公共卫生研究摘要 (2026-07-13)

共收录 63 篇研究文章

1. Feasibility of opportunistic screening for preserved ratio impaired spirometry using chest radiography-based deep learning models.

期刊: European journal of radiology open 发表日期: 2026-Dec 链接: PubMed

摘要

Although deep learning models using chest radiographs can estimate spirometry measurements, further investigation is needed to evaluate their ability to screen for preserved ratio impaired spirometry (PRISm), an important pre-COPD subtype. This study assessed whether a chest radiograph-based deep learning model can accurately detect PRISm and perform efficient opportunistic screening. This retrospective study included 54654 paired chest radiography and spirometry datasets from 38470 health checkup participants at a Japanese institution who underwent chest radiography and spirometry on the same day in 2018 and 2019. The dataset of 80% participants was used for model development, and the remaining 20% was used for performance evaluation. We developed a deep learning model that used frontal chest radiographs and demographic scalar inputs to detect PRISm and other pulmonary dysfunction subtypes, including FEV₁ decline, FVC decline, FVC and FEV₁ decline, and airflow limitation. Model performance was evaluated on the internal testing dataset. Subgroup analyses were performed across five independent factors: age, height, ppFVC, ppFEV₁, and FEV₁/FVC. The model achieved an AUROC of 0.892 (95% CI, 0.875-0.906), a sensitivity of 71.6%, and a specificity of 87.9% for PRISm detection on the testing dataset (N = 10917). No significant differences in AUROC were observed across subgroups defined by age, height, FEV₁/FVC, or ppFEV₁. The AUROC values for detecting all pulmonary dysfunction subtypes exceeded 0.8. The chest radiography-based model can effectively detect PRISm and may be useful for opportunistic screening of PRISm for supporting early risk management and intervention for pre-COPD conditions and obstructive pulmonary diseases.

2. Economic burden of adult mild traumatic brain injury in the United States: a scoping review of healthcare-related charges and costs.

期刊: Lancet regional health. Americas 发表日期: 2026-Oct 链接: PubMed

摘要

Mild traumatic brain injury (mTBI) accounts for 80-90% of all traumatic brain injuries, yet its economic burden remains poorly characterized. We synthesized direct healthcare charges and costs associated with mTBI in the United States (U.S.). A PubMed search through October 14, 2025 identified primary studies reporting direct healthcare-related charges or costs among adults with mTBI. All estimates were standardized to 2025 U.S. dollars. Twenty-one studies (1996-2023) out of 3300 screened (0.64%) met inclusion criteria. Index hospitalization costs ranged from $3984 to $31,316 and remained stable over time, whereas national hospital charges increased from $26,021 (mean, standard deviation (SD) $1895) in 1996 to more than $172,080 in recent reports. First-year healthcare costs ranged from $16,898 to $29,045 in civilian populations and reached $182,094 (mean, SD $161,743) in military rehabilitation settings. These findings indicate mTBI imposes substantial costs beyond initial hospitalization and highlight growing financial pressures on trauma systems.

3. Prevalence and correlates of 24-hour movement behaviors among Thai preschoolers.

期刊: Journal of exercise science and fitness 发表日期: 2026-Oct 链接: PubMed

摘要

Early childhood is a critical period for children’s growth and development. Given that over 30% of Thai children under age five experience developmental delays, it is important to examine their movement behavior: physical activity, sedentary behavior, and sleep. These three components are important factors for optimal development. This study assessed 24-h movement behaviors of Thai preschoolers, determined the proportion meeting WHO guidelines, and explored how demographic factors differentiate these behaviors. Data from the Sunrise Thailand Dataset 2023, comprising 518 children aged 3-4 years (50.5% boys and 49.5% girls), were analyzed. Physical activity, sedentary behavior, and sleep were measured using ActiGraph GT3X + accelerometers. Children’s adherence to WHO guidelines was evaluated using descriptive statistics. Independent-samples t-tests and one-way ANOVAs examined differences across demographic subgroups. Multiple linear regression models identified predictors of movement behaviors. Only 26.3% of Thai preschoolers met recommended physical activity levels, 49.8% adhered to sleep duration guidelines, and 68.5% followed sedentary behavior limits. Just 7.5% met all three recommendations simultaneously. Regression analyses revealed socioeconomic factors as the strongest predictors: children from low-income households and those with parents in agriculture or government sectors showed significantly reduced sleep duration and increased sedentary time. Single-parent families demonstrated the lowest overall adherence. The majority of Thai preschoolers failed to meet WHO guidelines, with particularly low compliance in physical activity. These results emphasize the need for developing public health strategies to improve movement behavior, especially in vulnerable populations such as single-parent families and rural communities. Policies should focus on increasing access to safe play environments, promoting active lifestyles, and providing targeted support to caregivers to help children meet these critical health recommendations.

4. Implementation of a specialized inpatient HIV care model and in-hospital mortality in South Brazil: a before-after study.

期刊: Lancet regional health. Americas 发表日期: 2026-Oct 链接: PubMed

摘要

Advanced HIV disease (AHD) remains a major cause of hospitalization and mortality among people living with HIV (PLHIV). We evaluated the association between implementation of a structured specialist-led inpatient HIV care model and clinical outcomes among hospitalized PLHIV in southern Brazil. We conducted an observational before-after study at a tertiary public hospital in Porto Alegre, Brazil, comparing a pre-intervention period (January 2023-April 2024) with a post-intervention period (May 2024-August 2025). The intervention included a dedicated infectious diseases team, standardized protocols for AHD and opportunistic infections, and rapid antiretroviral therapy (ART) initiation during hospitalization. Adults admitted with AHD were included. Adjusted risk ratios (aRR) for mortality, ICU admission, and a composite adverse outcome were estimated using modified Poisson regression. A total of 963 hospitalizations among 899 unique patients were included (406 pre-intervention; 557 post-intervention). Baseline characteristics were similar between periods. In-hospital mortality declined from 24% to 17% (p = 0.014). In adjusted analyses, the post-intervention period was associated with lower risks of in-hospital mortality (aRR 0.74, 95% CI 0.57-0.96), ICU admission (0.70, 0.57-0.86), and composite adverse outcomes (0.78, 0.67-0.92). Opportunistic infection screening increased, lumbar puncture was performed more frequently, and ART was initiated earlier. Implementation of a structured inpatient HIV care model was associated with improved clinical outcomes among PLHIV with AHD. Structured multidisciplinary inpatient HIV care may represent a promising approach to strengthen delivery of WHO-recommended AHD care in hospital settings and warrants further evaluation in controlled studies. Pan American Health Organization (PAHO), US Centers for Disease Control and Prevention (CDC), and Unitaid.

5. Curcumin relieves gas explosion-induced brain injury via TLR4-mediated M2 polarization of microglia.

期刊: Brain, behavior, & immunity - health 发表日期: 2026-Oct 链接: PubMed

摘要

Acute microglia-mediated neuroinflammation and oxidative stress play important roles in the pathogenesis of gas explosion (GE)-induced traumatic brain injury (TBI). Curcumin has documented neuroinflammatory protective properties; however, its effects on gas explosion (GE)-induced TBI and the underlying mechanism remain unclear. In this study, we established a male rat model of acute TBI and an in vitro model of acute microglial impact injury using shockwave physiotherapy. The effects of curcumin on the extent of the brain injury, as well as the levels of inflammatory cytokines, oxidative stress indicators, microglia polarization, and toll-like receptor 4 (TLR4) protein expression in model rats and microglial cells were evaluated using histological staining, western blotting, qPCR, immunohistochemistry, immunofluorescence, and biochemical assays. The results showed that curcumin reduced the pathological changes induced by GE and significantly inhibited the expression of neuron-specific enolase (NSE) (P < 0.05), a marker of microglial activation. Curcumin treatment also promoted M2 polarization of microglia (P < 0.05) and reduced the protein expression levels of TLR4, myeloid differentiation factor 88 (MyD88), NF-κB (P < 0.05), and the pro-inflammatory factors tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6, and NLRP3 (P < 0.05). Moreover, curcumin treatment significantly reduced the levels of oxidative stress factors in rat tissues (P < 0.05). In summary, our findings indicated that curcumin alleviated acute neuroinflammation and oxidative stress induced by GE in vivo and in vitro by inhibiting TLR4-mediated M2 polarization of microglia, thus providing a new treatment target for the neuroinflammation associated with TBI caused by explosives.

6. Non-ionizing radiation and cancer: A review on current evidence, mechanistic insights, and public health implications.

期刊: Biochemistry and biophysics reports 发表日期: 2026-Sep 链接: PubMed

摘要

Non-ionizing radiation (NIR) generated from the high power transmission lines, broadcasting antennas and cellular phones represent one of the widespread environmental exposures which can induce carcinogenic outcome. Although NIR lacks sufficient energy to dislodge the electrons for ionization, an indirect mechanism has been proposed to be involved in adverse outcomes under certain exposure conditions. Consequently, radiofrequency electromagnetic field (RF-EMF) exposure remains a consistent scientific and public health concern regarding its possible role in cancer manifestation. This review aims to analyze the findings of RF-EMF exposure and carcinogenicity by integrating epidemiological studies and experimental findings to demonstrate its potential function in cancer manifestation.The available evidence is not sufficient to conclude that RF-EMF exposure is a direct-acting genotoxic carcinogen or cancer initiator. However, laboratory studies have indicated that long-term exposure to non-thermal RF-EMF can cause oxidative stress, genomic instability, epigenetic alterations, ion transport disruption and dysregulation of cell-signaling pathways. These biological effects may contribute to the promotion and progression stages of carcinogenesis, but are not directly responsible for tumor/cancer initiation. The epidemiological evidence significantly varies between extremely low-frequency magnetic fields (ELF-MF) and radiofrequency electromagnetic fields (RF-EMF). Although ELF-MF exposure has demonstrated a more reliable association with childhood leukemia, the data connecting RF-EMF exposure to cancer is less consistent.Studies with the larger sample size and increased exposure duration are needed to strongly corroborate its involvement in cancer development.

7. Expression and experience domains of negative symptoms in relation to social functioning in patients with schizophrenia: Results from a commonality analysis.

期刊: Schizophrenia research. Cognition 发表日期: 2026-Sep 链接: PubMed

摘要

Negative symptoms in schizophrenia are often conceptualized as comprising two domains, i.e., expression and experience, which have been associated with social functioning. However, whether these two negative symptom domains independently or jointly contribute to social functioning in this population remains unclear. Therefore, we investigated this issue by utilizing commonality analysis (CA). Data were analyzed from 45 outpatients diagnosed with schizophrenia. Negative symptoms were assessed using the Positive and Negative Syndrome Scale, and social functioning was measured with the Specific Levels of Functioning Scale, which includes three subdomains: interpersonal relationships, activities, and work skills. Correlation analyses were conducted to examine the association between the expression and experience domains. Regression analyses were performed to predict the three subdomains of social functioning from the two negative symptom domains. Finally, CA was used to quantify their unique and shared contributions to social functioning. There was a significant positive correlation between expression and experience scores (r = 0.52, p < .01). Regression analyses showed that expression scores were more strongly associated with the activities subdomain, and experience scores with the interpersonal relationships and work skills subdomains. CA revealed that a large proportion (≥ 0.48) of the explained variance in social functioning across subdomains was attributable to shared variance across the expression and experience domains. These findings underscore the importance of assessing both aspects of negative symptoms when planning interventions for patients with schizophrenia. In particular, treatment targets may need to be tailored according to deficits in specific subdomains of social functioning.

8. Exploring the therapeutic potential of Heliotropium strigosum leaves through biological activity evaluation.

期刊: Pakistan journal of pharmaceutical sciences 发表日期: 2026-Sep 链接: PubMed

摘要

Heliotropium strigosum is a traditionally used medicinal plant with reported therapeutic potential, particularly in the management of liver disorders and oxidative stress-related diseases. However, its pharmacological properties require systematic scientific validation. This study aimed to evaluate the antioxidant, hepatoprotective and cytotoxic potential of Heliotropium strigosum leaf extract using in-vitro and in-vivo experimental models. Phytochemical screening was performed to identify bioactive constituents of the plant extract. Antioxidant activity was assessed using the DPPH assay at concentrations of 50, 100, 200, 500 and 1000 µg/mL. Cytotoxic potential was evaluated using the MTT assay to determine cancer cell viability following treatment with the extract. Hepatoprotective activity was assessed in a CCl4-induced hepatotoxicity model in rabbits through biochemical analysis and histopathological examination. Data were expressed as mean ± SEM and analyzed using one-way ANOVA followed by Bonferroni post hoc test, with significance set at p < 0.05. The extract contained key phytochemicals associated with antioxidant and hepatoprotective activities. In the DPPH assay, the extract exhibited dose-dependent free-radical scavenging activity. Cytotoxic analysis using the MTT assay revealed reduced cancer cell viability in treated groups compared to untreated controls. In-vivo, the extract exhibited significant hepatoprotective effects, as evidenced by improvement in liver biomarkers and restoration of normal hepatic architecture in histopathological analysis. The findings suggest that Heliotropium strigosum possesses significant antioxidant, hepatoprotective and cytotoxic properties, supporting its traditional medicinal use. Further studies focusing on isolation of active compounds, detailed mechanistic investigations and clinical trials are required to validate its therapeutic potential.

