刊: Journal of animal science 发表日期: 2026-Jul-10 链接: PubMed

摘要

Gestational diabetes mellitus (GDM) is a metabolic condition of pregnancy, characterized by hyperglycemia and glucose intolerance first diagnosed during the 2nd or 3rd trimester of pregnancy. In healthy pregnancies, pancreatic islets adapt by increasing beta-cell mass and function to maintain glucose homeostasis in the face of systemic insulin resistance, which develops with progression of pregnancy. However, in GDM, individuals experience hyperglycemia when beta-cells fail to compensate for this pregnancy-induced insulin resistance. GDM is a heterogeneous condition, with subtypes characterized by defects in insulin sensitivity, secretion, or both. Despite a substantial number of GDM cases being primarily the result of defects in insulin secretion, the majority of research concerns only insulin sensitivity in peripheral tissues, with less attention paid to insulin secretion and associated islet dysfunction, largely due to the absence of adequate models. Here, we review the pathophysiology of GDM at the islet and beta-cell levels. Numerous factors, including glucotoxicity and proinflammatory cytokines, can contribute to beta-cell dysfunction in GDM, similar to the metabolic dysfunction mechanisms of type 2 diabetes mellitus. Other potential contributors to beta-cell dysfunction in GDM are pregnancy-specific, including dysregulation of placental steroid hormones and lactogenic peptide hormones. Various models have been generated in an attempt to recapitulate the effects of GDM, with the use of modified diets and genetic alterations in animal models common in GDM research. However, there remains no well-characterized physiological animal model of GDM. In vitro models and analysis of human tissues offer promise, but human samples are difficult to access due to the rarity of cadaveric donors for this transient and survivable disease. Defining the molecular and cellular mechanisms driving GDM pathophysiology, specifically at the islet level, is fundamental to developing precise therapeutic strategies that prevent both gestational complications and long-term diabetic sequelae. Gestational diabetes mellitus (GDM) affects about 14% of all pregnancies. Whether left untreated or treated with current therapies, GDM has far-reaching impacts on both maternal health as well as future disease risk for babies born to pregnancies afflicted by the disease. We currently understand GDM to be caused by a combination of problems with two related systems: 1) the pregnant body’s inability to adequately respond to the hormone insulin, known as insulin resistance, and 2) an inability of the maternal insulin-producing cells, beta-cells, to secrete enough insulin to maintain healthy blood sugar levels. Despite insulin secretion by beta-cells being an extremely important aspect of GDM development, the vast majority of research on the disease concerns only insulin resistance. In this review, we dive into what is known about beta-cell failure in GDM, how nutrients, inflammation, and hormones direct the beta-cells toward function or dysfunction, and describe the challenges inherent in investigating these insulin-producing cells in the context of pregnancy.

11. School absence and mental health service referral: Cohort study of a South London data linkage.

期刊: JCPP advances 发表日期: 2026-Jul-09 链接: PubMed

摘要

The longitudinal relationship between school absence and mental health has important policy implications; if school absence predicts later mental health problems, it could be used to identify young people at increased risk and enable further assessment, prevention, and early intervention. We analysed an existing data linkage between the National Pupil Database and healthcare records representing a sample of 47,926 young people aged 11-15 in the UK. We used logistic regression to examine the longitudinal association between persistent school absence (defined by the Government Department for Education in England as missing more than 10% of available school sessions) and later contact with secondary care mental health services. We also compared the sensitivity and positive predictive value of the >10% absence threshold to alternative thresholds for predicting adverse mental health outcomes. At the currently applied threshold of >10%, persistent school absence was associated with 2.77 (95% CI 2.33-3.30, girls) and 1.58 (95% CI 1.29-1.95, boys) times the odds of accepted referral to secondary care mental health services in the following year, after adjustment for sociodemographic and educational factors. The absolute risk difference for girls was 4.7% (95% CI 3.9-5.4) and for boys, 2.8% (95% CI 2.1-3.4). Compared to other thresholds, the >10% absence threshold provided a good balance between sensitivity (40.5%), positive predictive value (5.5%), and identifying a manageable proportion of young people as high risk (18%). The longitudinal relationship between school absence and later secondary care mental health service contact suggests that school absence may be a useful marker for educators to identify children in need of support. The >10% absence threshold used in education policy in England may also serve as a useful marker of later mental health risk in other national policy contexts.

12. Virologic Outcomes of Common First-Line Antiretroviral Regimens Among Adults with HIV - China, 2021-2023.

期刊: China CDC weekly 发表日期: 2026-Jul-03 链接: PubMed

摘要

Antiretroviral therapy (ART) is the cornerstone of HIV care. In China, efavirenz-based regimens have long been widely used as first-line treatment, while integrase strand transfer inhibitor (INSTI)-based regimens are increasingly available. However, nationwide evidence on virologic outcomes across common first-line regimens remains limited. This nationwide cohort study found higher viral suppression with EFV 400 mg-based regimens compared with EFV 600 mg- and LPV/r-based regimens, while INSTI-based regimens showed the highest suppression overall. Findings support expanded use of INSTI-based regimens and consideration of EFV 400 mg-based regimens during ongoing optimization of first-line ART in China.

13. Dynamic Prediction of 3-Month Recurrence After First-Ever Ischemic Stroke Using a Two-Stream Attention-LSTM Model - Henan Province, China, 2025.

期刊: China CDC weekly 发表日期: 2026-Jul-03 链接: PubMed

摘要

We aimed to develop a dynamic model for predicting 3-month recurrence after first-ever ischemic stroke using multimodal longitudinal data. Patients with first-ever ischemic stroke admitted to a tertiary hospital in Zhengzhou, China between January 2023 and January 2025 were enrolled. Data on static baseline characteristics, discharge variables, and 1-month follow-up variables were collected. Imaging phenotypes were derived from diffusion-weighted imaging (DWI) and Fluid-Attenuated Inversion Recovery (FLAIR) using automated lesion segmentation and unsupervised clustering. The dataset was divided into training and validation sets (8∶2) using a fixed random seed. Seven models were trained and evaluated: logistic regression, random forest (RF), support vector machine (SVM), XGBoost, multi-layer perceptron (MLP), standard Long Short-Term Memory (LSTM), and two-stream attention-LSTM. External validation was conducted at three independent hospitals. The predictive performance was assessed using the area under the curve (AUC), accuracy, sensitivity, specificity, and Brier score. Among 625 patients, recurrence occurred in 79 (12.64%) patients 3 months after discharge. In the validation set, the AUCs were ranked as follows: two-stream attention-LSTM (0.857); SVM (0.838); XGBoost (0.808); MLP (0.768); RF (0.761); standard LSTM (0.754); logistic regression with follow-up features (0.748); and discharge-only logistic regression (0.686). Two-stream attention LSTM identified key predictors, including dynamic changes in C-reactive protein, systolic blood pressure, and imaging phenotypes. External validation showed stable discrimination (pooled AUC=0.83) and good calibration. Two-stream attention-LSTM improved prediction of 3-month recurrence after first-ever ischemic stroke and may support early post-discharge risk stratification.

14. Mapping of the Global Importation Risk of Malaria to China - Global, 2024.

期刊: China CDC weekly 发表日期: 2026-Jul-03 链接: PubMed

摘要

China achieved World Health Organization certification for malaria elimination in 2021; however, the risk of local retransmission from imported malaria remains a primary challenge in the post-elimination era. While international trade is a critical driver of importation risk, current risk assessments are constrained by the lack of granular cross-border population mobility data. This study introduces service trade volume as a proxy for population mobility. By integrating global malaria epidemiology, socioeconomic factors, and geographic resistance, an enhanced gravity model was developed to stratify global malaria importation risks. The findings revealed that Plasmodium falciparum importation risk exhibited pronounced geographic clustering, predominantly in sub-Saharan Africa. Conversely, Plasmodium vivax importation showed a distinct “connectivity-driven” pattern. Notably, low-endemicity countries geographically adjacent to China or sharing intensive trade relations (such as Republic of Korea, Thailand, and Vietnam) present substantial cryptic importation pressures, identifying them as pivotal surveillance targets in the post-elimination era. The risk stratification matrix provides a scientific framework for tailoring surveillance strategies. For “high-endemicity, high-mobility” regions (such as specific African nations), priorities should focus on strengthening port-of-entry screening and post-arrival follow-up. For “low-endemicity, high-mobility” regions, heightened vigilance is required against cryptic importations driven by frequent commercial and economic exchanges. Public health strategies must move beyond analyses based solely on geographic proximity and incorporate economic connectivity metrics into active surveillance frameworks.

15. A Multi-Agent Framework for Real-Time Sentiment Monitoring and Predictive Analysis of Public Health Policies.

期刊: China CDC weekly 发表日期: 2026-Jul-03 链接: PubMed

摘要

Rapid policy rollouts can trigger localized dissatisfaction that is difficult to detect using text-only monitoring and single-pass large language model pipelines. This study aimed to evaluate whether a multimodal, multi-agent framework improves the accuracy, reliability, and early warning sensitivity of public response surveillance during a long-term care policy monitoring window. This comparative evaluation study analyzed multimodal public discourse captured during a predefined monitoring window by integrating text with images and videos. The sentiment classification outputs were assessed against a human-consensus reference standard using the F1 score. Summarization reliability was quantified as the rate of unverifiable or fabricated claims in the generated policy feedback summaries. Temporal dynamics were characterized using sentiment trajectories, engagement acceleration, and topic subcluster tracking, with policy-relevant drivers estimated as shares of negative discourse volume. The multi-agent framework achieved a higher sentiment classification performance, with an F1 score of 0.89 compared with 0.82 for a single-pass baseline. Robustness improved most noticeably in sarcastic and implicit complaint content, where negative intent was consistently recovered despite superficially positive phrasing. Generative reliability improved sharply, with unverifiable or fabricated claims decreasing to 1.2% versus 14.0% from the baseline. Multimodal recovery increased the captured discourse volume by 34% and added 4,200 unique data points available only in the images and videos. Multimodal multi-agent monitoring strengthened sentiment validity, reduced summary fabrication, and detected topic-level escalation signals in the observed monitoring window. The framework may support earlier identification of policy implementation issues, but its outputs should be interpreted as decision support signals rather than as substitutes for formal policy evaluation.