9. Feasibility of an Adapted Participatory Group Programme for Caregivers of Children With Complex Neurodisability in the United Kingdom: Results From the Encompass-2 Study.

期刊: Health expectations : an international journal of public participation in health care and health policy 发表日期: 2026-Aug 链接: PubMed

摘要

‘Encompass’ is a participatory group-based intervention originating from low- and middle-income countries, co-developed with parents and professionals to enhance the well-being, health literacy and empowerment of caregivers of young children with complex neurodisability. We aimed to assess the feasibility and acceptability of (a) intervention delivery in two socially deprived UK urban areas and (b) evaluation methods including data collection on programme outcomes and costs. We conducted a mixed-methods pilot and feasibility study with caregivers of children under 5 years with complex neurodisability. Feasibility of intervention delivery was assessed based on recruitment rates, group attendance, fidelity checklists and qualitative interviews with caregivers and facilitators. The suitability of evaluation methods was explored through follow-up rates, questionnaire completeness and caregiver feedback on outcome measures. Data relating to implementation at organisational and system levels were explored through interviews with facilitators and key partners. Results were compared to predefined traffic light criteria (green, amber and red) to determine whether a larger scale evaluation was warranted. Eight caregivers participated in the programme. Fidelity of delivery and follow-up questionnaire completion met green criteria, while recruitment and attendance met amber criteria, indicating that minor adaptations are required before scaling up. Qualitative findings demonstrated high acceptability of the programme among caregivers and facilitators, particularly valuing the co-facilitation model, participatory approach and peer support. Flexible delivery, including online participation and communication support, enhanced accessibility for families with diverse needs. Capturing programme delivery costs was feasible and provided preliminary estimates to inform future economic evaluation. Our findings provide proof of principle that ‘Encompass’ can feasibly and acceptably be delivered and evaluated with caregivers of children with complex neurodisability in an ethnically diverse UK community health setting. The findings support progression to a larger scale evaluation, with refinements to recruitment strategies and delivery logistics. Caregivers with lived experience were central to developing the ‘Encompass’ programme and this study. Four local mothers of children with complex neurodisability contributed to planning, recruitment and sense-checking the findings. ClinicalTrials.gov identifier: NCT06310681.

10. Patient Expectations in High-Risk Abdominal Surgery for Cancer.

期刊: Health expectations : an international journal of public participation in health care and health policy 发表日期: 2026-Aug 链接: PubMed

摘要

Despite the central role of expectations in informed consent and surgical shared decision-making, patient expectations frequently remain unelicited or underexplored and are often assumed rather than explicitly addressed. To explore how patients form expectations about high-risk abdominal surgery for cancer and how preoperative expectations influence the experience of surgical recovery and life after surgery. Qualitative study using semi-structured interviews informed by cognitive task analysis and analysed using an abductive thematic framework. Adults (n = 34) at two U.S. academic hospitals who were either scheduled to undergo, or had recently undergone, high-risk abdominal surgery for cancer; interviews were conducted preoperatively (52.9%) and postoperatively (47.1%). Analysis of the interviews revealed three overarching themes characterising how patients formed, understood, and experienced expectations around high-risk cancer surgery. Theme 1: Origin of Expectations- Expectation development was dynamic, context-dependent, and shaped by multiple information sources. Theme 2: The Complexity of Expectations- Patients varied widely in how much they wanted to know; expectations were often internally inconsistent and frequently conflated with hopes. Theme 3: Contrasting Anticipated and Actual Recovery After Surgery- Postoperative experiences commonly diverged from preoperative expectations, and many patients expressed uncertainty regarding recovery and prognosis, even in medically uncomplicated recoveries. The wide variation and inconsistency in patient expectations reflect both the complexity of how patients prepare for high-risk abdominal cancer surgery and their need to navigate uncertainty in ways that align with their individual preferences, values, and tolerance for information. Mismatches between anticipated and actual postoperative experiences underscore the need for structured, patient-centred communication strategies that support realistic preparation for surgical recovery. This study provides insight into how patients with cancer form expectations regarding high-risk abdominal surgery and how these expectations shape preparation for the experience of surgical recovery. Expectations were often incomplete, internally inconsistent, and difficult for patients to articulate, contributing to gaps between anticipated and actual recovery. These findings highlight the need for intentional, patient-centred approaches to elicit, clarify, and better align patient and clinician expectations in surgical oncology. Future work should evaluate intervention strategies to support this goal. Patients participated in in-depth interviews that form the basis of this study. Caregiver interviews were conducted in parallel as part of a related study but were not included in the present analysis. Patients and/or caregivers were not formally involved in the design of the study or in the analysis of the qualitative data.

11. Co-Producing Equitable Perinatal Mental Health Care: Facilitators and Barriers to Access Among Underserved Women in the PRAMS Study.

期刊: Health expectations : an international journal of public participation in health care and health policy 发表日期: 2026-Aug 链接: PubMed

摘要

Underserved women experience disproportionately high rates of perinatal mental health (PMH) difficulties but face substantial barriers to accessing appropriate care. Evidence on how services can be redesigned to improve equitable access remains limited. The Perinatal Redesign for Accessing Mental Health Services (PRAMS) study aimed to co-produce an intervention to improve access to PMH support for underserved women and birthing people. PRAMS is a mixed-methods study informed by Accelerated Experience-Based Co-Design and the Medical Research Council framework for complex intervention development. This paper reports findings from Work Packages 1 and 2. Work Package 1 included a national survey of professionals (n = 129) and semi-structured interviews (n = 19) exploring service provision and barriers to care. Work Package 2 involved 10 focus groups and 4 interviews with underserved women and birthing people (n = 50) recruited through Community Research Link Workers with lived experience. Data were analysed using framework analysis guided by the Candidacy Framework. Barriers to PMH care were identified across all domains of candidacy. Structural barriers included fragmented services, unclear referral pathways, and limited resources. Cultural stigma, language barriers and fears regarding child protection services limited help-seeking. Trust, continuity of care and community-based services facilitated engagement. Both professionals and women described a mismatch between rigid service models and women’s preferences for relational, flexible and culturally responsive support. Access to PMH care among underserved populations is shaped by complex structural and relational factors. Findings highlight the need for flexible, community-based and relationship-centred models of care. Co-production with underserved communities offers a promising approach for developing equitable PMH services to better meet the needs of women facing multiple vulnerabilities.

12. Preparing Emergency Medical Services for Prehospital Buprenorphine: Examining a Train-the-Trainer Approach to Strengthening the Overdose Chain of Survival.

期刊: Journal of the American College of Emergency Physicians open 发表日期: 2026-Aug 链接: PubMed

摘要

Opioid-related overdoses remain the leading cause of accidental death in the US. Many jurisdictions are exploring emergency medical services (EMS)-initiated prehospital buprenorphine induction at overdose scenes to reduce subsequent risk. This study evaluated a training strategy preparing EMS agencies to implement these protocols by examining barriers and facilitators affecting their readiness to integrate buprenorphine into standard care. Leadership from 6 Missouri EMS agencies participated in a 6-month training program to support prehospital buprenorphine implementation. We described this evidence-informed frame-and-foster training approach and present findings from a readiness checklist and interviews with 8 trainees. Analysis followed a deductive, exploration, preparation, implementation, sustainment (EPIS)-guided framework approach to assess trainees’ perceptions of the training and inner and outer barriers and facilitators to agency-wide implementation. All agencies reported readiness, with (1) frontline staff training and (2) partnering with peer-linkage programs as areas for further preparation. Training increased confidence and clarified workflows. Remaining inner barriers within EMS agencies included stigma among paramedics toward people who use drugs, staff resistance, and burnout, while facilitators included clear protocols and integration into community paramedicine programs. Outer barriers included inconsistent community buprenorphine availability, while facilitators included continued training and state support. This evaluation provides early insights into how a structured training strategy can prepare EMS agencies to implement prehospital buprenorphine. Findings can inform future policy and practice to ensure EMS can effectively incorporate buprenorphine induction into overdose response and improve patient outcomes.

13. Associations between smoking-induced deprivation, cigarette purchase price, and coupon use among California adults ages 18-64, 2022-2023.

期刊: Preventive medicine reports 发表日期: 2026-Aug 链接: PubMed

摘要

California has reduced overall smoking prevalence but people with low income still experience disparities in tobacco use. We examined the associations between recent smoking-induced deprivation (SID; spending on cigarettes instead of other needs), daily smoking, cigarette prices, and coupon use. Weighted data from two waves of the Online California Adult Tobacco Survey Supplement collected between November 2022 and November 2023 were combined then limited to current smoking and other variables (n = 2288; weighted n = 1,718,238) for bivariate analysis and multivariable stepwise logistic regression with an interaction term to produce estimates of recent SID. Nearly one-third of California adults (33.04%; CI: 29.36, 36.94%) reported recent SID. We found a significant interaction (p < 0.01) for coupon use at last purchase and non-daily smoking (aOR: 6.85; CI: 4.00, 11.73). Cigarette pack price was not significantly associated with recent SID. Other factors associated with SID were inability to meet basic expenses, higher educational attainment, female gender, and younger age. Policymakers should consider increasing cessation outreach to populations more likely to report recent SID paired with coupon and minimum pack price policies. Interventionists should also consider new programs to address those who do not smoke daily or have high educational attainment.

14. Overcoming social determinants: World trade center health program monitoring use among the general responders.

期刊: Preventive medicine reports 发表日期: 2026-Aug 链接: PubMed

摘要

In the United States, social determinants of health (SDOH) influence preventive health care, morbidity and mortality. As World Trade Center (WTC) general responders’ morbidity has been associated with SDOH, we assessed whether their morbidity was associated with WTC Health Program participation. Five clinical center staff (in New York/New Jersey) collect periodic program data. Adjusted linear, linear mixed model and generalized estimating equation regressions compared general responders’ monitoring visits frequencies between January 1, 2008 (when annual monitoring was recommended) and December 31, 2024 in 15,515 members with marginalized and advantaged SDOH (age, sex, race, ethnicity, health care insurance, marital, educational, income occupational and primary language status) characteristics (excludes 7910 non-consenting; 6953 attending <2 visits; 6968 not seen after 2021; and 15,579 with missing data). No substantial (≥3 months) differences were observed. For example, Black (-0.8, 95% CI -1.3, -0.02) and Hispanic (-0.7, 95% CI -1.4, 0.1) members respectively attended monitoring visits approximately 0.75 months sooner than White and non-Hispanic members. While the cohort has proportionately fewer people of color, women and elderly and more private health insurance coverage than the general population, the program has achieved remarkably similar health monitoring participation across the socio-economic spectrum.

15. 'Just Normal Everyday Things': Patient experiences of occupation-based therapy in an intensive care unit (EFFORT-ICU).

期刊: The British journal of occupational therapy 发表日期: 2026-Aug 链接: PubMed

摘要

Occupational therapy is emerging as one of the components of early rehabilitation for patients in intensive care units (ICUs). This study aimed to explore the lived experience of mechanically ventilated patients participating in an occupation-based intervention, delivered in an ICU by occupational therapists. Interpretative description methodology guided a qualitative study of participants in the intervention group of a single site randomised controlled feasibility trial (EFFORT-ICU). Semi-structured interviews were completed with 11 participants at 90-day post-randomisation. Data were analysed using reflexive thematic analysis. Three themes emerged from the data including (1) relationships with health professionals, (2) mastery of self through participation in daily occupations and (3) the journey of recovery. Participants perceived early engagement in therapy as positive. Participation in early occupation-based therapy, incorporating activities such as grooming and selfcare, was considered beneficial by patients who perceived it had a positive impact on their recovery and the experience of an ICU admission. The results support the contribution of the occupational therapist in ICUs in contributing to humanising care and enhancing longer-term outcomes of patients and highlight the importance of collaboration with families.

16. Editorial: BJOT special collection on race, culture and occupational therapy.

期刊: The British journal of occupational therapy 发表日期: 2026-Aug 链接: PubMed

摘要

17. Occupational participation challenges in adults with mood disorders: A Kawa (River) Model-guided qualitative study.

期刊: The British journal of occupational therapy 发表日期: 2026-Aug 链接: PubMed

摘要

Mood disorders disrupt occupational participation by interfering with routines, roles, and social connectedness. The Kawa (River) model offers a culturally sensitive, metaphor-based framework to explore how individuals perceive and navigate barriers, supports, and opportunities in daily life. Thirteen adults with mood disorders were recruited from a university psychiatry clinic. Participants completed semi-structured interviews guided by the Kawa model, including river drawings and reflective questions. Interviews were transcribed and analyzed using Colaizzi’s phenomenological method. Rigor was supported through reflexive memos, consensus coding, audit trails, peer debriefing, and integration of field notes. Participants described life flow as turbulent, stagnant, or clear, reflecting disrupted routines, fluctuating motivation, and occasional stability. Occupational participation was limited by psychological symptoms, strained relationships, stigma, and rigid environments, yet supported by driftwood resources such as strengths, hobbies, spirituality, social support. Spaces reflected aspirations for independence, growth, stability. The Kawa model provided participants with a supportive framework to share experiences of occupational participation and challenges. Its metaphorical and visual structure encouraged reflection, made complex experiences more accessible, and highlighted barriers and resources. Findings suggest the model can help occupational therapists understand how mood disorders shape daily life and support collaborative goal-setting within culturally responsive practice.

18. Relationship between behavioural observational rating scale of attention function and toileting ability in patients with acute stroke: A cross-sectional study.

期刊: The British journal of occupational therapy 发表日期: 2026-Aug 链接: PubMed

摘要

Toileting independence is a key factor influencing discharge to home for patients with stroke and is a primary target in rehabilitation. Achieving toileting independence requires multiple physical and cognitive functions, including attention. Attentional deficits, occurring in up to 80% of stroke survivors, may hinder toileting independence; however, their impact has not been systematically examined using standardised behavioural observation scales such as the Moss Attention Rating Scale (MARS). We aimed to investigate the relationship between MARS scores and the degree of toileting independence in patients with acute stroke. This cross-sectional study included 61 Japanese patients with stroke (44 with cerebral infarctions, 4 with cerebral haemorrhages and 13 with subarachnoid haemorrhages). The primary outcomes were toileting and toilet trans scores of the Functional Independence Measure. The secondary outcomes were MARS scores, grip strength and Trail Making Test scores. Ordinal logistic regression analysis indicated that MARS scores were independently associated with the degree of toileting independence (R 2 > 0.50, p < 0.05). Toileting independence relies on physical and cognitive functions. The MARS is valuable for determining toileting independence. Using behavioural observation scales, such as the MARS, along with neurological and neuropsychological tests may further support the establishment of occupational therapy goals and interventions.

19. Spatiotemporal differences in traffic efficiency and CO2 emissions across day types: A city-level data-driven analysis of cooperative vehicle-infrastructure systems.

期刊: Journal of environmental management 发表日期: 2026-Jul-12 链接: PubMed

摘要

Speed-guided Cooperative Vehicle-Infrastructure System (CVIS) can alleviate congestion and reduce emissions, but the performance differences between weekdays and weekends are unclear. This study analyzes traffic optimization and CO2 emissions on weekdays and weekends using big data from CVIS in Zibo, a representative, medium-sized, prefecture-level city in China at an early stage of low-penetration citywide CVIS adoption. We developed a trajectory-based peak travel period detection method, a Traffic Resistance Index (TRI), and a CO2 emission quantification model. Analysis of 47 million trajectories revealed that CVIS increases vehicle speed but intensifies its volatility, with the effect more pronounced on weekends. CVIS significantly reduces traffic resistance and improves operational efficiency. Both the relative improvement rate and the absolute optimization effect of traffic resistance are more pronounced on weekends than on weekdays. In terms of time periods, CVIS amplifies the weekend advantage of TRI under both off-peak and peak conditions, strengthens the spatial aggregation of CO2 emissions during peak periods and weakens it during off-peak periods, while it weakens the spatial aggregation of TRI during weekday peak periods and uniformly across all weekend periods. However, CVIS increases CO2 emission factors, with 11.0% on weekends and 5.6% on weekdays, due to its prioritization of speed improvements and low vehicle penetration rates. Accordingly, this paper proposes three optimization strategies for CVIS to improve its performance across different day types and road classes. These findings provide decision support for CVIS applications and promote the development of green, intelligent transportation.

20. Prompt Framing and Evidence Requirements for AI-Generated Educational Responses in Dental Education: An Experimental Study.

期刊: JMIR medical education 发表日期: 2026-Jul-12 链接: PubMed

摘要

Large language models (LLMs) are increasingly used in health professions education; however, the role of prompt design in shaping their outputs remains poorly understood in clinical training contexts. In dentistry, where the presentation of information, perceived credibility, and procedural reasoning are important, the effects of instructional framing and evidence requirements on artificial intelligence (AI)-generated educational responses are particularly relevant. This study examined whether instructional framing and evidence requirements were associated with rater-assessed perceived factuality, confidence of tone, stance orientation, citation behavior, safety notices, hedging, and response length in cavity preparation responses generated using the web-based ChatGPT-5. In a 2 × 2 factorial experiment, we manipulated instructional framing (patient-centered vs. skill-centered) and evidence requirement (evidence-required vs. no evidence) across 10 base prompt topics and four experimental conditions, yielding 40 outputs. Five trained raters independently coded each response for perceived factuality, confidence of tone, stance orientation, hedging, citation presence, safety notices, and response length. Inter-rater reliability was assessed using intra-class correlation coefficients and Fleiss’ κ. Consensus scores were analyzed using factorial analyses of variance and chi-square tests. Requiring evidence was associated with greater citation presence (19/20, 95%, vs. 5/20, 25%; P<.001) and longer responses (P<.001). In exploratory analyses, it was also associated with higher ratings of perceived factuality (P=.015). Hedging and confidence of tone showed non-significant patterns. Instructional framing was associated with stance orientation (P=.006) but was not associated with response length. No refusals occurred, and safety notices were infrequent across conditions. Inter-rater reliability was high for citation presence but low or variable for several subjective measures, particularly perceived factuality and safety notices. Prompt design was associated with differences in the presentation, structure, and stance orientation of LLM-generated educational responses in dentistry. Evidence requirements increased citation inclusion and response length, whereas instructional framing was associated with the stance emphasized in the response. These findings suggest that deliberate, pedagogically aligned prompt design may support the development and evaluation of AI-generated content in dental education. However, the effects of prompt wording on objectively verified accuracy, clinical safety, and learning outcomes require further investigation.

21. Successful Implementation of Hepatitis C Virus Point-of-Care Testing in a Syringe Services Program.

期刊: Substance use & addiction journal 发表日期: 2026-Jul-12 链接: PubMed

摘要

Syringe services programs (SSPs) serve many people who use drugs (PWUD) who need treatment for hepatitis C virus (HCV). The need for laboratory-based HCV RNA testing can present a barrier to diagnosis, care, and treatment. We evaluated the receipt of HCV test results and initiation of the treatment evaluation process among PWUD who received a point-of-care (POC) HCV RNA testing in an SSP. We conducted an observational, prospective study of clients of a health department-run SSP in Seattle, Washington. Participants completed a one-step HCV testing algorithm using POC HCV RNA testing (Xpert® HCV). Participants with HCV received referrals to onsite and offsite treatment providers; same-day treatment was not available at the time of study. Two hundred participants enrolled and received testing. Most participants (74.5%) reported a history of injection drug use (IDU), and 28.5% reported IDU in the past 30 days. Thirty-one participants (15.5%) had a positive HCV RNA test result, 161 (80.5%) had a negative result, and 8 (4.0%) had no result. Nearly all participants (97.0%) received their test result. Six months after testing, among 31 participants with HCV, 8 (25.8%) had initiated the treatment process at the SSP by scheduling at least 1 appointment; 3 (9.7%) started HCV medications through the SSP. No additional participants achieved SVR4 from treatment at another local site at 6 months. We successfully implemented POC HCV RNA testing at an SSP with a high level of returned results. Despite the availability of onsite treatment, relatively few participants with HCV initiated the treatment evaluation process. Linkage to treatment may be improved with additional social supports and/or implementing a protocol with a streamlined initial evaluation and same-day treatment initiation. One-step HCV RNA Testing Among SSP Participants (HOT Study). https://clinicaltrials.gov/study/NCT06634342.

22. What Does It Really Mean to Support Exclusive Breastfeeding in Southern Africa? It's Time to Shift the Paradigm.

期刊: Journal of human lactation : official journal of International Lactation Consultant Association 发表日期: 2026-Jul-12 链接: PubMed

摘要

Breastfeeding is one of the most cost-effective health interventions in existence, improving child survival through improved health and nutritional status and providing numerous benefits to the mother, including lowering the risk of breast, ovarian, and endometrial cancer. Current WHO guidelines recommend exclusive breastfeeding (EBF) for the first 6 months of an infant’s life, which Ministries of Health across Southern Africa support. However, rates of EBF in this region, particularly Sub-Saharan Africa, vary widely and fail to reach global targets. Botswana and South Africa offer specific examples of this variation. Need to return to work has been highlighted as a significant barrier to sustained EBF among women who initiate EBF. Broader workplace structures and expectations for women hinder EBF, particularly in Southern Africa. The informal sector, which employs the majority of women in Southern Africa, often lacks labor protections and social benefits. Conditions within the workplace or at school are also not conducive to the specific demands of EBF, without dedicated space to express milk, facilities to safely store breastmilk, or protected time for breastmilk expression. Guidelines around how best to support breastfeeding women vary widely, and few lay out specific strategies to support EBF in the workplace. Women, regardless of where they live, deserve the choice to elect EBF for their infant. Persistent barriers to EBF prevent postpartum women and their infants, particularly in Southern Africa, from realizing its countless benefits.

23. Barriers and Facilitators for Breastfeeding Among Low-Wage Employees in the Washington, DC, Area.

期刊: Journal of human lactation : official journal of International Lactation Consultant Association 发表日期: 2026-Jul-12 链接: PubMed

摘要

The workplace experience of low-wage breastfeeding employees is not well studied.Research Aims/Questions:To identify low-wage employees’ workplace barriers and facilitators to breastfeeding at 4 and 6 months. Data were collected from 111 low-income participants in a Washington, DC, pediatric clinic. Eligible participants had a child less than 3 years old, were employed when their child was less than 1 year old, and had either breastfed while employed or never breastfed because they planned to return to work. 81.0% of participants breastfed at least 4 months, and 69.8% breastfed for 6 months or greater. Participants who worked in the childcare sector had the highest breastfeeding rates at 4 (92.3%) and 6 months (80.0%) compared to other job sectors. Employees with greater levels of support in the workplace were more likely to breastfeed at 4 (p = .01) and 6 months (p = .02). Employees who were provided break times to pump had higher odds (odds ratio [OR] = 8.80, 95% CI: 1.90/40.68) of breastfeeding at 4 months. Additionally, having supportive coworkers and managers was associated with higher odds of breastfeeding at 4 months (OR = 7.55; 95% CI:1.58/36.07). Factors associated with having a manager supportive of employees’ breastfeeding included working in childcare (p = .009), having a higher education (p = .046), and having a written workplace breastfeeding policy (p = .04). Greater enforcement of breastfeeding policies, improved workplace accommodations, and enhanced support from managers and coworkers may improve breastfeeding rates in low-wage employees.

24. Rivaroxaban Then Aspirin vs. Aspirin Alone after Total Hip or Knee Arthroplasty.

期刊: The New England journal of medicine 发表日期: 2026-Jul-12 链接: PubMed

摘要

Aspirin after an initial short course of rivaroxaban has been shown to be safe and effective for the prevention of venous thromboembolism after total hip or total knee arthroplasty, but uncertainty remains about the use of aspirin alone. In this multicenter, double-blind, randomized, controlled trial, we assigned patients to receive once-daily thromboprophylaxis with either 81 mg of aspirin or 10 mg of oral rivaroxaban for the first 5 days after total hip or total knee arthroplasty. All the patients then received further thromboprophylaxis with 81 mg of aspirin daily for 9 additional days after knee arthroplasty and for 30 additional days after hip arthroplasty. Patients were followed for 90 days for symptomatic venous thromboembolism, which consisted of either proximal deep-vein thrombosis or pulmonary embolism (primary effectiveness outcome), and for bleeding complications (primary safety outcome). The noninferiority margin for aspirin alone as compared with rivaroxaban-aspirin was 0.7 percentage points. A total of 5429 patients underwent randomization. Venous thromboembolism developed in 13 of 2718 patients (0.48%) in the aspirin-alone group and in 12 of 2647 patients (0.45%) in the rivaroxaban-aspirin group (risk difference, 0.02 percentage points; 95% confidence interval [CI], -0.34 to 0.39; P<0.001 for noninferiority). Major bleeding or clinically relevant nonmajor bleeding events occurred in 45 of 2718 patients (1.66%) in the aspirin-alone group and in 54 of 2647 patients (2.04%) in the rivaroxaban-aspirin group (risk difference, -0.38%; 95% CI, -1.11 to 0.34). After total hip and total knee arthroplasty, the use of aspirin alone was not inferior to a strategy of using rivaroxaban followed by aspirin for the prevention of symptomatic venous thromboembolism, with no clinically relevant difference in bleeding events. (Funded by the Canadian Institutes of Health Research; EPCAT III ClinicalTrials.gov number, NCT04075240.).