16. Emergence of Lineage E.4 and Structural Plasticity of A28L Protein in Mpox Virus: Characterization of LCR7 Length Polymorphisms Across Lineages - Shenzhen City, Guangdong Province, China, 2023-2025.

期刊: China CDC weekly 发表日期: 2026-Jul-03 链接: PubMed

摘要

The A28L protein is involved in mpox virus (MPXV) attachment and fusion, is a major target of neutralizing antibodies, and contains regions prone to genetic variation. Analysis of 6,834 global and 260 Shenzhen MPXV genomes identified lineage-specific length polymorphisms in the A28L low-complexity region (LCR7). Emerging E.4 viruses exhibited complex deletion patterns and a characteristic OPG153_E293Q substitution, indicating ongoing structural diversification. Structural variation in A28L provides additional insight into MPXV evolution beyond conventional single-nucleotide analyses. Continued surveillance of these genomic features may improve monitoring of viral transmission and the emergence of new variants.

17. Group C Rotavirus Gastroenteritis Outbreak in a Primary School - Luzhou City, Sichuan Province, China, October 2025.

期刊: China CDC weekly 发表日期: 2026-Jul-03 链接: PubMed

摘要

Group C rotavirus (RVC) infections occur globally, but are still considered a relatively rare cause of acute gastroenteritis compared to group A rotaviruses. Prior to this outbreak, RVC had not been reported in southwestern China, and routine surveillance predominantly focused on group A rotaviruses. Most characterized Chinese RVC strains belong to the M3 genotype. This investigation documented the first laboratory-confirmed RVC outbreak in southwestern China, which affected 32 students across multiple grades. Spatiotemporal analysis linked the transmission cluster to shared school facilities, specifically classrooms adjacent to male restrooms on floors 2 to 5. Whole-genome sequencing revealed that all five sequenced strains shared an identical genotype (G4-P[2]-I2-R2-C2-M2-A2-N2-T2-E2-H2) with 0-1 single-nucleotide polymorphism differences, confirming a single-source transmission chain. Phylogenetic analysis revealed that the Luzhou strains belonged to the M2 genotype and clustered with recent strains from the Yunnan Province, Russia, and European countries, challenging the previous understanding that Chinese RVC strains predominantly belong to the M3 genotype. Public health laboratories should enhance surveillance of non-group A rotaviruses in gastroenteritis outbreaks with negative group A results, particularly in school settings. Standardized control measures effective for norovirus outbreaks, including proper vomitus management, dedicated toilet facilities, and strict hand hygiene enforcement, successfully contained this RVC outbreak within one incubation period, and should be adopted for RVC outbreaks despite the absence of pathogen-specific guidelines.

18. Non-invasive diagnostic model for myocarditis using cardiac magnetic resonance radiomics.

期刊: Quantitative imaging in medicine and surgery 发表日期: 2026-Jul-01 链接: PubMed

摘要

Myocarditis is an inflammatory myocardial disease with high clinical heterogeneity, and its early diagnosis relies on invasive endomyocardial biopsy (EMB) or advanced cardiac magnetic resonance (CMR) techniques with poor accessibility in primary hospitals. Conventional CMR interpretation is subjective with inter-observer variability, and single-modality radiomics models have insufficient diagnostic accuracy. This study aimed to construct and validate a machine learning model integrating multimodal CMR radiomics features and clinical parameters for early non-invasive and accurate diagnosis of myocarditis. This study recruited 344 participants from two hospitals (185 with myocarditis and 159 without myocarditis). Radiomics features were extracted from the left ventricular myocardium using multimodal CMR sequences [cine sequence (CINE), T2-weighted imaging (T2WI), and late gadolinium enhancement imaging (LGE)] and combined with clinical parameters. Feature selection was performed sequentially: first, intraclass correlation coefficient (ICC) analysis was used to retain features with ICC >0.8 for reproducibility; then, Mann-Whitney U test, Pearson correlation analysis, and least absolute shrinkage and selection operator (LASSO) regression (for dimensionality reduction). For clinical predictors, univariate logistic regression (P<0.10) was used for preliminary screening, and multivariate logistic regression (P<0.05) for further selection. Models were constructed using random forests, including single-modality, radiomics fusion, and clinical-radiomics fusion variants. Model performance was evaluated in the training set, internal validation set, and external validation set. The Fusion_Clinical_Radiomic model exhibited optimal and stable diagnostic performance, with area under the curve (AUC) values of 0.936 [95% confidence interval (CI): 0.905-0.967], 0.862 (95% CI: 0.779-0.944), and 0.854 (95% CI: 0.754-0.953) in the training set, internal validation set, and external validation set, respectively. Its accuracy, specificity, and sensitivity in the training set were 0.848, 0.845, and 0.850, respectively, with a favorable Brier score of 0.141. In the external validation set, it maintained a specificity of 0.906 and a Brier score of 0.193. The model’s performance was significantly superior to all unimodal models and the radiomics fusion model alone (all P<0.05). Decision curve analysis (DCA) showed that the model had extensive clinical net benefits. The fusion model provides an accurate, non-invasive auxiliary diagnostic tool for the diagnosis of acute myocarditis within 14 days of symptom onset. By relying on conventional CMR sequences (CINE, T2WI, LGE), it may reduce the reliance on invasive EMB and enhance diagnostic accessibility in primary hospitals. Supported by multicenter internal and external validation, the model exhibits favorable generalizability, offering a promising reference for clinical practice in the early identification of acute myocarditis.

19. A predictive model integrating three-dimensional displacement for osteonecrosis of femoral head following femoral neck fractures: a retrospective cohort study.

期刊: Quantitative imaging in medicine and surgery 发表日期: 2026-Jul-01 链接: PubMed

摘要

Fracture displacement is a recognized risk factor for osteonecrosis of the femoral head (ONFH) after femoral neck fractures (FNFs), yet the relationship between ONFH and three-dimensional (3D) displacement has not been clearly quantified. This study aims to develop a computed tomography-based method to measure 3D displacement at the FNF site and to build a predictive model that integrates these parameters. We retrospectively analyzed 302 FNF patients treated with closed reduction and internal fixation within 3 years. Univariate analysis and multivariable logistic regression were used to assess the association between ONFH and multiple variables, including 3D displacement. The prediction model for ONFH was evaluated using receiver operating characteristic curve, a nomogram, calibration curve, and decision curve analysis (DCA). During the 3-year follow-up period, ONFH was identified in 68 cases (incidence rate 22.5%). Univariate analysis showed that Garden classification, age, time to surgery, osteoporosis, comminution, fixation removal, and displacement parameters (vertical, separation, and comprehensive) were significantly associated with ONFH (P<0.05). Multivariable logistic analysis confirmed that vertical displacement, separation displacement, age, and time to surgery were independent predictors [P<0.05; odds ratio (95% confidence interval): 1.20 (1.01-1.42), 1.19 (1.08-1.30), 0.92 (0.88-0.95), 1.87 (1.41-2.49), respectively]. The model showed an area under the curve >0.91, sensitivity >81%, specificity >89%, and a Youden index of 0.769. Calibration curves showed good agreement between predicted and actual probabilities (Hosmer-Lemeshow test, P>0.05), while DCA indicated clinical usefulness within a risk threshold of 0.10-0.90. In the nomogram, separation displacement contributed the highest score. ONFH is related to factors such as Garden classification, age, time to surgery, osteoporosis, comminuted status, fixation removal, and vertical, separation, and comprehensive displacement. Among these, age, time to surgery, and vertical and separation displacement are independent risk factors. The predictive model that incorporates 3D displacement can quantify the risk of postoperative ONFH and shows good predictive ability in FNF patients. However, further external validation is still required.

20. Addressing workplace practices: combating the rising prevalence of computer vision syndrome.

期刊: Annals of medicine and surgery (2012) 发表日期: 2026-Jul 链接: PubMed

摘要

Computer vision syndrome (CVS) is an increasingly prevalent occupational health concern associated with prolonged use of digital devices, affecting millions worldwide. Characterized by symptoms such as eyestrain, dryness, blurred vision, redness, and headaches, CVS significantly affects productivity and quality of life. This review highlights the growing burden, risk factors, pathophysiology, and preventive strategies related to CVS. Key contributing factors include extended screen time, poor ergonomics, reduced blink rate, improper screen positioning, and lack of regular breaks. Dry eye disease plays a central role in its pathogenesis due to increased corneal exposure and decreased tear film stability. Preventive strategies, particularly the 20-20-20 rule, have shown effectiveness in reducing symptoms and improving ocular surface health. Ergonomic modifications, such as positioning screens below eye level and maintaining proper posture, further help in minimizing discomfort. Despite its high prevalence, awareness regarding CVS remains inadequate among both employees and employers, leading to underutilization of preventive measures. Implementation of workplace policies, regular awareness sessions, and adherence to evidence-based ergonomic practices are essential to mitigate the rising burden of CVS. Addressing these factors is crucial to promote ocular health and ensure a safer, more productive working environment in the digital age.

21. Effectiveness of a chronic care model-based transitional care program for patients with biliary drainage: a randomized controlled trial.

期刊: Annals of medicine and surgery (2012) 发表日期: 2026-Jul 链接: PubMed

摘要

Patients undergoing biliary drainage are at high risk of readmission. We evaluated a Chronic Care Model (CCM)-based transitional care program designed to improve post-discharge outcomes. This prospective, two-center randomized controlled trial assigned 300 patients requiring biliary drainage to an intervention (CCM-based transitional care) or control (usual care) group. Primary outcomes were 90-day hospital readmission and complication rates. Time-to-readmission was analyzed using the Kaplan-Meier method. Secondary outcomes included patient-reported readiness for hospital discharge, self-care behavior, and quality of life. Predictive models, including logistic regression and support vector machine (SVM), were developed to identify risk factors for readmission. The intervention group had significantly lower 90-day readmission rates (16.3% vs. 37.1%; P = 0.001) and complication rates (12.1% vs. 26.5%; P = 0.010). Intervention patients reported higher mean scores (all P < 0.001) for discharge readiness (88.09 vs. 60.49), self-care behavior (88.04 vs. 59.95), and quality of life (88.16 vs. 60.84). Logistic regression confirmed that these patient-reported scores predicted lower readmission risk (OR: 0.97, 95% CI: 0.95-0.99). Furthermore, the SVM model demonstrated high discriminatory ability (AUC: 0.93; 95% CI: 0.89-0.95). A structured, CCM-based transitional care program effectively reduces readmissions and complications while prolonging community-based stability for patients with biliary drainage. Furthermore, patient-reported metrics integrated into an SVM model accurately predict readmission risk, enabling targeted interventions.

22. Pseudologia fantastica: a systematic review of sociodemographic features and psychiatric comorbidities.

期刊: Annals of medicine and surgery (2012) 发表日期: 2026-Jul 链接: PubMed

摘要

Pseudologia fantastica (PF), or pathological lying, involves elaborate fabrications without clear external gain. Despite its clinical significance, PF lacks recognition in the DSM-5, posing diagnostic and legal challenges. A systematic search of PubMed, PsycINFO, and Scopus identified studies on PF demographics, motives, comorbidities, and outcomes. After applying inclusion and exclusion criteria, 34 articles comprising 55 cases were analyzed. PF predominantly affected men (72.7%), presenting in the third to fourth decades. Major motives included self-aggrandizement (38.2%), attention-seeking (36.4%), and sick-role assumption (29.1%). Common themes were health-related lies (67.3%) and occupational or educational fabrications (43.6%). Cluster B personality disorders (25.5%), depressive disorders (16.4%), and trauma-related disorders (16.4%) were frequent comorbidities. Suicidality (27.3%) and substance use (30.9%) were notable. PF significantly impacts social, occupational, and legal functioning. Early recognition and clinician-legal awareness are essential for appropriate management.

23. Tutorial: translating a validated breast cancer prediction model into a web-based decision aid using R Shiny.

期刊: Annals of translational medicine 发表日期: 2026-Jun-30 链接: PubMed

摘要

Risk prediction model development has expanded rapidly, but few models have been translated into patient-facing tools that support informed decision-making. Existing breast cancer models provide no guidance on how to incorporate risk into decisions around screening or prevention medications, limiting their practical utility. To address this gap, we previously developed and validated a competing risk regression model that simultaneously predicts breast cancer and non-breast cancer death and then developed a web-based decision aid application that integrates this model with interactive, personalized information on screening and prevention medications. Using this application as a case study, we present a framework for developing an online decision aid using R Shiny. While prior Shiny tutorials have focused on simple applications or calculators, practical guidance for integrating risk prediction into multi-page, interactive decision support tools remains limited. In our tutorial, we describe key components of development, including application structure, user input collection, real-time calculation of individualized risk estimates, and presentation of results in a clear, interpretable format. We also demonstrate implementation of core Shiny functionalities, including reactive values for dynamic updates, data visualization techniques to contextualize risk estimates, and use of the observeEvent function to enable conditional display and navigation. Through this tutorial, we illustrate how risk calculators can be extended into comprehensive, dynamic and clinically useful tools that support informed decision-making.

24. Beyond the algorithm: health technology assessment frameworks for AI in cardiology under the European Union Health Technology Assessment Regulation: a systematic review.

期刊: Annals of translational medicine 发表日期: 2026-Jun-30 链接: PubMed

摘要

Artificial intelligence (AI) is increasingly used in cardiovascular care to support diagnosis, monitoring and clinical decision-making. However, its dynamic and adaptive nature challenges conventional health technology assessment (HTA) frameworks, which are typically designed for static interventions. This review aims to assess how existing literature supports HTA-relevant evaluation of AI-based cardiovascular technologies and examine their alignment with the evidentiary requirements outlined in the European Union Health Technology Assessment Regulation (EU HTAR). A structured literature search was conducted in PubMed, Scopus, and ScienceDirect databases for studies published between January 2020 and December 2025. After screening 223 records, 33 full texts were reviewed and six met inclusion criteria. A narrative synthesis was performed, alongside a comparative analysis of three HTA frameworks. Six studies were included in the final synthesis, covering cardiovascular AI applications such as stroke outcome prediction, atrial fibrillation screening and wearable-based monitoring. Supported by 17 documents. Four studies incorporated real-world data, though lifecycle adaptability and post-deployment evaluation were rarely addressed. Most focused on clinical or economic performance, without referencing formal HTA frameworks. Alignment with the EU HTAR was indirect and stakeholder engagement, particularly with cardiologists, was inconsistently reported. These findings indicate increasing clinical adoption of cardiovascular AI but limited integration with structured HTA processes or regulatory foresight. While AI tools in cardiology show increasing promise, current HTA practices do not yet fully align with the regulatory and methodological expectations of the EU HTAR. Adapted evaluation models are needed to support the effective, evidence-based adoption of AI technologies in cardiovascular care.

25. Does lung adenocarcinoma subtyping offer clinical benefits?-a retrospective population-based cohort study from Sweden.

期刊: Annals of translational medicine 发表日期: 2026-Jun-30 链接: PubMed

摘要

Classification of lung adenocarcinoma into subtypes is relatively recent and not universally practiced. Consequently, large representative studies describing clinical outcomes are rare, failing to pervasively present the advantages of subtyping, which might potentially improve treatment and survival. Although many related studies have been published, few of them include large patient numbers of unselected adenocarcinoma subtypes, which has probably resulted in discrepant results. We describe the situation in Sweden with the largest study on a European population with a focus on survival. Patient data were obtained from the Swedish Cancer Registry from 2005 to 2021, accounting for 1,418 patients, less than 5% of the reference group ‘adenocarcinoma not otherwise specified (NOS)’. All reported adenocarcinoma patients were included from the cancer registry, with complete national coverage of patients and pathological verification of diagnoses. Non-parametric survival estimates were calculated using the Kaplan-Meier method and testing for linear consistency using Weibull modelling. Survival was generally better for women compared to men and this was most prominent for early-stage cancers. Female 5-year survival decreased in order, lepidic [59%, 95% confidence interval (CI): 55-65%], papillary (51%, 95% CI: 40-64%), invasive mucinous (46%, 95% CI: 32-66%), colloid (36%, 95% CI: 30-43%) and adenocarcinoma NOS (24%, 95% CI: 24-25%). Male 5-year survival for lepidic (46%, 95% CI: 40-53%) and colloid subtypes (22%, 95% CI: 16-29%) was significantly lower than female survival. Survival slopes for T1, T2, N0, M0 cases of lepidic, papillary and adenocarcinoma NOS were almost linear, suggesting homogeneous diagnostics. Survival kinetics were in agreement with Weibull modelling k-values of 1.00 or slightly higher, implying that mortality increased slowly with time, only moderately faster than for the background population of similar age. The present study is among the largest ones so far published on unselected stages of adenocarcinoma subtypes. Our findings demonstrate a significant female survival advantage across most adenocarcinoma subtypes. Survival in T1 and T2 classes with N0 and M0 for lepidic, papillary and adenocarcinoma NOS was close to linear, suggesting that patients are homogeneously diagnosed and treated. Survival benefits of lepidic and papillary subtypes over adenocarcinoma NOS give justification for adenocarcinoma subclassification, and independently validate the prognostic advantage of lepidic and papillary subtypes proposed in the World Health Organization (WHO) 2021 adenocarcinoma grading classification.

26. Chronic eczematous eruptions of aging: a clinical practice review.

期刊: Annals of translational medicine 发表日期: 2026-Jun-30 链接: PubMed

摘要

Chronic eczematous skin disorders that first appear in later life are poorly characterized, partly because existing terminology is inconsistent and often conflates morphologic descriptors with specific diagnoses. This review introduces chronic eczematous eruptions of aging (CEEsA) as an umbrella term, summarizes current knowledge on its epidemiology, etiologies, and clinical presentation, outlines best practices in management, and highlights gaps requiring further investigation. CEEsA frequently present as ill defined, intensely pruritic eruptions on the trunk and extensor limbs, are often refractory to standard topical therapies, and may be precipitated by calcium channel blockers or thiazide diuretics. A structured diagnostic algorithm-incorporating exclusion of mimickers (e.g., tinea pedis-linked auto-eczematization, scabies, contact dermatitis, cutaneous T-cell lymphoma), lesional biopsy, patch testing, and strategic drug withdrawal-is essential before escalating to systemic therapy. This approach helps avoid unnecessary treatment or other etiologies with different management. Although traditional broad spectrum immunosuppressants carry age related safety concerns, emerging targeted agents that dampen type 2 cytokine signaling (dupilumab, tralokinumab) or Janus kinase pathways (upadacitinib) show promising efficacy and tolerability in small case series of CEEsA, including idiopathic forms. Recognizing CEEsA as a distinct clinical construct should streamline nomenclature, sensitize clinicians to reversible drug triggers, and catalyze research into pathophysiology-specific, age appropriate treatments for this under studied geriatric dermatology domain.