25. Neighborhood Characteristics and Depressive Symptoms Among Black Pregnant Women in Two Midwest Metropolitan Areas.

期刊: Western journal of nursing research 发表日期: 2026-Jul-12 链接: PubMed

摘要

Approximately 15% of women report depressive symptoms during pregnancy, with Black women more likely to report depressive symptoms prenatally compared with White women. Depressive symptoms are associated with small for gestational age infants and preterm birth. Neighborhood affordability, socioeconomic, ethnic, and racial segregation may adversely influence maternal mental health. We sought to estimate the effect(s) of residential racial composition (ie, percentage of Black residents living within the block group) and neighborhood socioeconomic factors on depressive symptoms among Black pregnant women attending prenatal clinics in Detroit, MI and Columbus, OH. This was a secondary analysis of the Biosocial Impact on Black Births study. We analyzed self-reported depressive symptoms in Black women (N = 565) at 8 to 18 weeks’ gestation. The primary measure was the Center for Epidemiological Studies-Depression Scale (CES-D). The primary explanatory variables were neighborhood-level residential racial composition and rates of poverty, homeownership, household assistance, and educational attainment. A 2-level mixed-effects regression model was used to account for clustering of participants within the study areas. For each percent increase in residential racial composition, there was a 0.66-point decrease in the Center for Epidemiological Studies-Depression Scale (-0.66; 95% CI, -0.112 to -0.021). Adjusting for individual differences among women, the protective effect of residential racial composition on the CES-D persisted (-0.62; 95% CI, -0.108 to -0.017). Our results suggest that living in neighborhoods with a greater proportion of Black individuals may be protective of depressive symptoms for pregnant Black women. These findings were not significant for neighborhood socioeconomic factors.

26. Surgical Wound Care Practices of Nurses in a Low-Resourced Setting: An Observational Study.

期刊: Journal of clinical nursing 发表日期: 2026-Jul-12 链接: PubMed

摘要

To observe and describe the surgical wound care practices of nurses in a Sri Lankan tertiary care hospital. A cross-sectional observational study. We observed surgical wound care practices of registered nurses (RNs) working in 13 general surgical wards of a 3000-bed tertiary care hospital in Sri Lanka. An observation tool developed based on clinical practice guidelines (CPGs) and a chart audit tool were used for data collection. Field notes were taken to describe contextual details. A convenience sample of RNs and a consecutive sample of adult, postoperative patients were recruited. Patients were included once, while nurses were observed on multiple occasions. Descriptive statistics were used, and field notes were added to contextualise the data. We observed wound care episodes across 250 postoperative patients with 63 RNs. Nurses’ hand hygiene (HH) adherence was 58.4% (n = 146) before dressing changes and 43.2% (n = 108) after dressing changes. Wound care education was observed in only 22% (n = 55) of episodes. Documentation of wound care was noted only on 53 (21.2%) occasions. Field notes highlighted the lack of standard wound assessment and management protocols and resource constraints influencing the nurses’ adherence to CPGs on many occasions. Our findings suggest that nurses’ adherence to CPGs was limited, and there are unwarranted variations in nurses’ surgical wound care practices. Unavailability of standard wound care protocols and resource constraints were also identified. These variations appear multifactorial, reflecting limitations in training, staffing, resources and the absence of standardised wound care protocols. Targeted training programs should be conducted for nurses, and context-sensitive wound management protocols should be introduced. As one of the first studies to describe nurses’ surgical wound care practices in a resource-limited country, these findings offer valuable insights into both practice and the contextual influences. The Strengthening the Reporting of Observational Studies in Epidemiology guidelines. No patient or public contribution.

27. Risk factors for iatrogenic retinal breaks during induction of posterior vitreous detachment in macula surgery.

期刊: International ophthalmology 发表日期: 2026-Jul-12 链接: PubMed

摘要

To determine risk factors for retinal breaks (RB) during the surgical induction of posterior vitreous detachment (IPVD) in macula surgery. We retrospectively reviewed electronic records for all adult patients undergoing 25-G or 27-G vitrectomy for macula pathology between November 2019 and January 2024 requiring intraoperative IPVD. We excluded eyes with pre-existing PVD, panretinal photocoagulation, trauma, age < 18 years or missing information. The outcome measure was non-sclerotomy-related iatrogenic RB. We assessed the effect of age, gauge size (25-G vs 27-G), surgical indication (epiretinal membrane [ERM] vs macular hole[MH]/vitreomacular traction syndrome[VMTS]), lens status (Phakic vs Aphakic/Pseudophakic) and surgeon (Consultant vs Fellow) on the odds of RB. Among 185 eyes included in our study, 15.1% experienced a RB during IPVD. Breaks were predominantly located in the inferior retina (69%). Multivariable analysis revealed gauge size significantly impacted RB rate (27-G OR 0.13 95%CI 0.03-0.60, p = 0.008). Other factors including age (OR 0.98 95%CI 0.96-1.01, p = 0.18), lens status (Phakic OR 0.36 95%CI 0.13-1.01, p = 0.053), surgeon grade (Fellow OR 1.8 95%CI 0.18-18.9, p = 0.61) and surgical indication (MH OR 0.70 95%CI 0.30-1.7, p = 0.42) were not significantly associated with odds of RB. There is a high rate of iatrogenic RB in eyes requiring IPVD undergoing macula surgery. Smaller instrument gauge size was associated with lower odds of RB during IPVD, however causal inferences cannot be drawn from these findings. Neither age, surgical indication nor lens status were associated with odds of RB.

28. Outcomes and revision rates after antegrade continence enema (ACE) appendicostomy in a single-center LMIC paediatric cohort.

期刊: Pediatric surgery international 发表日期: 2026-Jul-12 链接: PubMed

摘要

Antegrade continence enema (ACE) appendicostomy is widely used in children with complex colorectal and neurogenic bowel conditions, yet data from resource-constrained settings remain limited. We aimed to describe the experience of a single-center pediatric cohort in a low-middle-income country (LMIC). A retrospective review of all ACE procedures performed between 2012 and 2026 was conducted. Demographics, diagnoses, indications, complications, surgeries, and functional outcomes (assessed with Milan Bowel Function Questionnaire) were collected from clinical and operative records. Descriptive statistics were applied. Forty-five children (80% male) underwent ACE procedures, with a median age of 8.3 years. Most had appendicostomy; two required cecostomy intraoperatively. The most common diagnosis was anorectal malformation (n = 33, 73.3%), followed by neurogenic bowel (n = 7, 15.5%). Eight patients (17.7%) underwent a concomitant Mitrofanoff procedure. The main complication was skin-level stricture (n = 17, 37.8%), representing the only indication for surgical revision (n = 15, 33.3%), with a median time to revision of 5.5 months. Nearly all patients achieved clinical success, with high satisfaction reported on the questionnaire. ACE appendicostomy is an effective and satisfactory option in LMICs, with outcomes comparable to high-income settings, supported by careful patient selection and ongoing quality improvement efforts.

29. Associations between urinary non-essential metal mixture and abdominal obesity in Chinese older adults: the roles of insulin resistance and vitamin D.

期刊: Environmental geochemistry and health 发表日期: 2026-Jul-12 链接: PubMed

摘要

While exposure to individual non-essential metals (NEMs) links to abdominal obesity (AOB), the NEM mixture effects and mechanisms remain unclear, particularly in vulnerable aging populations. We included 3795 community-dwelling Chinese older adults (age ≥ 60 years), measured 6 urine NEMs [gallium (Ga), arsenic (As), cesium (Cs), barium (Ba), thallium (Tl), and uranium (U)] via ICP-MS, defined AOB by sex-specific waist circumference, assessed insulin resistance (IR) via triglyceride-glucose (TyG) index, and determined vitamin D status by serum 25-hydroxyvitamin D [25(OH)D]. Multivariable logistic regression, mixture models [weighted quantile sum (WQS), quantile g-computation (QGC), and Bayesian kernel machine regression (BKMR)], mediation and moderation analyses, and network toxicology analyses were performed. Multivariable logistic regression showed a positive association between urinary Tl and AOB (OR = 1.18, 95% CI: 1.05-1.32). Mixture analyses consistently revealed a significant overall effect of NEMs on AOB, with Tl identified as the primary contributor (WQS weight = 0.481; QGC weight = 0.428; conditional PIP = 0.918). The TyG index was identified as a potential mediator, accounting for 10.18-7.84% of the associations between Tl and AOB and the NEM mixture and AOB, respectively. Vitamin D sufficiency [serum 25(OH)D ≥ 75 nmol/L] significantly attenuated TyG index-AOB association. Network toxicology identified the AGE-RAGE signaling pathway and several hub genes as candidate biological pathways for future investigation of the association between NEM exposure and AOB. These findings highlight the metabolic implications of NEMs, particularly Tl, and suggest that Vitamin D sufficiency may influence metabolic responses associated with AOB, offering novel insights into AOB prevention in the context of NEMs exposure.

30. Flexible ureteroscopy with a flexible and navigable suction ureteral access sheath versus mini-percutaneous nephrolithotomy for renal stones larger than 2 cm in patients with a solitary kidney: a propensity score-matched and win ratio analysis.

期刊: World journal of urology 发表日期: 2026-Jul-12 链接: PubMed

摘要

To compare the efficacy and safety of flexible ureteroscopy using a flexible and navigable suction ureteral access sheath (FANS f-URS) with mini-percutaneous nephrolithotomy (mini-PCNL) for > 2 cm renal stones in patients with a solitary kidney. This retrospective study included patients with a solitary kidney and renal stones > 2 cm who underwent either FANS f-URS or mini-PCNL between July 2023 and January 2026. Propensity score matching (PSM) was performed in a 1:2 ratio. The primary analysis consisted of a pair-matched win ratio analysis using a hierarchical composite endpoint comprising postoperative complications, 1-month stone-free rate (SFR), and length of postoperative hospital stay. Perioperative outcomes and postoperative complications were also compared between the two groups. After PSM, 88 patients were included (41 FANS f-URS and 47 mini-PCNL). In the win ratio analysis, FANS f-URS demonstrated significantly greater overall clinical benefit than mini-PCNL (win ratio = 4.12, 95% CI 1.50-21.02, p < 0.001). Although mini-PCNL achieved a significantly higher immediate SFR, the 1-month SFR was comparable between the two groups after second-stage treatment. Compared with mini-PCNL, FANS f-URS was associated with significantly lower postoperative morbidity, reduced hemoglobin decrease, shorter hospitalization, lower postoperative pain scores, and greater improvement in quality of life. In patients with a solitary kidney and renal stones > 2 cm, a staged FANS f-URS strategy achieved a 1-month SFR comparable to that of mini-PCNL while offering a lower risk of complications and improved postoperative recovery. FANS f-URS may represent a safer and less invasive treatment strategy for this high-risk population.

31. Digital rectal examination in rectal cancer response assessment: clinical performance and the need for standardized reporting.

期刊: Techniques in coloproctology 发表日期: 2026-Jul-12 链接: PubMed

摘要

Accurate assessment of treatment response after neoadjuvant therapy is crucial to select patients with rectal cancer for organ-preserving strategies. Digital rectal examination (DRE) remains a key component of response assessment, but its precise clinical role and the lack of standardized reporting limit its utility. This study aimed to assess variability in DRE reporting and to explore the association between DRE findings at first reassessment and subsequent local oncological outcome within a watch-and-wait pathway, rather than to evaluate DRE as a stand-alone diagnostic test. In this retrospective cohort study at a Belgian tertiary referral center, all patients with rectal cancer considered for active surveillance between January 2018 and January 2023 were reviewed. DREs at diagnosis and first post-treatment reassessment were classified as normal or abnormal. Clinical outcomes during surveillance, including sustained clinical complete response (cCR), local regrowth, and salvage surgery, were recorded. For the primary analysis, histopathologically confirmed viable tumor at salvage surgery was classified as residual tumor, whereas sustained cCR for at least 2 years or salvage surgery without viable tumor was classified as no residual tumor. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated descriptively as exploratory estimates of clinical performance within this multimodal surveillance pathway. Among 105 eligible patients, 20 (19.0%) had abnormal DRE findings at first reassessment. Of these, 19 underwent salvage surgery due to clinical suspicion of local regrowth, and 17 (85.0%) had viable tumor confirmed histopathologically. Among the 85 patients with a normal DRE at reassessment, 24 (28.2%) later underwent salvage surgery for suspicion of local regrowth during follow-up, and all had histologically confirmed viable tumor, while 61 (71.8%) maintained a sustained cCR. At the time of later local regrowth or clinical suspicion, 35 of 39 available DRE reports (89.7%) were abnormal. DRE documentation was brief and heterogeneous, typically consisting of one to two free-text sentences. Within a multimodal watch-and-wait pathway, DRE at first reassessment appears to function primarily as a clinical warning-sign examination rather than as an isolated diagnostic test. A normal DRE does not exclude future residual disease or regrowth, whereas an abnormal DRE should be considered a relevant warning sign within multimodal reassessment. These findings are hypothesis-generating. The marked variability in reporting underscores the need for standardized terminology and structured documentation in rectal cancer response assessment.