27. Mushroom Poisoning Outbreaks - China, 2025.

期刊: China CDC weekly 发表日期: 2026-Jun-12 链接: PubMed

摘要

Mushroom poisoning is a major food safety threat in China. Since 2019, systematic investigations by China CDC have mapped the spatial and temporal patterns of poisoning incidents and documented the diversity of poisonous mushroom species nationwide. From 2019 to 2024, the annual number of incidents ranged from 276 to 676, and the case fatality rate ranged from 0.87% to 2.86%. In 2025, China CDC investigated 828 mushroom poisoning incidents across 27 provincial-level administrative divisions (PLADs), affecting 2,165 individuals and causing 13 deaths - a case fatality rate of 0.6%, the lowest of the past six years. In total, 138 poisonous mushroom species were identified, including 34 newly recorded in poisoning incidents in China. Prompt identification of the mushroom species, detection of toxins, and confirmation of the clinical syndrome are critical for guiding appropriate treatment and implementing effective public health interventions. Continued efforts are needed to strengthen public education and to enforce stricter market regulation of wild mushroom sales.

28. Patterns and Outcomes of Surgically Treated Non-traumatic Acute Abdomen in a Teaching Hospital in Nigeria: A 10-Year Retrospective Study.

期刊: Cureus 发表日期: 2026-Jun 链接: PubMed

摘要

This study aimed to investigate the epidemiology, clinical patterns, and outcomes of surgically treated non-traumatic acute abdomen in a Nigerian teaching hospital, identifying key predictors of morbidity and mortality. This retrospective study, conducted from 2014 to 2024 at Federal Teaching Hospital, Ido-Ekiti, Nigeria, included 611 patients undergoing surgery for non-traumatic acute abdomen. Obstetric, gynecological, pediatric, traumatic, or conservatively managed cases were excluded. Data on demographics, diagnoses, complications, and outcomes were collected from medical records and analyzed using IBM SPSS Statistics for Windows, version 21.0. Logistic regression identified predictors of adverse outcomes, with significance set at p < 0.05. Non-traumatic acute abdomen accounted for 16.94% (611/3,605) of surgical operations. The cohort (51.06% male, 312/611; 48.93% female, 299/611; mean age 39.70 years) predominantly comprised younger patients (18-27 years, 35.19%, 215/611). Acute appendicitis (51.06%, 312/611), intestinal obstruction (30.61%, 187/611), and perforation (13.75%, 84/611) were the leading diagnoses. Complications occurred in 21.77% (133/611) of cases, primarily wound infection (29.29%, 39/133), sepsis (13.74%, 18/133), and chest infection (9.00%, 12/133). Mortality was 9.98% (61/611), mainly due to septic shock (52.46%, 32/61) and fecal fistula (19.67%, 12/61). Fever, comorbidities, delayed presentation (>7 days), and referred status were significant predictors of adverse outcomes, as detailed in the multivariate analysis. Non-traumatic acute abdomen carries a high burden in Nigeria, driven largely by appendicitis, bowel obstruction, and visceral perforation. Outcomes are worsened by delays at several points along the care pathway, from late recognition of symptoms and delayed decisions to seek care, to prolonged transit to facilities and protracted waits for diagnosis and surgery once patients arrive. These cumulative delays, compounded by systemic infection and coexisting comorbidities, escalate morbidity and mortality, underscoring the need for earlier presentation, faster diagnostic access, and timely surgical intervention.

29. Psychological Correlates of Life Satisfaction Among Medical Students in Northern India: A Cross-Sectional Study.

期刊: Cureus 发表日期: 2026-Jun 链接: PubMed

摘要

The medical curriculum is demanding and often associated with significant stress among students. This study aimed to assess life satisfaction among undergraduate medical students in Northern India and explore factors associated with life satisfaction, including sociodemographic and psychological factors.  This cross-sectional study was conducted among undergraduate medical students from selected medical colleges in Northern India. A multistage random sampling technique was used to select institutions and participants. Data were collected using a structured questionnaire administered through confidential face-to-face interviews after obtaining informed consent. Postinterview deidentification procedures were implemented. No names or direct identifiers were recorded on the questionnaire forms, and each participant was assigned a unique study code.  A total of 415 students participated, of whom 64.1% were male participants. Overall, 64.6% reported being satisfied with their lives. Life satisfaction showed a significant negative correlation with perceived stress (r = -0.331, p < 0.001) and moderate positive correlations with subjective happiness (r = 0.477, p < 0.001) and self-confidence (r = 0.411, p < 0.001). Weak positive correlations were observed between life satisfaction and meditation practice (r = 0.181), spirituality (r = 0.189), gratitude (r = 0.184), and appreciation of beauty (r = 0.227), indicating small effect sizes despite statistical significance (all p < 0.001). In multiple linear regression analysis, subjective happiness (β = 0.328, p < 0.001), self-confidence (β = 0.191, p < 0.001), and perceived stress (β = -0.170, p < 0.001) emerged as significant independent predictors of life satisfaction.  Subjective happiness and self-confidence were independently associated with higher life satisfaction, whereas perceived stress was independently associated with lower life satisfaction. Although coping practices such as meditation and gratitude showed weaker associations, the findings highlight the potential relevance of psychological well-being and coping-related factors in understanding life satisfaction among medical students.

30. It's All in Your Head: A Case Report of Persistent Postural-Perceptual Dizziness and Chronic Anxiety Treated Simultaneously With Osteopathic Cranial Manipulative Medicine.

期刊: Cureus 发表日期: 2026-Jun 链接: PubMed

摘要

Persistent postural-perceptual dizziness is a chronic functional vestibular disorder characterized by persistent dizziness, imbalance, motion sensitivity, and significant psychological distress, frequently including anxiety. Symptoms often persist despite normal imaging and multidisciplinary evaluation, contributing to diagnostic uncertainty and misattribution to psychiatric causes. Osteopathic cranial manipulative medicine is not routinely incorporated into the management of persistent postural-perceptual dizziness despite osteopathic principles, emphasizing the interrelationship between cranial structure, autonomic regulation, vestibular function, and psychological well-being. A 30-year-old female patient with a longstanding history of anxiety, depression, and post-traumatic stress disorder presented with a greater than two-year history of persistent postural-perceptual dizziness, recurrent falls, and imbalance that began following a motor vehicle accident. Her psychiatric symptoms had been refractory to psychotherapy and pharmacologic treatment, while her imbalance remained refractory to physical therapy and neurologic evaluation. The chronic persistence of vestibular symptoms coincided with worsening psychological distress and functional decline. Magnetic resonance imaging demonstrated a suprasellar pituitary lesion without a definitive explanation for her symptoms. Osteopathic structural examination identified decreased cranial rhythmic impulse amplitude, increased dural tension, and superior sphenoid strain at the sphenobasilar synchondrosis (SBS). Osteopathic manipulative treatment was performed, including osteopathic cranial manipulative medicine techniques directed at reducing dural tension and restoring balanced motion at the cranial base. Two treatment sessions were performed one week apart. Following the first treatment session, the patient reported mild improvement in balance and substantial reduction in anxiety symptoms. Following the second session, she reported further improvement in balance, anxiety, and ambulatory confidence compared with pretreatment baseline. Generalized Anxiety Disorder-7 scores improved to below the screening threshold for generalized anxiety disorder, while Patient Health Questionnaire-9 score improved from 11, consistent with moderate depression, to 5, consistent with mild depressive symptoms. The patient additionally reported fewer falls, improved confidence with ambulation, and immediate subjective relief following treatment. This case suggests a potential role of osteopathic cranial somatic dysfunction in persistent postural-perceptual dizziness and associated psychological distress refractory to conventional management. Identification and treatment of superior sphenoid strain were temporally associated with clinically meaningful improvements in vestibular symptoms, anxiety, depressive symptoms, and functional capacity. These findings support further investigation into osteopathic cranial manipulative medicine as a potential adjunctive treatment approach for persistent postural-perceptual dizziness and related neuropsychiatric symptomatology. This case also highlights the importance of comprehensive, multidisciplinary evaluation in patients whose physical symptoms may be prematurely attributed solely to psychiatric diagnoses.

31. Implementation and adaptation of WASH FIT in healthcare facilities: A systematic scoping review.

期刊: World development sustainability 发表日期: 2026-Jun 链接: PubMed

摘要

Environmental health services are important for patient safety and strong health systems, yet access in many countries is poor. To address this, the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) developed the Water and Sanitation for Health Facility Improvement Tool (WASH FIT) to drive improvements. While widely used, there is no systematic documentation of how WASH FIT has been adapted across contexts and the implications of these adaptations. We conducted a systematic scoping review to assess WASH FIT implementation contexts and processes, adaptations, and good practices for implementation. We included peer reviewed and grey literature that described the implementation and/or adaptation of WASH FIT in at least one healthcare facility in a low- or middle-income country. Our search yielded 20 studies; few reported details on healthcare facility contexts. Adaptation was widespread, with nearly all studies deviating from the five-step WASH FIT cycle as designed in the WHO/UNICEF manual. Many studies conducted only one facility assessment and one or no rounds of improvement. Good practices for implementation included adequate resourcing, government leadership, and providing WASH FIT teams with sufficient training and autonomy. Low-quality reporting and a high degree of adaptation make it challenging to determine how and why WASH FIT achieves change. We hypothesize that healthcare facility-level action by WASH FIT teams to assess conditions and implement improvements has some effect. However, advocacy that uses WASH FIT indicators to highlight deficiencies and promotion of WASH FIT by WHO and UNICEF to pressure government action may be equally or more powerful drivers of change. More rigorous evidence to understand how and why WASH FIT works is essential to improve its performance and inform scale-up.

32. Clinical and Epidemiological Characteristics of Suspected Child Maltreatment Reported After Caregiver Emergency Department Visits in Japan.

期刊: Acute medicine & surgery 发表日期: 2026 链接: PubMed

摘要

Child maltreatment is a major public health concern, yet identification in emergency department settings remains challenging. Caregiver-focused approaches may help identify families at risk. We describe cases reported to a hospital-based Child Protection Team following caregiver emergency department visits in Japan. We conducted a single-center retrospective observational study at an urban tertiary hospital. We included caregiver emergency department visits between January 2022 and December 2024 when the presenting adult was 18 years or older, the visit was reported to the Child Protection Team regarding at least one child under 18 years in that adult’s care, and the team subsequently judged that involvement was required. We extracted medical record variables and used descriptive analyses. We included 79 index caregivers and 101 emergency department visits. A documented history of mental health conditions was present in 53% of caregivers. Common diagnoses included drug intoxication, alcohol-related disorders, somatic symptom-related or dissociation-related diagnoses, injuries related to domestic violence, and self-inflicted injuries. Neglect was the most common reason for notification. Fifty-seven percent of caregivers had prior involvement with the Child Protection Team or the Council for Children Requiring Care and Support, and 30% required new registration or temporary child protection after the team review. This study describes a selected group of caregiver emergency department visits that were reported to a hospital-based Child Protection Team and subsequently judged to require team involvement. Further studies with defined caregiver denominators and comparison groups are needed to evaluate caregiver-focused emergency department assessment pathways.

33. Evaluating the implementation of a mental health joint response with young people and families: protocol for the care responders study, a realist and health economic evaluation.

期刊: Frontiers in health services 发表日期: 2026 链接: PubMed

摘要

Mental health crises among children and young people are increasing in frequency and complexity, yet emergency responses often lack appropriate tailoring for young people and responders cite a need for further workforce training and support. This study will integrate immersive theatre, co-production methods, health economic analysis, research data, and a realist synthesis to develop a holistic programme theory informing joint responses to crisis care for children and young people. It will incorporate novel triangulation across these methods and, where appropriate, draw on the recently published Realist Economic Evaluation Methods(REEMS) guidance. This study aims to evaluate a novel intervention involving a joint response by police officers and mental health practitioners. A realist and health economic evaluation design will be employed, incorporating multiple data collection methods. Participants will include children and young people aged 5-18, their families, carers, and practitioners. Data will be collected through surveys, interviews, and routine service records, with recruitment via five distinct pathways including direct response and online participation. The evaluation will explore how, why, and for whom the joint response car works, identifying mechanisms and contextual factors that influence outcomes. A cost-consequence analysis will assess the financial implications of the intervention compared to usual care. Findings will inform best practice guidance for emergency mental health care and support national implementation of joint response models. The study will also contribute to understanding service integration and stakeholder engagement in crisis care.

34. The mental health and wellbeing outcomes and mechanisms of change in arts inclusive programs for children aged 6-12: a systematic review.

期刊: Frontiers in health services 发表日期: 2026 链接: PubMed

摘要

Arts-based programs have re-emerged as a focus of population mental health policy, with the World Health Organisation Healing Arts initiative and social prescribing programs across the UK, Australia, USA, and Canada signaling growing interest in scalable, accessible approaches to mental health prevention. With this growing trend there is an opportunity for seeking complementary scalable approaches implemented during childhood to prevent mental-ill health. The aim of this study was to provide a broad overview of the nature of the relationships between participation in arts programs and mental health and wellbeing outcomes during middle childhood, with a specific emphasis on the mechanisms that may underlie this relationship. This review also aimed to identify program characteristics and the context in which this relationship exists. This systematic review was performed according to PRISMA guidelines with a focus on studies examining the relationships between arts participation and mental health and wellbeing outcomes among children in the general population during the middle childhood years (6 to 12 years). A total of 34 studies were included, made up of primarily quantitative studies. The evidence base reviewed suggests therapeutic approaches in non-clinical settings led by specialists over shorter periods of implementation (typically 4-10 weeks) shows preliminary signs of promise. Recreational programs showed inconsistent effects across outcome domains: some studies reported benefits to wellbeing and stress, while others reported no effect on internalising or externalising symptoms, with no consistent pattern across program features. Psychological and biological constructs were the most commonly identified mechanisms of change. The certainty of evidence across all mental health outcomes was rated as low or very low. This first systematic review of arts-inclusive programs in middle childhood points to preliminary signs of promise, particularly for therapeutic approaches in non-clinical settings, although the certainty of evidence is low. Future research should focus on conducting high quality studies in school contexts with a focus on pedagogical design and facilitator expertise. This would address cost effectiveness for scaling at the general population level for prevention. https://www.crd.york.ac.uk/PROSPERO/view/CRD42024581364.

35. Epidemiology of bone cancer in Saudi Arabia: a nationwide population-based study (2004-2020).

期刊: Frontiers in oncology 发表日期: 2026 链接: PubMed

摘要

Bone cancer is a rare malignancy worldwide, with incidence patterns that vary by age, sex, and geographic region. In Saudi Arabia, however, comprehensive population-based evidence describing the national epidemiology of bone cancer remains limited. This study aimed to describe bone cancer incidence in Saudi Arabia according to age group, sex, calendar year, and administrative region, with particular emphasis on age-standardized incidence rates (ASIRs). A retrospective population-based descriptive study was conducted using data from the Saudi Cancer Registry. All primary bone cancer cases diagnosed between 2004 and 2020 were included. Incidence patterns were summarized using frequencies, age-specific incidence rates, crude incidence rates (CIRs), and ASIRs, stratified by sex, age group, year of diagnosis, and region. Statistical analyses were performed using SPSS software version 30. Between 2004 and 2020, a total of 2,275 primary bone cancer cases were recorded in Saudi Arabia, including 1,318 males (57.9%) and 957 females (42.1%). Bone cancer accounted for approximately 2.0% of all cancers among males and 0.9% among females. Mean ASIRs were higher in males (≈1.0 per 100,000) than females (≈0.7 per 100,000), while CIRs remained below 2.0 per 100,000 throughout the study period. Age-specific incidence showed a clear adolescent peak, most prominent in the 15-19-year age group, followed by the 10-14-year group. Regional variation in ASIRs was observed, with higher rates in Al-Jouf and Najran and persistently lower rates in Jazan. Bone cancer in Saudi Arabia is rare but demonstrates distinct variation by sex, age, and region. The observed male predominance and adolescent peak are consistent with international epidemiological patterns. Continued enhancement of population-based cancer surveillance is essential to support accurate epidemiological assessment and informed public health planning.

36. Advancing Women's Global Health Leadership: Lessons from a Tripartite Model.

期刊: Annals of global health 发表日期: 2026 链接: PubMed

摘要

Background: Women in the Global South remain underrepresented in high-level leadership positions in global health. Three academic institutions developed the Women in Global Health Leadership Fellowship (WGHLF) to build and strengthen the capacity of emerging women leaders in global health in Kenya and South Africa. Objective: The purpose of this study was to evaluate how well the program met its intended outcomes in its first two years of operation. Methods: Twenty-eight participants (12 in 2024 and 16 in 2025) were evaluated. Participants included early- to mid-career women working in health policy, practice, and academia. We analyzed pre- and post-assessment data, mid-year surveys, and focus group responses. Results: Participants reported considerable knowledge and skill gains in global health policy, gender equity, leadership, and mentorship as well as increased confidence in their ability to succeed in higher-level leadership roles. Participants also noted an increased ability to lead gender equity projects at their workplace. Reported program strengths include high participant engagement, collaborative teaching approaches, growth in participant self-awareness, and the practical application of knowledge through their required leadership projects. Conclusions: The WGHLF improved participants’ confidence in advancing gender equity practices in local, regional, and global health. This type of fellowship training, offered in partnership between institutions in the Global North and Global South, can serve as a collaborative model for others seeking ways to help qualified women prepare for higher-level leadership positions, which are crucially needed to advance gender equity and local health systems.

37. A conceptual clinical reasoning framework for early syndromic recognition in dental practice.

期刊: Frontiers in oral health 发表日期: 2026 链接: PubMed

摘要

Oral and craniofacial findings are reported in more than 900 genetic syndromes, yet their relevance at the chairside is often unclear. Dentists routinely encounter these features as isolated observations, while most available literature-being syndrome-centered-provides limited guidance on when a finding should be considered clinically significant. Delayed recognition of syndromic patterns leads to missed opportunities for early intervention. We conducted a narrative review integrating evidence from syndromic dentistry, epidemiology, and clinical reasoning. A sentinel finding was defined as a common oral or craniofacial feature that, when present beyond a defined threshold or in a characteristic pattern, increases the likelihood of an underlying syndromic condition. Using predefined selection criteria, six sentinel findings were identified. For each finding, we specify when it becomes clinically relevant, outline associated syndromes and genetic links, and indicate what to elicit on history and examination, including extraoral features. These elements are considered together within a four-step analytical pathway, which distinguishes findings suitable for monitoring from those requiring referral. This feature-based framework is designed to guide decisions when routine findings raise suspicion of an underlying syndrome. By structuring how such features are interpreted, it aims to reduce diagnostic uncertainty and facilitate earlier recognition in practice. The framework remains conceptual and requires prospective validation.