32. Training Global Leaders in Perioperative Equity: An Evaluation of the CHESA Fellowship.

期刊: World journal of surgery 发表日期: 2026-Jul-12 链接: PubMed

摘要

Few programs exist to train learners in advancing equity in perioperative care. In response, the UCSF Center for Health Equity in Surgery and Anesthesia (CHESA) launched the CHESA Fellowship in 2021. This 18-month, non-ACGME fellowship uses asynchronous modules, expert-led seminars, mentored research, and community building to equip fellows with the skills to advance perioperative equity worldwide. This report describes the fellowship’s structure and evaluates its early impact on alumni career development. We conducted a mixed-methods fellowship evaluation comprising alumni and end-of-year surveys, focus groups, and a list of fellow-authored publications. Surveys assessed skill development, scholarly output, and satisfaction with curriculum elements. Qualitative data from focus groups were coded to highlight fellows’ experiences and identify areas for improvement. Since 2021, CHESA has trained 80 fellows across 18 countries and 12 specialties; 71.3% are from LMICs and 48.8% are female. Surveys demonstrated strong satisfaction with faculty mentorship, project work, and community-building. Fellows reported acquiring skills in academic writing, mentorship, and leadership, with 53.8% developing new collaborations with co-fellows and 75.0% integrating fellowship learning into their clinical practice. Among alumni, 76.5% reported advancement into new leadership roles or clinical positions. Across cohorts, alumni published 364 manuscripts during or after the fellowship, with 58.8% focusing on health equity. Fellow and faculty feedback identified needs for enhanced research support and faculty development, which were incorporated into subsequent program iterations. The CHESA Fellowship offers an innovative model for building global perioperative leadership. The part-time, virtual format allows fellows to complete the program alongside clinical duties, while seed grants for LMIC fellows support locally driven scholarly projects. By prioritizing cross-border collaborations between fellows, building long-term partnerships with LMIC institutions, and ensuring diversity across geography, specialty, and sex, the fellowship balances accessibility with mentorship and community-building. Alumni report high satisfaction and translate their training into academic, clinical, and advocacy outcomes that advance perioperative equity.

33. Screening for Neurodevelopmental Disorders in Japanese 18- and 36-Month Health Check-Ups: Utility and Reproducibility of the ESSENCE-Q.

期刊: Acta paediatrica (Oslo, Norway : 1992) 发表日期: 2026-Jul-12 链接: PubMed

摘要

The ESSENCE Questionnaire (ESSENCE-Q) helps detect early neurodevelopmental disorder signs across multiple developmental domains for timely intervention. We evaluated the feasibility, reliability, accuracy and reproducibility of ESSENCE-Q in 18- and 36-month Japanese infants and toddlers. Longitudinal data from 1373 children who participated in 18- and/or 36-month health check-up were analysed. ESSENCE-Q was completed independently by mothers (ESSENCE-Q-M), public health nurses (ESSENCE-Q-N) and psychologists (ESSENCE-Q-P). Its effectiveness was evaluated using receiver operating characteristic curves, and optimal cut-off values were established. The overall neurodevelopmental disorder prevalence was 11.2%. The internal consistency of ESSENCE-Q was good. ESSENCE-Q-P demonstrated the highest performance at 18 months. Both ESSENCE-Q-N and ESSENCE-Q-P demonstrated excellent performance at 36 months. ESSENCE-Q-M is not sufficient for standalone use. ESSENCE-Q is a highly useful and reproducible screening tool for professionals for 18- and 36-month check-ups. ESSENCE-Q completed by mothers should be supplemented with professional assessments. We assessed the utility of the ESSENCE Questionnaire (ESSENCE‐Q) at 18‐ and 36‐month check‐ups in Japanese children. ESSENCE‐Q assessed by psychologists showed the best performance at 18 months, while assessments by public health nurses and psychologists were best at 36 months. ESSENCE‐Q is highly useful and reproducible when used by professionals; assessments by mothers should be done in conjunction with professionals.

34. The Effects of Women's Work on Breastfeeding Outcomes and Time Allocation in Bangladeshi Shodagor Fishing and Trading Communities.

期刊: Journal of human lactation : official journal of International Lactation Consultant Association 发表日期: 2026-Jul-12 链接: PubMed

摘要

Maternal work promotes household and child wellbeing but often presents barriers to optimal breastfeeding outcomes. Maternal work in the variable informal economy has less well-established impacts, but may facilitate breastfeeding when work is childcare compatible. We conducted survival analysis using data from 110 breastfeeding dyads to assess occupation’s effects on time-to-return to work, time-to-complementary feeding, and time-to-breastfeeding cessation in a mixed cash/subsistence economy of fishers, traders, and housewives. We drew on 5,874 hours of longitudinal time-diary data for 68 dyads to evaluate whether occupation and maternal work/childcare strategy (home with child, working with child in tow, or working without bringing child) predicted daily breastfeeding patterns. Fishers returned to work significantly earlier postpartum than traders (p < .001) and began complementary feeding earlier than traders (p < .01) and housewives (p < .001). Occupation did not explain differences in breastfeeding cessation, though a higher proportion of fishers and housewives breastfed for at least 2 years compared to traders. Returning to work, with or without children, was negatively associated with total daily breastfeeding and with the percentage of breastfeeding occurring during daytime hours, with the greatest reductions for mothers working without children present (all p < .001). Working conditions that are compatible with childcare are beneficial for most breastfeeding outcomes, except exclusive breastfeeding. Our results emphasize the importance of childcare-compatible work that allows flexibility to breastfeed more frequently while working. Results also add to a growing call for institutional-level postpartum economic support for all women in the informal economy, regardless of their occupation’s compatibility with childcare.

35. Decalogue of the Declaration of Salamanca: Advancing Undergraduate Education in Allergy and Clinical Immunology Across Europe.

期刊: Allergy 发表日期: 2026-Jul-12 链接: PubMed

摘要

36. Comparative environmental assessment of rice straw valorization for integrated biohydrogen and green silica production.

期刊: Journal of environmental management 发表日期: 2026-Jul-12 链接: PubMed

摘要

Rice straw is a widely available agricultural residue with great potential for biofuels and bioproducts. However, the sustainability of its conversion remains uncertain due to the energy- and resource-intensive processing requirements. This study conducts a consequential life cycle assessment of four promising scenarios for the co-production of hydrogen and silica, each using different pretreatment strategies: (1) alkaline, (2) organosolv-alkaline, (3) acidic-alkaline, and (4) organosolv-alkaline coupled with nano-silica addition during fermentation. In all scenarios, silica was recovered from the alkaline pretreatment liquor, while cellulose-rich residues were subjected to enzymatic hydrolysis and dark fermentation to produce hydrogen. The results demonstrated that the environmental impacts, particularly from the pretreatment stage, outweigh the benefits of avoided products across all scenarios. While scenario 2 produced high experimental hydrogen yields (56.2 mL/g), it performed poorly in all damage categories. Despite the enhanced fermentation efficiency in scenario 4 (63.8 mL/g), the avoided products were still too low to offset the damages associated with organosolv pretreatment, and further impacts were created from adding nano-silica. In contrast, the least-burdensome pathway (scenario 3) with net impacts of 1.6 × 10-3 DALY, 3.3 × 10-6 species.yr, and 22.7 USD2013 per functional unit for the human health, ecosystem, and resource categories, respectively, did not show considerable differences compared to its corresponding single-hydrogen configuration. Sensitivity analysis identified opportunities to reduce the overall environmental impacts by enhancing the solid-to-liquid ratio and replacing fossil-based energy sources with renewable ones. These findings suggest that reducing pretreatment intensity and improving energy efficiency via process optimization and heat recovery may offer greater environmental benefits.

37. Applications and Material Design of Machine Learning-Enabled Metal Oxide Semiconductor Gas Sensors.

期刊: Langmuir : the ACS journal of surfaces and colloids 发表日期: 2026-Jul-12 链接: PubMed

摘要

Because of their facile fabrication and ease of integration, MOS gas sensors have been widely used in environmental monitoring, industrial safety, and health diagnostics. However, under complex application scenarios, MOS sensors still face challenges such as cross-sensitivity, environmental interference, device drift, and strongly nonlinear response signals, which limit their detection accuracy and long-term stability. Machine learning offers significant advantages in high-dimensional data processing, nonlinear mapping, and pattern recognition, thereby providing new avenues for improving the performance of MOS gas sensors. Centered on the sensing mechanisms and data characteristics of MOS gas sensors, this review systematically summarizes recent progress in the application of machine learning to quantitative gas concentration analysis, gas species identification, drift compensation, and stability enhancement, as well as the machine-learning-assisted design of gas-sensing materials, while comparing the roles and applicability of different models in feature extraction, signal interpretation, and performance optimization. In addition, this review summarizes the challenges facing the field, including limited sample sizes, model generalization, interpretability, and edge deployment, and further outlines future research directions. This review may serve as a useful reference for the deeper integration of machine learning with MOS gas sensors and for the development of intelligent gas-sensing systems.

38. Spatial enrichment, chemical speciation-based ecological risk assessment, and source apportionment of toxic metal(loid)s in surface and core sediments from a drinking-water reservoir, Southeast China.

期刊: Environmental geochemistry and health 发表日期: 2026-Jul-12 链接: PubMed

摘要

Samples were taken from 16 surface sediments (0-10 cm) and 12 core sediments from the drinking-water reservoir, the Wan’an Reservoir, which is located near small-scale and historical tungsten occurrences. The total concentrations and chemical speciation of As, Cd, Cr, Cu, Pb, Zn and W were analyzed by inductively coupled plasma optical emission spectrometry (ICP-OES) and the BCR sequential extraction procedure. Spatial distribution analysis indicated that toxic metal pollution exhibited significant downstream enrichment characteristics, among which Cd, W, and Cu were particularly prominent. The geo-accumulation and ecological risk analyses indicated that Cd was the dominant risk contributor. As a result, 87.5% of the surface sampling points were classified as having extremely high potential ecological risk. The Risk Assessment Code further indicated that the proportion of the acid-soluble/exchangeable fraction of Cd was relatively high, indicating strong mobility risk. Core sediment analysis indicated abrupt historical Cd enrichment peaks in the midstream area, while Zn and Cu exhibited surface enrichment over the past decade. Multivariate statistical analysis, along with geographical data on mining areas, revealed that mining activities were the primary anthropogenic source of complex pollution from Cu, Pb, Zn, W, and Cd in the downstream regions. In contrast, the middle and upper reaches are primarily influenced by natural geology and agricultural non-point sources. Comprehensive assessment suggests prioritizing the control of Cd migration in the downstream areas. In the middle and upstream regions, efforts should focus on preventing agricultural non-point source pollution to safeguard the reservoir’s water quality.

39. Association between metal co-exposure and frailty: exploring the potential explanatory pathway of inflammation.

期刊: Biometals : an international journal on the role of metal ions in biology, biochemistry, and medicine 发表日期: 2026-Jul-12 链接: PubMed

摘要

Frailty is a critical geriatric syndrome associated with disability and mortality, yet the associations and mechanisms between environmental metal co-exposure with frailty remain unclear. This cross-sectional study included 4484 adults aged ≥ 60 years from China. Metal concentrations were measured by inductively coupled plasma mass spectrometry (ICP-MS), and frailty was assessed using a frailty index (FI). Single-metal analyses used generalized linear models (GLMs). For multi-metal analyses, we applied machine-learning-based variable selection, followed by Bayesian kernel machine regression (BKMR) and quantile g-computation (qg-comp) model. Potential explanatory pathways involving inflammatory markers, as well as interactions with age, sex, and lifestyle, were also explored. Positive associations were observed for magnesium (Mg), molybdenum (Mo), and vanadium (V) with FI, whereas rubidium (Rb) showed an inverse association (P < 0.001). Significant effect modification by age, sex, and lifestyle was identified. Positive metal‑FI associations were stronger in older females, while the inverse Rb‑FI correlation was more evident in participants with unhealthy lifestyles (P for interaction < 0.05). Multi-metal models showed overall positive co-exposure effects on frailty, with Mo (positive) and Rb (negative) contributing the largest weights. In exploratory mediation analyses, the neutrophil-to-high-density lipoprotein ratio (NHR) accounted for 2.09% of the Rb-FI association and 1.81% of the Mo-FI association. The platelet-to-albumin ratio (PAR) accounted for 1.52% of the Mo-FI association and 5.30% of the Mg-FI association (P < 0.05). These findings suggest that metal co-exposure is positively associated with frailty, with inflammation as a potential explanatory pathway. Metal‑frailty associations vary by age, sex and lifestyle, with distinct patterns for different metals. Although longitudinal studies are needed to establish temporality and causal pathways, these findings identify high-risk subgroups for future investigation.

40. Impact of Environmental Microparticles on Insect Olfaction.

期刊: Environmental toxicology 发表日期: 2026-Jul-12 链接: PubMed

摘要

Terrestrial insects underpin key ecosystem services, including pollination, herbivory regulation, decomposition, nutrient cycling, and disease control. These functions depend on chemical communication that guides insects to food, mates, hosts, shelters, and oviposition sites while helping them avoid threats. Environmental microparticles, such as micro- and nanoplastics, tyre wear particles, soot, mineral dust, and agricultural residues, are now widespread across air, soil, vegetation, and indoor environments, exposing insects through contact, deposition, and ingestion. Growing evidence shows that these particles disrupt insect olfaction by adsorbing volatile compounds, blocking antennal sensilla, and interfering with receptor and neuronal processes. These disruptions impair foraging, mating, oviposition, and host seeking, leading to reduced individual performance and declines in population density. As a result, insect-mediated services such as pollination, biological control, seed dispersal, and nutrient cycling are weakened, with consequences for plant community composition, biodiversity, food web stability, and crop yields. Despite these advances, the mechanisms linking microparticles to olfactory disruption remain poorly resolved, and no synthesis has integrated evidence across the full pathway from signal emission to neural processing. This review brings together chemical, physiological, and ecological evidence to map how microparticles interfere with insect olfaction across this pathway, identify key knowledge gaps, and propose a multi-level research framework to guide future work from molecular mechanisms to ecological consequences.