38. Determinants of smoking cessation program completion and continued tobacco use in a referral program in West Virginia: An EHR data analysis from 2018-2023.

期刊: Tobacco prevention & cessation 发表日期: 2026 链接: PubMed

摘要

Smoking is a risk factor for various comorbidities, yet only a few who attempt to quit are successful. This study examined factors associated with program completion (defined as at least four clinic visits) of a tobacco cessation program in West Virginia and identified predictors of continued tobacco use at the last visit. An observational retrospective cohort study analyzed electronic health records (2018-2023) collected from a tobacco cessation clinic. Patients aged ≥18 years with a history of tobacco use received individualized treatment combining pharmacological and behavioral therapy. Follow-up visits assessed cessation progress. Logistic regression estimated odds ratios (ORs) and 95% confidence intervals for predictors of program completion and continued tobacco use. Among 407 participants, 85% completed at least four clinic visits, but 81.57% continued tobacco use at the last visit. Cancer (AOR=2.77; 95% CI: 1.36-5.65) and hypertension (AOR=3.26; 95% CI: 1.64-6.47) were associated with higher odds of program completion, whereas alcohol use was associated with lower odds of program completion (AOR=0.52; 95% CI: 0.29-0.93). Continued tobacco use was associated with higher tobacco pack-years (AOR=1.01; 95% CI: 1.0-1.02) and lower number of clinic visits (AOR=0.98; 95% CI: 0.96-0.99). Alcohol use, cancer, and hypertension were predictors of program completion, while continued tobacco use on the last visit was associated with tobacco pack-years and the number of clinic visits. Despite high program completion, most participants continued using tobacco on the last visit, highlighting the persistent challenge with the poor effectiveness of smoking cessation treatments. Integrating tailored cessation strategies and utilizing chronic diseases as motivational tools could improve the effectiveness of interventions in high-prevalence states like West Virginia.

39. Normal Trauma and Abnormal Diagnosis: A Discursive Analysis of Sexual Violence Law and Policy in England and Wales.

期刊: Feminist legal studies 发表日期: 2026 链接: PubMed

摘要

This paper interrogates the discursive construction of the relationship between sexual violence and ‘mental health’ in case law and legal policies from England and Wales. It shows that the law invariably enacts a binary discursive construction of those who have experienced sexual violence where mental health evidence is introduced. Individuals are constructed as either experiencing ‘normal trauma’ or an ‘abnormal diagnosis’. These findings are contextualised within recent feminist legal reforms to the treatment of mental health evidence in sexual violence cases, and emphasise the pressing need to centre the experiences of those who identify with psychiatric diagnoses in feminist anti-sexual violence politics.

40. Mapping the availability of climate and health education in European schools of public health: a baseline assessment for indicator development.

期刊: International journal of public health 发表日期: 2026 链接: PubMed

摘要

Climate and health education is increasingly recognised as essential for preparing a climate-competent public health workforce, yet reliable European baseline data remain limited. This cross-sectional study assessed the availability of climate and health education in degree-granting Schools of Public Health across the World Health Organization European Region. A survey of Association of Schools of Public Health in the European Region member institutions was combined with a large-language-model-assisted web scan and manual verification of institutional websites, curricula, syllabi, and programme descriptions. Overall, 268 Schools of Public Health were identified across 53 countries, including 131 ASPHER members and 137 non-members. Of these, 111 institutions (41.4%) offered at least one verified climate and health education programme or course in 2024/2025. Availability was similar among ASPHER members (41%) and non-members (43%). Most identified programmes were offered at master’s level, while vocational, bachelor, doctoral, and continuing professional development opportunities were less frequent. Climate and health education is present across much of Europe but remains uneven and concentrated at postgraduate level. The findings provide a verifiable baseline for future monitoring and policy action.

41. Ecological and engineered modulation of the mosquito microbiome: mechanisms, vector competence, and translational prospects for disease control.

期刊: Frontiers in microbiology 发表日期: 2026 链接: PubMed

摘要

Malaria, dengue fever, Zika, chikungunya, yellow fever, and West Nile fever are mosquito-borne diseases that collectively impose an enormous global health burden, disproportionately affecting low- and middle-income countries where vector-control tools remain limited or compromised by insecticide resistance. Over the past two decades, the characterization of mosquito-associated microbiomes has transformed our understanding of vector biology, revealing complex, ecologically contingent assemblages of bacteria, fungi, viruses, and protists that profoundly influence mosquito physiology, immunity, and pathogen transmission competence. This review synthesizes current knowledge on the composition and determinants of the mosquito microbiome across major vector genera-Aedes, Anopheles, and Culex-and critically evaluates evidence for microbiome roles in larval development, adult fitness, immune homeostasis, and pathogen-vector interactions. We examine how resident microbiota can inhibit or, in some contexts, facilitate pathogen establishment, dissemination, and transmission, and we discuss the mechanistic pathways underlying these effects, including immune priming, niche competition, antimicrobial metabolite production, and modulation of midgut barrier integrity. We then review major strategies for deliberate microbiome modulation, including Wolbachia-based pathogen blocking and population suppression, paratransgenesis, symbiont supplementation, microbiota engineering, and habitat-level manipulation, and evaluate their biological rationale, current evidence base, field feasibility, and limitations. Attention is given to the gap between laboratory proof-of-concept and operational deployment, as well as to biosafety, regulatory, ecological, and ethical challenges that must be resolved before microbiome-based interventions can be integrated into public health programs. We conclude by identifying priority research questions and the technological advances most likely to accelerate progress from descriptive microbiome science to predictive, actionable vector control.

42. Moral courage efficacy among medical students: associations with environmental professionalism, empathy attitudes, and communication self-efficacy.

期刊: Frontiers in medicine 发表日期: 2026 链接: PubMed

摘要

Moral courage efficacy is the belief in one’s perceived ability to take an active stand or action in the face of others- and self-wrongdoing or moral injustice, despite a risk of negative consequences. Although moral courage is important for enhancing patient safety and quality of care, there is limited research on moral courage efficacy and its environmental and personal contributing factors to guide educational interventions. The current study examined the complex relationships between environmental professionalism, empathy attitudes, communication self-efficacy, and moral courage efficacy. The sample included 178 clinical medical students who had completed online self-reported questionnaires. Data were analyzed via Pearson’s correlation tests and Hayes’s regression-based PROCESS macro. The study findings showed that environmental professionalism was directly associated with moral courage efficacy toward others (β = 0.40) and toward the self (β = 0.44). Empathy attitudes was indirectly associated with both moral courage efficacy dimensions through communication self-efficacy (β = 0.08 and β = 0.09, respectively). The findings highlight the need for educational interventions to focus on organizational (environmental) and personal (enhancing empathy and communication self-efficacy) levels to enhance moral courage efficacy. Intervening on both levels may help create a safer space, increased motivation, and perceived ability for students to disclose others’ and their own wrongdoing, thus potentially promoting a safer and more moral medical environment.

43. Engaging Faith Communities in Hispanic Child Obesity Prevention: Church Leaders' Insights on Barriers and Cultural Strategies.

期刊: Global qualitative nursing research 发表日期: 2026 链接: PubMed

摘要

Childhood obesity disproportionately affects Hispanic children, yet culturally responsive interventions within faith-based organizations remain underutilized. This formative study explored faith leaders’ perspectives on promoting healthy eating to inform church-based obesity prevention in predominantly Hispanic congregations. Using a qualitative-dominant mixed-methods design guided by Community-Based Participatory Research principles, we conducted surveys and in-depth interviews with faith leaders from diverse Arkansas denominations, including 30 who participated in interviews. Participants described balancing formal religious duties with informal roles as role models, community builders, and cultural translators connecting congregants to external resources. Three themes were developed through reflexive thematic analysis: (1) faith leadership as relational and cultural brokerage; (2) navigating tensions between spiritual mission and health promotion; and (3) the church as a culturally anchored space for holistic well-being. Leaders emphasized integrating health initiatives into existing church activities, adapting traditional foods rather than replacing them, and using culturally resonant materials delivered by trusted messengers. Findings demonstrate that faith-based organizations can support sustainable healthy eating interventions when programs align with spiritual priorities and cultural traditions, informing the development of a culturally-tailored, faith-based healthy eating intervention for Hispanic families.

44. Oral microbiome dynamics across periodontitis severity stratified by type 2 diabetes status.

期刊: Journal of oral microbiology 发表日期: 2026 链接: PubMed

摘要

The oral microbiome serves as an effector of bidirectional promotion between periodontitis and type 2 diabetes mellitus (T2DM). However, the association between diabetes status and oral microbiota alterations and whether these patterns explained increased periodontitis severity remains unclearly illuminated. In this study, an investigation was conducted into the association of T2DM with periodontitis severity from the perspective of the oral microbiome. This cross-sectional study enrolled cohorts of patients with and without T2DM presenting periodontitis. Combined with bioinformatics and statistical analyses, 16S rRNA gene sequencing was utilized for characterizing the oral microbiome across four oral niches in patients with different T2DM statuses and periodontitis severity. Oral microbiome composition was dysregulated in the context of periodontitis with or without T2DM. The variation pattern of the oral microbiome showed obvious differences. Capnocytophaga sputigena, Fusobacterium hwasookii, and Capnocytophaga gingivalis demonstrated a significant down-regulation exclusively in T2DM subjects. Compared with non-diabetic (ND) subjects, T2DM subjects exhibited markedly altered correlation patterns between Filifactor alocis, Fusobacterium nucleatum, and other periodontitis-associated differential microbes and clinical parameters. Solobacterium moorei, Catonella morbi, and several additional taxa were potential biomarkers of periodontitis severity in T2DM subjects. In addition, T2DM altered microbial interaction between plaque (Pla) and gingival crevicular fluid (GCF) communities, which may form an oral microbial environment facilitating periodontitis severity. T2DM greatly reshapes periodontitis-associated oral microbial dysbiosis patterns, which additionally display T2DM-specific microbial traits. This highlights the unique regulatory role and significant impact of T2DM on oral microbiome alterations in periodontitis.

45. Cross-cultural differences in exercise motivation among U.S. and Korean college students: evidence from the Exercise Motivations Inventory-2 (EMI-2).

期刊: Frontiers in public health 发表日期: 2026 链接: PubMed

摘要

As college students increasingly face academic and social pressures, maintaining regular physical activity has become an important public health concern. However, Preliminary data indicate that physical inactivity remains a global public health concern, with college students experiencing barriers influenced by social and cultural factors. Thus, this study aimed to examine cross-cultural differences in exercise motivation among college students in the United States and South Korea. Participants were recruited from two public 4-year universities located in the southern United States and from two 4-year universities in Korea. A total of 752 college students (373 U.S. and 379 Korean) were analyzed using the Exercise Motivation Inventory-2 (EMI-2). The findings indicated that U.S. students generally exhibit higher motivation for exercise, particularly that inspired by stress management (p < 0.001), revitalization (p < 0.001), enjoyment (p < 0.001), and health-related factors, while Korean students prioritize social recognition (p = 0.007). Additionally, U.S. female students demonstrated greater motivation across all subscales than their Korean counterparts, whereas Korean male students emphasized challenge (p = 0.027) and social recognition (p < 0.001) more than U.S. males. The present findings indicate that exercise motivation differs between U.S. and Korean college students across several motive dimensions. The results suggest that some exercise motives may be relatively stable across student populations, whereas others may be more sensitive to educational and social context. These findings may inform future efforts to design context-sensitive physical activity promotion strategies in university settings.

46. Situation report: reactions to mammalian amniotic fluid and blood among veterinarians.

期刊: Frontiers in allergy 发表日期: 2026 链接: PubMed

摘要

Reactions to animal biological fluids are poorly described in veterinary occupational health, despite exposures during obstetrical and surgical procedures. This study aimed to characterize the clinical features and risk determinants of reactions to mammalian amniotic fluid (AF) and blood in veterinarians. A questionnaire was distributed to veterinarians practicing in France and Belgium. Data collected included demographics, allergic history, types of animal exposure, clinical features of reactions, time of onset of symptoms, use of protective equipment. Among 317 respondents, 46% reported reactions to AF and 16% to blood. These reactions were predominantly cutaneous and often delayed, contrasting with the more frequent respiratory symptoms reported after common animal contact. Most cases were linked to bovine exposure and occurred early in obstetrical practice. A strong association was observed between the onset of parturitions practice and first symptoms. Increased number of parturitions and absence of protective measures were associated with higher risk. Reactions to mammalian AF and blood represent a distinct occupational entity in veterinary medicine. The symptoms could be suggestive of protein contact dermatitis. Early exposure and insufficient protection may contribute to their development, highlighting the need for preventive strategies and validated diagnostic tools.

47. Integrative oncology in colorectal cancer: evidence-based strategies from prevention through survivorship.

期刊: Frontiers in oncology 发表日期: 2026 链接: PubMed

摘要

Colorectal cancer (CRC) is a leading global malignancy, with approximately 1.9 million new cases and over 900,000 deaths recorded in 2022, yet evidence-based integrative oncology strategies remain inconsistently incorporated into routine care. This narrative review synthesizes current evidence across the full CRC care continuum, from primary prevention through long-term survivorship. High-fiber diets, Mediterranean dietary patterns, calcium supplementation, regular physical activity, healthy weight maintenance, and berberine each demonstrate reproducible CRC risk reduction in large prospective cohorts and multicenter randomized controlled trials. The CHALLENGE trial (NEJM 2025) provides the first randomized phase 3 evidence that structured exercise after adjuvant chemotherapy reduces disease recurrence (HR 0.72) and death (HR 0.63) in colon cancer. Aspirin chemoprevention requires individualized risk-benefit assessment per 2022 US Preventive Services Task Force guidelines; preliminary CaPP3 trial data (conference presentation, June 2025; not yet peer-reviewed) suggest non-inferiority of low-dose aspirin (75-100 mg/day) to 600 mg/day in Lynch syndrome, pending formal publication. Fusobacterium nucleatum promotes colorectal carcinogenesis through five mechanistically distinct pathways: FadA-mediated Wnt/β-catenin activation, Fap2- and CbpF-mediated immune evasion via TIGIT and CEACAM1, succinate-HIF-1α-EZH2-mediated immune suppression, Hippo pathway-mediated suppression of pyroptosis, and autophagy-induced chemoresistance. Perioperative multi-strain probiotics significantly reduce postoperative infectious complications, and fecal microbiota transplantation shows preliminary promise for sensitizing microsatellite-stable CRC to immunotherapy. The 2022-2024 SIO-ASCO and ASCO-SIO clinical practice guidelines endorse mindfulness-based interventions, yoga, and acupuncture for anxiety, depression, fatigue, and cancer-related pain. Systematic integration of these interventions into multidisciplinary CRC care requires standardized implementation frameworks, CRC-specific clinical trials for mind-body modalities, and bioavailability-optimized phytochemical formulations.

48. Targeting the osteoimmune microenvironment to prevent regulated chondrocyte death in osteoarthritis: therapeutic potential of natural products.

期刊: Frontiers in cell and developmental biology 发表日期: 2026 链接: PubMed

摘要

Osteoarthritis (OA) is increasingly recognized as a whole-joint disease driven by a dysregulated osteoimmune microenvironment, rather than mere mechanical wear. Despite the high prevalence of OA, current pharmacotherapies are largely palliative, failing to halt cartilage degeneration or reverse chondrocyte death. Consequently, the development of Disease-Modifying Osteoarthritis Drugs (DMOADs) targeting the underlying pathology remains an urgent unmet need. Natural products, distinguished by their pleiotropic nature, have emerged as promising candidates capable of functioning as “network regulators” to restore joint homeostasis. This review systematically elucidates the multi-dimensional mechanisms by which natural products prevent regulated cell death (RCD) in chondrocytes. We highlight their capacity to orchestrate upstream immune responses by repolarizing synovial macrophages, blocking inflammatory cascades (e.g., NLRP3 inflammasome), and restoring downstream cellular defenses. Special attention is given to emerging mechanisms, including the inhibition of ferroptosis and the reversal of metabolic reprogramming via the modulation of the HIF-1α/HIF-2α switch and the NAD+/SIRT1 axis. Furthermore, we extend the discussion to the subchondral bone, emphasizing the restoration of the osteochondral unit. To bridge the gap between preclinical success and clinical translation, we discuss current challenges such as bioavailability and propose future strategies involving biomimetic nanodelivery systems and precision medicine based on OA endotypes. Collectively, this review provides a comprehensive framework for utilizing natural products to rewire the osteoimmune microenvironment, highlighting their potential as promising candidates for future DMOAD development.

49. Comparative Evaluation of Urine, Sputum, and BALF for Human Microplastic Exposure Monitoring Using a Multicriteria Decision Framework.

期刊: Journal of toxicology 发表日期: 2026 链接: PubMed

摘要

Microplastic (MP) contamination in human biological systems has become a global health concern. However, the selection of the most suitable matrix for biomonitoring remains an open area of investigation. This study evaluates three biological matrices-urine, sputum, and bronchoalveolar lavage fluid (BALF)-for their suitability in MP detection and monitoring. Using data collated from a recent observational study (30 patients) and peer-reviewed literature, we assessed detection sensitivity, polymer diversity, sample availability, and practical feasibility via a multicriteria decision analysis (MCDA) framework inspired by the analytic hierarchy process (AHP). Results showed that sputum exhibited the highest median MP concentration (9.4 particles/mL) and BALF showed the greatest polymer diversity (6 polymer types), while urine showed the lowest levels (2.7 particles/mL). The composite MCDA scores ranked urine highest (26/35) for population studies due to its noninvasiveness and reproducibility, followed by sputum (25/35) for respiratory exposure assessment and BALF (21/35) for deep-lung mechanistic studies. We conclude that a matrix-specific strategy is essential for advancing human MP biomonitoring.

50. Editorial: Harnessing aquatic microbial symbioses for sustainable aquaculture: unveiling biodiversity and ecosystem dynamics.

期刊: Frontiers in microbiology 发表日期: 2026 链接: PubMed

摘要

51. Microbial community composition and diversity in nodules and rhizosphere soil of bitter white lupine (Lupinus albus L.) and rhizosphere soil of triticale (×Triticosecale Wittmack).

期刊: Frontiers in microbiology 发表日期: 2026 链接: PubMed

摘要

This study aimed to elucidate the composition and diversity of microbial communities associated with bitter white lupine (BWL) root nodules, BWL rhizosphere soil, and neighboring triticale (×Triticosecale Wittmack) rhizosphere soil via 16S rRNA gene sequencing. Significant differences in microbial composition and diversity were observed among the sample types. BWL nodules harbored distinct bacterial communities dominated by nitrogen-fixing Bradyrhizobium (61.09%). While both BWL and triticale rhizosphere soils had high bacterial diversity dominated by Actinobacteriota and Proteobacteria (32.81 and 25.18% in BWL, and 27.73 and 26.41% in triticale, respectively). Although BWL and triticale rhizosphere soils shared some microbial taxa, each had substantial unique bacterial communities. Alpha diversity analysis revealed higher bacterial diversity in rhizosphere soils than in nodules. Edaphic factors, such as the organic carbon to clay ratio (soil health indicator), available phosphorus, and clay content, are important factors of rhizosphere microbial community structure. Positive correlations were found between soil organic matter, total nitrogen, and microbial diversity in rhizosphere soils. These findings provide novel insights into plant-microbe interactions in acidic, nutrient-poor soils of northwestern Ethiopia and suggest that microbiome management could enhance soil health and crop productivity in marginal agricultural lands.