41. Antibacterial peptide nanofibrils for targeted elimination of drug-resistant Staphylococci.

期刊: Nanoscale 发表日期: 2026-Jul-12 链接: PubMed

摘要

Antibacterial resistance represents a major global health challenge, particularly due to drug-resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA), which is known for causing persistent, biofilm-associated infections. In this study, we introduce self-assembling, tryptophan-rich peptide nanofibrils derived from DVFLGREEWWWWC (D4W) as potent antibacterial agents against Staphylococcus species, including MRSA. These self-assembling D4W units form amyloid fibril-like structures through controlled polarity reversal, enhancing their structural stability and antibacterial efficacy. The DVFLG motif enables selective recognition of Staphylococci, while the WWWW segment facilitates β-sheet formation and deep membrane penetration via hydrophobic interactions, effectively disrupting bacterial membranes. Moreover, D4W-derived nanofibrils engage in multivalent interactions with bacterial surfaces, significantly enhancing targeting precision and antibacterial efficacy. Beyond eradicating planktonic Staphylococci, D4W-derived nanofibrils significantly inhibit biofilm formation, a main factor in antibiotic resistance. Notably, D4W-derived nanofibrils exhibit low cytotoxicity and hemotoxicity, addressing their therapeutic potential. Their efficacy was validated in ex vivo pig skin and in vivo zebrafish embryo models, where they successfully inhibited MRSA growth. In addition, molecular dynamics simulations were employed to elucidate the interactions between D4W and model lipid membranes. This study introduces a strategy for designing effective antibacterial agents with enhanced stability, selectivity, and biofilm-prevention capabilities against drug-resistant Staphylococci. Our results indicate the promise of self-assembling peptide-based therapeutics in combating antibiotic-resistant Staphylococcal infections.

42. Meta-Analysis: Redefining Liver Disease Risk in Heterozygous Alpha-1 Antitrypsin Deficiency.

期刊: Alimentary pharmacology & therapeutics 发表日期: 2026-Jul-12 链接: PubMed

摘要

Heterozygous SERPINA1 genotypes (MZ, SZ) have historically been regarded as carrier states with limited liver relevance. Emerging evidence suggests increased liver injury, but the magnitude of risk remains uncertain. We synthesized evidence on heterozygous SERPINA1 liver phenotypes to quantify this risk. We performed a systematic review of bibliographic databases from inception to 21 October 2025 for studies reporting liver outcomes in MZ or SZ genotypes. Outcomes were grouped into metabolic comorbidities, biochemical markers, and clinical liver disease. Random-effects meta-analyses pooled mean differences (MDs) and odds ratios (ORs); risk of bias was assessed with established tools (PROSPERO CRD420251165586). Twenty-six studies including 27,933 heterozygotes and 547,961 controls met inclusion criteria. BMI (MD -0.09 [-0.20-0.02]) and steatosis risk (OR 1.09 [0.74-1.60]) were comparable between groups. Heterozygotes had modestly higher liver enzymes (ALT MD 1.03 [0.41-1.66]; AST MD 0.68 [0.51-0.85]; ALP MD 2.58 [1.58-3.58]) and higher odds of abnormal ALT (OR 1.18 [1.11-1.25]), AST (OR 1.16 [1.07-1.26]), and ALP (OR 1.41 [1.18-1.68]). They had significantly increased odds of fibrosis (OR 2.14 [1.52-3.02]), cirrhosis (OR 2.24 [1.73-2.91]), and liver transplantation (OR 2.28 [1.45-3.59]). Heterozygous SERPINA1 genotypes are bona fide liver risk states, with effect sizes comparable to established genetic and environmental determinants. MZ/SZ heterozygosity should be recognized as moderate-penetrance liver susceptibility genotypes in chronic liver disease risk assessment.

43. The Risk of Cardiovascular Diseases for Shift Workers in the Prospective Heinz Nixdorf Recall Study.

期刊: American journal of industrial medicine 发表日期: 2026-Jul-12 链接: PubMed

摘要

Shift work can disrupt circadian rhythms and is postulated to play a role in cardiovascular diseases (CVD). In the German prospective population-based Heinz Nixdorf Recall Study, we analyzed longitudinal associations between shift work and night-shift work with CVD. CVD was defined as a fatal or non-fatal cardiac or cerebrovascular event or interventional coronary revascularization during an average follow-up of 15 years. Retrospective shift-work information was assessed as binary and as lifetime duration in years. Adjusted log-linear Poisson regression models were applied to estimate incidence rate ratios (IRR) and 95% confidence intervals (CI) for the effect of shift and night-shift work on incident events. Stratified analyses by sex, diurnal preference, and blue-collar status were also performed. Incident CVD was not associated with shift work (N = 3024; shift work for at least 1 year: IRR = 0.87, 95% CI = 0.68-1.10; night-shift work for at least 1 year: IRR = 0.87, 95% CI = 0.66-1.14). However, we observed sex differences with reduced incidence of CVD for long duration of night-shift work among men (N = 1369 with 380 night-shift workers; model for duration of night-shift work: 1- < 10 years: IRR = 1.08, 95% CI = 0.74-1.57; 10+ years: IRR = 0.64, 95% CI = 0.42-0.96). For women, we found slightly elevated IRRs (N = 1438 with 91 night-shift workers; model for duration of night-shift work: 1- < 10 years: IRR = 1.11, 95% CI = 0.35-3.50; 10+ years: IRR = 2.05, 95% CI = 0.75-5.61). These estimates were stronger in women that never worked in blue-collar jobs (10+ years night-shift work: IRR = 3.22, 95% CI = 1.17-8.92). We did not observe consistently increased risks of CVD with shift and night workers. However, stratified analyses pointed toward sex- and job-specific vulnerable subgroups.

44. Pharmacotherapeutic Decisions in Autism.

期刊: The New England journal of medicine 发表日期: 2026-Jul-11 链接: PubMed

摘要

45. A systematic review of forward simulation-based methods for point-source water pollution localization.

期刊: Journal of contaminant hydrology 发表日期: 2026-Jul-09 链接: PubMed

摘要

Accurate localization of point-source water pollution is essential for mitigating the adverse environmental and health impacts of unauthorized wastewater discharges. However, localization methods relying solely on pollutant characteristics suffer from significant limitations, necessitating a systematic synthesis of forward simulation-based localization techniques. To fill the gap, this review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework to systematically analyze 62 publications (2001-2024), focusing on three main methods (simulation-optimization, probability-selection, and surrogate-modeling) in surface water, groundwater, and water supply networks. The analysis reveals a marked methodological shift since 2015 toward surrogate-modeling as the dominant method, identifies positive correlations between water body type and both the modeling software (r = 0.8) and study area scale (r = 0.4), and tracks the evolution of target pollutants from conservative substances to conventional and emerging contaminants. Methodological advances in the three methods have evolved to enhance global search capabilities, improving accuracy and Markov Chain Monte Carlo (MCMC) sampling efficiency, and capturing spatiotemporal dynamics. Overall, this review aims to provide practical guidance for researchers and engineers on method selection and software choice in water pollution localization, while also revealing persistent challenges including model opacity, emerging contaminant identification, and multi-source data integration. Future studies demand explainable AI, and IoT-remote sensing fusion, and interdisciplinary collaboration to achieve more transparent, robust, and reliable systems.

46. Widespread Exposure to Human Parvovirus B19 in the Brazilian Amazon: Evidence from a Community-Based Seroprevalence Survey in Manaus.

期刊: Diagnostic microbiology and infectious disease 发表日期: 2026-Jul-06 链接: PubMed

摘要

Human parvovirus B19 (B19V) causes a broad spectrum of clinical manifestations but is often asymptomatic. In the Brazilian Amazon, where B19V may mimic endemic arboviral infections, epidemiological data remain limited. This study investigated B19V seroprevalence among residents of Manaus, Amazonas, Brazil. A cross-sectional study included 450 age-stratified participants recruited from 2021 to 2023 across different zones of Manaus. Plasma samples were tested for anti-B19V IgG and IgM by enzyme-linked immunosorbent assay. Associations were estimated using Poisson regression with robust variance and reported as prevalence ratios (PRs) with 95% confidence intervals (95% CIs). Anti-B19V IgG seroprevalence was 67.56% (304/450; 95% CI: 63.10-71.72), and IgM positivity was 2.89% (13/450; 95% CI: 1.70-4.88). In multivariable analysis, age group was the only independent factor associated with IgG seropositivity (p < 0.001). Seropositivity was not associated with sex, skin color, education, income, blood transfusion history, or geographic zone. IgG levels varied by age group (p = 0.0108) but not by sex (p = 0.33). B19V exposure is widespread in Manaus, with approximately two-thirds of participants showing evidence of past infection, whereas serological evidence of recent infection was uncommon. Age was the only independent determinant of IgG seropositivity, consistent with the progressive accumulation of exposure across the life course. These findings establish a contemporary epidemiological benchmark for Manaus and highlight the need for targeted investigation of B19V in patients with febrile-exanthematous illness in arbovirus-endemic settings.

47. Cost-effectiveness of comprehensive geriatric assessment: systematic review of economic evaluations.

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

摘要

Comprehensive geriatric assessment (CGA) can be resource-intensive as its delivery involves multidisciplinary personnel, multidimensional assessment, care planning and follow-up. The aim of this systematic review is to appraise and synthesise evidence on the cost-effectiveness of CGA across settings. Full economic evaluation studies examining CGA were searched across five databases. We included studies involving adults aged ≥65 years who were identified as living with frailty or at risk of adverse outcomes. Two independent reviewers screened studies against eligibility criteria and extracted data using a pretested extraction form. Reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards framework. We reported the results through narrative summaries, tables and figures. A total of 4864 studies were identified, of which 17 were included across 7 settings (11 community, 6 hospital). Of 13 cost-utility analysis studies, incremental quality-adjusted life years ranged from -0.06 to 0.54 and incremental costs ranged from €-12 744 to €29 785. The probability CGA was cost-effective ranged from 0% to 98.9% across stated willingness-to-pay thresholds (cost-effective in 5/13, not cost-effective in 7/13, 50% chance in 1/13). Two studies showed that cost-effectiveness can vary by frailty severity and residential status. The resource intensity of CGA varied, ranging from 25% (case management protocol) to 81% (comprehensive assessment). Only five studies accounted for informal caregiver costs. The reporting quality ranged from 38% to 90%. The cost-effectiveness of CGA remains uncertain. Variations in resource intensity of CGA, frailty severity, residential status of older adults and setting may explain this heterogeneity. CRD42023492586.

48. Combining Anterior Talofibular Ligament Ultrasonography With Anterior Drawer Displacement Refines Stratification of Chronic Ankle Instability.

期刊: Journal of orthopaedic research : official publication of the Orthopaedic Research Society 发表日期: 2026-Jul 链接: PubMed

摘要

Chronic ankle instability (CAI) is commonly defined using symptom-based criteria, but these do not explicitly incorporate structural instability after lateral ankle sprain. Whether ATFL findings and anterior displacement reflect symptoms and function remains unclear. This study examined the relationships among ATFL ultrasonography findings, anterior ankle displacement, perceived ankle instability, and self-reported function. This cross-sectional study included 187 participants classified as healthy, coper, or CAI using International Ankle Consortium criteria and the Cumberland Ankle Instability Tool (CAIT). ATFL ultrasonographic classification and instrumented anterior displacement were assessed by blinded examiners. Self-reported function was assessed using the Foot and Ankle Ability Measure (FAAM) in a subsample. Five groups defined by symptom classification and ATFL ultrasonographic classification were compared. Median anterior ankle displacement was 5.25, 5.63, 7.49, 6.14, and 9.02 mm in the healthy-ATFL normal, coper-ATFL normal, coper-ATFL abnormal, CAI-ATFL normal, and CAI-ATFL abnormal groups, respectively. Displacement was greater in the coper-ATFL abnormal and CAI-ATFL abnormal groups than in the healthy-ATFL normal and coper-ATFL normal groups (all p ≤ 0.004). The CAI-ATFL abnormal group also showed greater displacement than the CAI-ATFL normal group (p = 0.012). CAIT scores did not differ between CAI subgroups. In the FAAM subsample, the CAI-ATFL abnormal group had lower scores than several comparison groups. Section Specialty Area: Section IV: Sports Medicine & Orthopaedics. Investigation performed: Hokkaido Chitose College of Rehabilitation. ATFL ultrasonography stratified anterior ankle displacement within symptom-defined coper and CAI groups, whereas symptom-defined classification and self-reported function did not consistently reflect structural and mechanical findings. Structural assessment may refine phenotypic stratification in CAI research.

49. Reversible left ventricular trabecular remodeling after bariatric surgery in obesity: a prospective cohort study using quantitative cardiac MRI.