52. Text recycling: defining the boundaries of acceptable reuse of one's own work.

期刊: Conservation physiology 发表日期: 2026 链接: PubMed

摘要

53. Processus organisationnels et pratiques cliniques pour la gestion de la douleur chronique en soins primaires : une offre de service découlant du plan d'action en douleur chronique 2021-2026 ministériel du Québec, Canada.

期刊: Canadian journal of pain = Revue canadienne de la douleur 发表日期: 2026 链接: PubMed

摘要

La douleur chronique demeure un enjeu majeur, particulièrement en soins primaires où l’accès à des services appropriés et coordonnés est limité. Pour y répondre, le Plan d’action ministériel québécois en douleur chronique 2021-2026 vise à améliorer l’accès à des soins intégrés grâce à de nouveaux projets de services interprofessionnels en soins primaires. Documenter la mise en œuvre de ces projets en analysant les processus décisionnels, organisationnels et cliniques, ainsi que les innovations et défis observés. Une étude de cas multiméthode a été menée dans cinq projets. Dix gestionnaires et responsables ont participé à des entretiens semidirigés et rempli une enquête organisationnelle. Les données qualitatives et quantitatives ont été analysées pour identifier les facilitateurs et les obstacles à l’implantation. Tous les projets ont implanté des modèles interprofessionnels, mais avec une hétérogénéité importante selon les ressources disponibles. Le triage est principalement assuré par les infirmières, avec une implication médicale limitée. Des pratiques collaboratives dynamiques et qui renforcent la continuité des soins et services ont émergé. Malgré tout, les équipes font face à des défis organisationnels majeurs, dont le financement temporaire, la pénurie de personnel et une coordination intersectorielle fragile. Ces services représentent une avancée significative, mais leur pérennité requiert un soutien institutionnel et un financement durable. Introduction: Chronic pain remains a major issue, particularly in primary care, where access to appropriate, coordinated services is limited. To address this issue, Quebec’s 2021–2026 Ministerial Action Plan for Chronic Pain aims to improve access to integrated care through new interprofessional primary care service projects.Objective: To document the implementation of these projects by analyzing decision-making, organizational, and clinical processes, as well as observed innovations and challenges.Methods: A multi-method case study was conducted across five projects. Ten managers and project leads participated in semi-structured interviews and completed an organizational survey. Qualitative and quantitative data were analyzed to identify facilitators and barriers to implementation.Results: All projects implemented interprofessional models, but with considerable heterogeneity depending on available resources. Triage was mainly performed by nurses, with limited physician involvement. Collaborative practice dynamics emerged, helping to strengthen continuity of care and services. Nevertheless, teams faced major organizational challenges, including temporary funding, staffing shortages, and fragile intersectoral coordination.Conclusion: These services represent a significant step forward, but their sustainability requires institutional support and stable funding.

54. Patterns of Chemotherapy Exposure and Adherence to Safety Practices Among Nurses: A Pilot Descriptive Study.

期刊: Journal of nursing education and practice 发表日期: 2026 链接: PubMed

摘要

The aim of the study was to describe the patterns of exposure to chemotherapy and adherence to chemotherapy safe handling practices among oncology nurses. A cross-sectional survey design was employed. Oncology nurse participants completed online surveys assessing nurses’ demographics, exposure patterns, and their chemotherapy handling practices. One hundred and twenty-three nurses completed the surveys. Participants were recruited from two medical centers in the Midwest region in the United States and social media. Generally, the study findings indicate that nurses are exposed to chemotherapy through various routes, and their use of personal protective equipment (PPE) and chemotherapy-specific equipment is less than the recommended standards. Twenty-one participants (18.1%) experienced chemotherapy exposure, primarily through skin. The participants followed safe chemotherapy handling guidelines at 54.5% of the time. The adherence level was lowest during chemotherapy preparation (43.5% of the time) and highest during chemotherapy administration (63.2% of the time). Engineering control equipment (i.e., closed system transfer devices) was used most of the time during chemotherapy preparation and administration. Among PPE, chemotherapy-specific gloves and gowns were used most frequently across all handling procedures, while eye and respiratory protective equipment were used least frequently. This study highlights the necessity of developing interventions to enhance adherence to safe chemotherapy handling guidelines among nurses at the individual and institutional levels and to address any potential barriers to adherence. Future research is needed to investigate organizational factors and individual factors and their relationships with the patterns of adherence to handling guidelines.

55. Diagnostic complexity and potentially avoidable invasive procedures before the recognition of pneumoconiosis.

期刊: Frontiers in medicine 发表日期: 2026 链接: PubMed

摘要

Pneumoconiosis remains a major occupational health problem worldwide and is frequently initially mistaken for malignancy or infection due to overlapping radiological features. This diagnostic uncertainty may lead to unnecessary invasive procedures, increasing both patient risk and healthcare burden. However, data on how occupational exposure and imaging findings influence diagnostic pathways remain limited. In this retrospective single-center study, we evaluated 121 patients with pneumoconiosis who had undergone invasive diagnostic procedures before pneumoconiosis was considered (2021-2025), representing a population with increased diagnostic complexity. We examined occupational exposure, radiological phenotypes, diagnostic decision-making, and procedure-related outcomes. In these patients, in whom pneumoconiosis had not been considered as a preliminary diagnosis, diagnostic concordance was defined as confirmation of the leading preprocedural working diagnosis by invasive findings. Radiological patterns commonly associated with malignancy or infection were strongly linked to invasive diagnostic procedures. Higher radiological burden was associated with reduced pulmonary function (p < 0.001). Diagnostic discordance between initial clinical working diagnosis and invasive findings was observed in a substantial proportion of cases, reflecting challenges in lesion-based diagnostic approaches. The overall complication rate was 10.7%, with pneumothorax being the most frequent adverse event, particularly following percutaneous procedures. In patients with occupational dust exposure, radiological misinterpretation may contribute to unnecessary invasive diagnostic procedures. Integrating occupational history into early diagnostic evaluation may reduce procedural burden and improve patient safety. These findings highlight the importance of a multidisciplinary and exposure-oriented approach in the management of suspected pneumoconiosis within public health frameworks.

56. Knowledge gaps, psychological burden, and patient-reported symptom severity and daily functioning in autoimmune gastritis: a observational survey of Chinese patients.

期刊: Frontiers in medicine 发表日期: 2026 链接: PubMed

摘要

Autoimmune Gastritis (AIG) is a chronic inflammatory disorder characterized by autoimmune-mediated damage to the gastric mucosa, leading to gastric atrophy and may trigger serious complications such as vitamin B12 deficiency and pernicious anemia. This study aimed to evaluate knowledge gaps, psychological burden and patient-reported symptom severity and daily functioning (PR-SSDF) among Chinese patients with AIG. A questionnaire-based cross-sectional survey was distributed to 130 eligible AIG patients, of whom 113 participants fully completed the survey, achieving a response rate of 86.9%. The questionnaire collected information on sociodemographic characteristics, disease-related knowledge, lifestyle behaviors, as well as AIG-related impacts on patients’ daily activities and mental wellbeing. The majority of respondents were female (66.36%), with the highest proportion in the 40-65 years age group (64.55%). A significant portion of patients had been diagnosed with AIG for less than a year (49.09%). Most resided in urban areas (63.64%). Perceived knowledge about AIG was found to be limited, with only a minority of patients achieved adequate disease comprehension. The majority of patients reported experiencing symptoms that affected their daily life and occupational activities. A substantial proportion of patients also reported experiencing extra-gastrointestinal symptoms and psychological distress following diagnosis. The majority of patients were covered by some form of medical insurance, with the largest group having employee medical insurance (87.27%). Our results reveal prominent self-perceived knowledge inadequacies, psychological distress, and impaired daily functioning among Chinese AIG patients, indicating an urgent need for tailored disease education and psychological support interventions.

57. Systematic Review of Air Pollution in Morocco: Status, Impacts, and Future Directions.

期刊: Advanced sustainable systems 发表日期: 2024-Sep 链接: PubMed

摘要

Despite the recognition of the importance of air pollution in Morocco, current scientific studies are predominantly descriptive and limited. This systematic review aims to provide a comprehensive overview of air pollution in Morocco, delineating the research status and identifying gaps. Searches conducted across PubMed, Google Scholar, and Scopus from 2016 to May 2023 yielded over 3200 articles. From these, 64 original studies are deemed eligible and selected, focusing on air pollution in Moroccan regions or cities. Review articles and those dealing with indoor air quality are excluded, with no restriction on specific pollutant. Research highlights road traffic as the primary contributor to air pollution in Morocco, followed by industrial activities. Exposure to air pollutants is associated with adverse health effects, including mortality, lung disease, respiratory disorders, asthma attacks, and cardiovascular disease. Pollution levels vary among cities, with Casablanca, Kenitra, and Essaouira consistently facing higher pollution levels due to transportation and industrial emissions. Altitude also influences air quality, with higher-altitude areas generally experiencing lower pollutant concentrations. The review highlights the need for extensive research on air pollution’s health and economic effects, improved air quality modeling, and broader pollutant focus beyond just regulated ones.