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

摘要

Obesity is associated with structural and functional cardiac remodeling; however, its quantitative imaging characteristics and the role of left ventricular trabeculation remain incompletely understood. This study aimed to characterize left ventricular trabeculation using multi-parametric cardiac magnetic resonance in patients with obesity, explore its association with subclinical cardiac dysfunction, and evaluate longitudinal changes following bariatric surgery. In this prospective single-center study, 30 patients with severe obesity underwent cardiac magnetic resonance imaging before and approximately 12 months after bariatric surgery, along with 30 age- and sex-matched healthy controls. Quantitative parameters included the non-compacted to compacted layer ratio (NC/C), trabecular mass fraction, left ventricular mass, left ventricular ejection fraction, global longitudinal strain, and diastolic filling indices. Left ventricular ejection fraction indexed to body surface area was analyzed as an exploratory parameter. Mediation analysis was performed to assess whether trabeculation statistically explained part of the association between body mass index and cardiac function, adjusting for age, sex, and blood pressure. Compared with controls, patients with obesity showed significantly higher NC/C (1.68±0.24 vs. 1.11±0.19, P<0.001) and lower left ventricular ejection fraction (57.87%±6.22% vs. 63.40%±6.94%, P<0.05). In mediation analysis, the total effect of body mass index on left ventricular ejection fraction was -0.29 [95% confidence interval (CI): -0.56 to -0.02]. The indirect effect via the NC/C was statistically significant (β=-0.46, 95% CI: -0.81 to -0.09), while the direct effect was not significant (β=0.17, 95% CI: -0.25 to 0.59). Following bariatric surgery, trabeculation and left ventricular mass decreased significantly, while left ventricular ejection fraction, global longitudinal strain, and diastolic filling indices improved (P<0.05). Quantitative cardiac magnetic resonance analysis demonstrates increased left ventricular trabeculation in obesity, which decreases following weight reduction. Trabeculation is associated with subclinical cardiac dysfunction and may contribute to the association between obesity and impaired cardiac function. These findings suggest that trabecular remodeling in obesity represents a dynamic imaging phenotype, although further studies are required to clarify underlying mechanisms.

50. Oral cancer large observational screening study in Hungary.

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

摘要

Incidence and mortality of oral cancer slightly decreased in recent years in Hungary; however, age-standardized estimated incidence and mortality for both sexes are still among the highest in Europe. The objective of the large observational study was to conduct oral cancer screening in Hungary using mobile screening units to examine 5000 individuals living in converging municipalities with low population density and under challenging socio-economic conditions. The study also aimed to develop related patient pathways, and to educate the population on the prevention of oral malignancies. The population screened for oral cancers using Visual Oral Examination (VOE) between 21 June 2021 and 31 March 2023 included individuals of 18 years of age or older, living in converging municipalities and in other geographical locations across Hungary. In 2024, a retrospective cross-sectional study was carried out to analyze the results. During the studied time period, a total of 8266 people attended the oral cancer screening study from converging municipalities (n = 4275; 51.7%), and from other geographical locations (n = 3991; 48.3%). Oral mucosal lesions were detected in 1725 individuals, of whom only 66 people (3.8%)-13 men and 53 women-visited a specialist, and 6 were diagnosed with malignant neoplasms. Mobile screening units can be an effective tool of secondary prevention for screening high-risk groups in rural, socio-economically challenging settings. However, low compliance of screen positive individuals to attend follow-up visits poses a threat to the effectiveness of the screening programs and it needs to be addressed by optimizing patient pathways.

51. Reshaping the social meaning of smoking: the UK's tobacco-free generation policy.

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

摘要

52. Integration of Asthma Care into Primary Health Facilities of Iran: Findings from the Pilot Project.

期刊: Iranian journal of allergy, asthma, and immunology 发表日期: 2026-Jun-03 链接: PubMed

摘要

Iran has an extensive governmental network of primary health care facilities and hospitals. In 2019, the integration of asthma-related services into this network was designed and pilot-tested. Primary health care providers (PHCPs) and family physicians (FPs) are the main members of the care provision team and are responsible for case identification and management. The pilot was conducted from November 2019 through April 2020 in seven areas-Kerman, Maragheh, Ahvaz, Kashan, Urmia, Karun, and Qazvin-covering both urban and rural locations and a population of approximately one million people. Our objective was to report indicators related to the integration of asthma identification, referral, and management within the existing primary health care system. In total, 350,894 individuals were screened for asthma by PHCPs. The observed proportion of positive (probable) cases among those screened was 2.48%. Key process indicators included screening uptake (34%), attendance of referred cases at physician visits (83%), and follow-up adherence (49% of confirmed cases). We conclude that improving screening uptake and the accuracy of asthma case detection by PHCPs are the most effective strategies for enhancing care provision efficiency. The findings of the pilot project have significant implications for understanding efficient integration of asthma-related services. The results indicate that integrating asthma care into primary health services is feasible and can improve early detection and care coordination, informing policy decisions for broader implementation and resource planning.

53. Regulation of AQP4 Expression and Investigation of the Underlying Mechanisms by HIV-1 Tat Through the NMDAR/cAMP/PKA Signaling Pathway in Astrocytes.

期刊: Iranian journal of allergy, asthma, and immunology 发表日期: 2026-Jun-03 链接: PubMed

摘要

Human immunodeficiency virus (HIV)-associated neurocognitive disorder (HAND) remains a major neurological complication in people living with HIV despite effective antiretroviral therapy. Neurotoxicity caused by viral proteins, particularly the HIV-1 transactivator of transcription (Tat), contributes significantly to HAND. Although N-methyl-D-aspartate receptors (NMDARs) in astrocytes are known to regulate aquaporin-4 (AQP4) the mechanisms by which Tat influences NMDAR signaling and AQP4 expression remain unclear. This study investigated how HIV-1 Tat regulates AQP4 expression in astrocytes through the NMDAR/CaMKII/AC/cAMP/PKA signaling pathway and how secondary Ca2+ dynamics modulate this process. Astrocytic Ca2+ influx was measured using the Fluo-3 AM probe. Western blotting quantified AQP4, NR1, NR2A/B, CaMKII, p-CaMKII, PKA, and PKG expression. Real-time quantitative polymerase chain reaction (RT-qPCR) assessed mRNA levels of AQP4 and NMDAR-related genes. Enzyme-linked immunosorbent assay (ELISA) evaluated nitric oxide synthase activity, adenylate cyclase activity, and intracellular cAMP levels. Pharmacologic inhibitors-MK-801 (NMDAR blocker), H89 (PKA inhibitor), and KT5823 (protein kinase G [PKG] inhibitor)-were applied to investigate pathway interactions. HIV-1 Tat induced robust activation of NMDAR, resulting in increased Ca2+ influx and sequential activation of the CaMKII/AC/cAMP/PKA pathway, ultimately elevating AQP4. After prolonged Tat exposure (approximately 36 hours), a secondary surge in Ca2+ activated PKG, which acts as a protective negative feedback mechanism to inhibit excessive NMDAR activity, thereby stabilizing Ca2+ influx and preventing abnormal overexpression of AQP4. Cotreatment with MK-801, H89, or KT5823 suppressed Tat-induced Ca2+ influx and attenuated AQP4 upregulation, although persistent Tat exposure gradually restored Ca2+ elevations through compensatory mechanisms. HIV-1 Tat dynamically regulates AQP4 expression in astrocytes via the NMDAR/CaMKII/AC/cAMP/PKA pathway, with PKG-mediated feedback contributing to later stabilization. These findings highlight AQP4 as a potential therapeutic target for HAND.

54. Effects of CB2 Receptor Inverse Agonist on Airway Remodeling and Th1/Th2 Imbalance in Bronchial Asthma Rats via TLR4/NF-κB Signaling Pathway.

期刊: Iranian journal of allergy, asthma, and immunology 发表日期: 2026-Jun-03 链接: PubMed

摘要

Bronchial asthma (BA) has a complex pathogenesis involving immune imbalance and airway remodeling (AR). Cannabinoid receptor 2 (CB2) plays a role in inflammation regulation, so this study explored the therapeutic potential of a CB2 inverse agonist on BA rats’ AR and Th1/Th2 imbalance, and its mechanism via Toll-like receptor 4/nuclear factor kappa B(TLR4/NF-κB) pathway. Twenty-seven male SD rats (180-220 g) were divided into control (CG), model (MG), and intervention (IG) groups (n=9 each). MG/IG were BA-modeled by ovalbumin (OVA) sensitization (days 1/8: 100 μg OVA +1 mg aluminum hydroxide gel, i.p.) and 1% OVA aerosol challenge (day 15, 3×/week, 8 weeks). IG received CB2 inverse agonist (5 mg/kg, i.p., 3×/week, 4 weeks); CG/MG got saline. TH1/TH2 cytokines, subsets, AR parameters, and lung TLR4/NF-κB-related molecules were detected. Compared with CG, MG had TH1/TH2 imbalance, higher AR indices, upregulated TLR4/NF-κB, shorter asthma latency, and longer attack duration. vs. MG, IG reversed TH1/TH2 imbalance, reduced TLR4/NF-κB-related protein/mRNA (except elevated NFKBIA). CB2 inverse agonist has BA prevention/treatment potential by regulating Th1/Th2 balance, inhibiting AR, and acting on the TLR4/NF-κB pathway.

55. Unregulated Peptide Use in the Age of Biohacking: Digital Promotion, Gray-Market Access, and Emerging Public Health Risks.

期刊: Cureus 发表日期: 2026-Jun 链接: PubMed

摘要

Unregulated peptide use is emerging as a digitally mediated public health concern. Although peptide-based medicines have important therapeutic roles when developed, prescribed, manufactured, and monitored through regulated pathways, online biohacking and wellness spaces increasingly promote experimental or weakly evidenced peptides for fat loss, recovery, aesthetics, cognition, performance, and longevity. This narrative review examines how digital promotion, gray-market access, self-injection, stacking, informal titration, product-quality uncertainty, regulatory ambiguity, and weak pharmacovigilance interact to normalize poorly traceable peptide products outside clinical supervision. The central concern is not legitimate peptide medicine, but consumer experimentation with products of uncertain identity, purity, potency, sterility, and safety. Improved clinician awareness, adverse-event reporting, product-quality monitoring, digital risk communication, and proportionate regulatory oversight are needed to distinguish evidence-based peptide therapy from unregulated consumer use.

56. What counts? Defining scholarship in continuing professional development using a national modified Delphi study.

期刊: Canadian medical education journal 发表日期: 2026-Jun 链接: PubMed

摘要

In many domains within medical education, scholarship can have unique attributes. The accreditation standards for Canadian Continuing Professional Development (CPD) require scholarly output from each Office in Canada. However, it is unclear what scholarly outputs might be considered as CPD scholarship. Representatives from a national cross-section of collaborators within the Association of Faculties of Medicine of Canada (AFMC) Continuing Professional Development (CPD) network and other national organizations assisted in this project. Collaborators participated in a 3-phase, modified Delphi study from October 31st, 2023- June 17th, 2024. The three phases included: 1) Registration and Ideation; 2) Consensus Process; 3) Group Validation. A total of 31 individuals registered as part of the consensus panel, and 29 individuals (93.5% response) completed the 3-stages of the modified Delphi. The endorsement of 18/31 types of scholarship, including novel forms such as Community Engagement, Testing/Pilot Approaches, and Advocacy Scholarship, reflects an important shift in how CPD scholarship is understood. In a first for our field, the results of this study comprise a consensus-based definition that defines CPD scholarship at a national scale. The results crucially inform national accreditation processes, strategic planning exercises, and overall, in expanding the types and acceptance of activities as recognized scholarly work for those seeking recognition and promotion within the domain of CPD. We do so with the voice of our community to inspire new and emergent scholarship. Periodic reviews of these concepts should be conducted, as scholarly pursuits evolve over time. Dans de nombreux domaines de l’enseignement médical, la recherche peut présenter des caractéristiques uniques. Les normes d’accréditation du développement professionnel continu (DPC) canadien exigent que chaque bureau au Canada produise des travaux de recherche. Cependant, on ne sait pas exactement quels travaux de recherche peuvent être considérés comme relevant du DPC. Des représentants d’un échantillon représentatif de collaborateurs du réseau de développement professionnel continu (DPC) de l’Association des facultés de médecine du Canada (AFMC) et d’autres organisations nationales ont participé à ce projet. Les collaborateurs ont pris part à une étude Delphi modifiée en trois phases, qui s’est déroulée du 31 octobre 2023 au 17 juin 2024. Les trois phases comprenaient : 1) l’inscription et la conceptualisation ; 2) le processus de consensus ; 3) la validation par le groupe. Au total, 31 personnes se sont inscrites au panel de consensus et 29 personnes (93,5 % de réponse) ont terminé les trois étapes de l’étude Delphi modifiée. L’approbation de 18 des 31 types d’érudition, y compris des formes novatrices telles que l’engagement communautaire, les approches pilotes/tests et les connaissances de défense des droits, reflète un changement important dans la manière dont les savoirs de DPC sont compris. Pour la première fois dans notre domaine, les résultats de cette étude constituent une définition consensuelle qui définit la recherche du DPC à l’échelle nationale. Ces résultats fournissent des informations cruciales pour les processus d’accréditation nationaux, les exercices de planification stratégique et, de manière générale, pour élargir les types et l’acceptation des activités reconnues comme travaux universitaires pour ceux qui cherchent à être reconnus et promus dans le domaine du DPC. Nous le faisons avec la voix de notre communauté afin d’inspirer de nouvelles études et des découvertes. Ces concepts doivent faire l’objet de révisions périodiques, car les activités universitaires évoluent avec le temps.

57. Immunopathophysiology, biochemistry, and clinical implications of Daboia siamensis venom: A possible challenge to macrophages' immunomodulation.

期刊: Asian Pacific journal of allergy and immunology 发表日期: 2026-Jun 链接: PubMed

摘要

Daboia siamensis (Eastern Russell’s viper) envenomation remains a major public health problem in Southeast Asia and is frequently associated with severe systemic complications, particularly coagulopathy and acute kidney injury (AKI). A complex mixture of biologically active toxins, including snake venom metalloproteinases (SVMPs), serine proteases (SVSPs), phospholipase A2 (PLA2), and other enzymes, synergistically disrupts vascular integrity, hemostasis, and organ microcirculation. Beyond the direct toxic effects of venom, secondary immune-mediated processes amplify tissue injury through endothelial activation, inflammatory mediators, and oxidative stress that contribute to microvascular dysfunction and ischemic injury, a major pathophysiology of AKI even after correction of systemic coagulation abnormalities. Although antivenom therapy remains the most effective treatment when administered early, its ability to prevent established organ damage is limited once tissue injury has occurred. Hence, immunomodulatory strategies targeting macrophage activation may be beneficial. This review integrates current knowledge on venom composition, immunopathophysiological mechanisms, and clinical manifestations of D. siamensis venom, with particular emphasis on factors contributing to renal injury. Improved understanding of the interconnected processes between venom and immune responses may support the development of adjunctive strategies to reduce organ complications and improve outcomes following Russell’’s viper envenomation.

58. Hypersensitivity reactions associated with nutraceuticals and dietary supplements: A narrative review.

期刊: Asian Pacific journal of allergy and immunology 发表日期: 2026-Jun 链接: PubMed

摘要

The global use of nutraceuticals and dietary supplements-including vitamins, minerals, probiotics, and botanical extracts-has increased substantially, driven largely by consumer perceptions of safety and health benefits. However, their potential to cause hypersensitivity reactions (HSRs) is underrecognized. This review synthesizes published case reports, case series, systematic reviews, and pharmacovigilance data to characterize HSRs linked to these products, identify risk factors, and examine diagnostic and regulatory challenges. We classified reactions as immediate (< 1-6 h after administration), non-immediate (> 1-6 h after administration to several weeks). Immediate HSRs, including anaphylaxis, have been reported after vitamins B complex, short-chain galacto-oligosaccharides (GOS), whole-food supplements such as spirulina, natto (poly[γ-glutamic acid]) and royal jelly, and botanical/plant derived products; diagnosis commonly used skin-prick and intradermal testing and basophil activation tests. Non-immediate HSRs-ranging from maculopapular eruptions to severe cutaneous adverse reactions-have been associated with cobalamin, chromium picolinate, alpha-lipoic acid, diindolylmethane (DIM), glucosamine/chondroitin, and euglena; diagnosis often relies on patch testing, lymphocyte transformation assays, and cautious drug provocation when indicated. These products can also cause allergic contact dermatitis, and occupational sensitization (e.g., rhinitis/asthma) has been reported in workers exposed to psyllium and Aspergillus oryzae-derived lactase. Diagnostic accuracy is limited by nonstandardized reagents, variable test concentrations, complex product formulations, and cross-reactivity (notably within botanical families such as Asteraceae and among plant proteins/legumes), complicating interpretation and increasing risk for atopic individuals. Evidence remains dominated by case-based reports and passive surveillance. To reduce risk, we recommend heightened clinician awareness, development of standardized diagnostic reagents and protocols, mandatory adverse-event reporting, clearer ingredient labeling, and premarket allergenicity assessment.

59. Menopause matters: A community-based cross-sectional online survey among midlife women in Malaysia.

期刊: Malaysian family physician : the official journal of the Academy of Family Physicians of Malaysia 发表日期: 2026 链接: PubMed

摘要

Menopause is a substantial life transition for women, signifying the end of reproductive capability, with implications for symptoms, long-term health and well-being. Women’s experiences during menopause can differ widely, affecting their attitudes towards this transition. This study aimed to investigate knowledge and attitudes towards menopause among midlife women in Malaysia. A community-based cross-sectional online survey using non-probability sampling was conducted among Malaysian women aged 40-60 years residing in an urban setting. A validated online questionnaire was used to assess the study parameters. Knowledge and attitudes were quantified, and associations with sociodemographic factors were examined using the Kruskal-Wallis test. Descriptive statistics and Spearman’s correlation analysis were performed using the IBM Statistical Package for the Social Sciences Statistics version 26.0. Of the 300 respondents, the majority were Malay (94.7%), married (85.3%) and aged 55-60 years (27.3%). Over half (52.0%; mean score=12.98±6.77 [22 max score]) demonstrated poor knowledge, while 45.3% held negative attitudes towards menopause. The average attitude score was 33.48±6.58 [56 max score], indicating a generally negative orientation towards menopause. A weak but significant positive correlation was observed between knowledge and attitudes (r=0.249, P<0.01). Targeted educational initiatives may be beneficial in enhancing menopause-related knowledge and fostering more positive attitudes among midlife Malaysian women. Future research should rigorously assess changes in knowledge, attitudes and related clinical behaviours after such interventions to inform policy and practice.

60. A Multi-Hospital Assessment of Healthcare Service Quality and Patient Satisfaction in Ghana's Tertiary Hospitals: Implications for Sustainable Development Goal 3.

期刊: Health services insights 发表日期: 2026 链接: PubMed

摘要

Sustainable Development Goal 3 (SDG 3) emphasizes universal access to high-quality healthcare services as a cornerstone of global health improvement. Although access to care has expanded in many low- and middle-income countries, including Ghana, healthcare service quality (HSQ) and patient satisfaction (PS) remain uneven, particularly within tertiary hospitals. This study assessed PS and determinants of HSQ in Ghanaian tertiary hospitals using the RATER model. A multi-center cross-sectional survey was conducted among patients attending five tertiary hospitals in Ghana that were operational prior to the inception of SDG 3. PS was measured using the Client Satisfaction Questionnaire (CSQ-8), while HSQ was assessed using the RATER dimensions of SERVQUAL. Of the 354 participants targeted, 297 were enrolled with a response rate of 83.9%. Data were collected electronically using REDCap. Group differences, associations, and predictors of PS were examined using appropriate non-parametric tests and multivariable regression models. All analyses were performed using SPSS and R software. The mean age of participants was 38.96 ± 15.19 years (range: 18-75), and 65.7% were female. Overall PS was high with a mean score of 3.56 ± 0.41. All RATER gap dimensions were strongly intercorrelated (ρ= 0.62-0.80) and demonstrated moderate-to-strong positive associations with PS (ρ=0.50-0.59). Demographic characteristics were not significantly associated with satisfaction. However, monthly income predicted satisfaction, with low-income participants reporting higher satisfaction than those with no income. Institutional differences in unadjusted satisfaction were observed, with the highest satisfaction among patients attending Tamale and Komfo Anokye Teaching Hospitals, although these differences attenuated after multivariable adjustment. Among HSQ dimensions, reliability showed the strongest association with PS. Patient satisfaction in Ghana’s tertiary hospitals is driven more by structural and socioeconomic conditions, institutional performance and perceived service reliability than by demographic characteristics. Strengthening reliability in service delivery and reducing inter-hospital disparities are critical for advancing patient-centered care and achieving SDG 3.

61. Frailty-Informed Deprescribing of Glucose-Lowering Therapy in Older Adults with Type 2 Diabetes: A Pragmatic Clinical Framework.

期刊: Clinical interventions in aging 发表日期: 2026 链接: PubMed

摘要

Older adults with type 2 diabetes are often subjected to intensive glucose-lowering therapies with a high likelihood of hypoglycaemia, falls, functional decline, and treatment burden. While international recommendations advocate for individualised glycaemic targets, they provide little clarification on when, or how, to de-intensify therapies as health status changes. We undertook a targeted evidence synthesis of randomised controlled trials, observational cohort studies, target trial emulation studies, and international clinical guidelines focusing on glucose-lowering agents for the treatment of diabetes mellitus in patients aged 65 years and older. Evidence was synthesised and prioritised based on relevance for the important outcomes in later life, including hypoglycaemia, hospitalisation, functional decline, quality of life, and mortality. From this evidence and the principles of geriatric medicine, we constructed a pragmatic, frailty-informed clinical decision framework for the purposes of guiding deprescribing and the de-intensification of glucose-lowering therapy. Older adults in a variety of care continuum settings, particularly with frailty, multimorbidity, cognitive impairment, or a limited life expectancy, tend to stay on intensive glucose-lowering therapies for very little, if any, benefit. Target trial emulation studies and observational studies most often show that hypoglycaemia and treatment burden are lowered by de-intensifying high-risk medications, particularly insulin and sulfonylureas, without any clinically important deterioration in glycaemic control. Even with the evidence, existing guidance lacks a practical operational framework to implement such evidence in everyday clinical practice. We suggest a frailty-informed clinical decision framework that integrates functional status, physiologic vulnerability, treatment-related risks, and patient preferences in making glucose-lowering treatment decisions in older adults with type 2 diabetes. This framework shifts the focus to patient safety and functional outcomes, instead of HbA1c targets, to provide a practical approach to deprescribing and de-intensifying treatment to minimise iatrogenic harm and, most importantly, to align care with the preferences of older adults.

62. BioGraphX: bridging the sequence-structure gap via physicochemical graph encoding for interpretable subcellular localization prediction.

期刊: Bioinformatics advances 发表日期: 2026 链接: PubMed

摘要

Computational protein subcellular localization prediction is vital for understanding cellular mechanisms and disease treatments. However, current methods lack interpretability: they predict where a protein localizes but fail to explain why. Moreover, understanding protein behaviour requires costly, time-consuming three-dimensional structures. Here, we propose BioGraphX, a novel encoding framework that constructs protein interaction graphs directly from sequences using biochemical rules, providing a constraint-based structural proxy. Building upon this, BioGraphX-Net demonstrates superior performance on the DeepLoc 2.0 benchmark by integrating ESM-2 (Evolutionary Scale Modeling) embeddings with the proposed features via a gating mechanism. Gating analysis shows that while ESM-2 embeddings contribute strongly, BioGraphX features function as high-precision filters. SHAP (SHapley Additive exPlanations) analysis reveals feature importance patterns consistent with a sophisticated biophysical logic: sequence signals act as universal exclusion filters, while organelle-specific biophysical combinations enable precise compartment discrimination. Notably, Frustration features resolve targeting ambiguities in complex compartments, reflecting evolutionary constraints while preventing mislocalization from sequence mimicry. Cross-dataset validation on a protein solubility prediction task confirms the structural proxy captures genuine biophysical signal. Additionally, BioGraphX promotes Green AI in bioinformatics, matching state-of-the-art performance with a minimal parameter count of 13.46 million. In summary, BioGraphX provides accurate predictions and new insights into the language of life. Source code is available at https://github.com/Abubakar-Saeed/BioGraphX.

63. MicroRNA network regulation of developmental bone toxicity in a human embryonic stem cell osteogenic model.

期刊: NAM journal 发表日期: 2026 链接: PubMed

摘要

Developmental exposure to environmental toxicants is a cause of skeletal abnormalities. Yet the molecular mechanisms linking early exposure to impaired bone formation remain undefined. Skeletal tissues arise from both neural crest- and mesoderm-derived lineages that rely on shared osteogenic differentiation programs, suggesting that disruption of common regulatory processes may contribute to diverse skeletal outcomes. MicroRNAs (miRNAs) are key post-transcriptional regulators of gene networks and have appeared as indicators of toxicant-induced perturbation. In this study, we examined whether developmentally relevant toxicants are associated with miRNA regulatory networks during osteogenic differentiation. Using a human embryonic stem cell (hESC)-based osteogenic differentiation model, we assessed the effects of nine toxicants spanning distinct primary mechanisms. Toxicant exposure impaired osteogenic differentiation at their IC50, as reflected by altered expression of osteogenic markers and transcriptional remodeling. Global miRNA profiling revealed dysregulation of miRNAs enriched for bone-related biological processes, including regulators of osteogenic commitment and differentiation timing. Integrated miRNA-mRNA network analysis identified a subset of miRNAs linked to core osteogenic and lineage-associated pathways, including RUNX2-dependent transcription and BMP and Wnt signaling. Modulation of representative miRNAs produced osteogenic outcomes consistent with those observed following toxicant exposure and, in some cases, was associated with partial restoration of differentiation in exposed cultures. Collectively, these findings indicate that chemically diverse developmental toxicants are associated with miRNA-mediated regulatory patterns during osteogenic differentiation. Identification of shared miRNA regulatory features provides mechanistic insight into developmental bone toxicity and supports the use of miRNA network analysis as a human-relevant endpoint for skeletal hazard identification.