公共卫生文献雷达（2026-08-11）
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1. Student perceptions of a three-minute thesis presentation activity in undergraduate pharmacology education: a post-intervention evaluation.
主题：流行病学
期刊：The Libyan journal of medicine
发表日期：2026-Dec-31
内容状态：待评估
为什么值得看：包含可供初筛的摘要；仅作为选题线索，不代表证据质量结论。
Communication skills are a core competency in pharmacy education; however, traditional presentation approaches often place limited emphasis on clarity, engagement, and meaningful integration of knowledge. This study evaluated student perceptions and immediate post-activity knowledge following implementation of a Three-Minute Thesis (3MT) group presentation task among third-year Doctor of Pharmacy (Pharm.D) undergraduate students in a pharmacology course at Umm Al-Qura University, Makkah, Saudi Arabia. A single-group, post-intervention, cross-sectional evaluation design was used. Learning outcomes were assessed using a structured 20-item evaluation questionnaire measuring five domains (engagement, perceived learning, communication confidence, satisfaction, and peer perception) and a five-item knowledge quiz administered immediately after the activity. A total of 59 students participated (79.7% response rate). Perceptions were highly positive across all domains, with the highest mean scores observed for satisfaction ($M = 4.37$, $SD = 0.80$) and peer perception ($M = 4.32$, $SD = 0.79$), followed by engagement ($M = 4.21$, $SD = 0.74$), perceived learning ($M = 4.16$, $SD = 0.81$), and communication confidence ($M = 4.11$, $SD = 0.77$). Subscale reliability was strong (Cronbach’s $\alpha = 0.79-0.92$). Quiz performance reflected high immediate post-activity knowledge, with a mean score of 3.86 out of 5 ($SD = 1.18$), and 72.9% of participants achieving scores of 4 or 5. The 3MT-style format is a feasible and highly engaging active-learning strategy in undergraduate pharmacology. While the descriptive single-group design limits direct causal inferences, the strong student reception and solid immediate knowledge profiles demonstrate its pedagogical viability and educational value. Future controlled, multi-institutional studies are warranted to evaluate long-term impacts.
2. The global scientific consensus on genetically modified crop risk assessments.
主题：流行病学
期刊：GM crops & food
发表日期：2026-Dec-31
内容状态：待评估
为什么值得看：包含可供初筛的摘要；仅作为选题线索，不代表证据质量结论。
Initial risk assessments of genetically modified (GM) crops began in the early 1990 s, focusing on herbicide tolerance and insect resistance, with approvals by the mid-1990s. These assessments compare GM crops to non-GM equivalents, a framework unchanged for over 30 years. Since the first assessment in 1994, over 4,400 evaluations have been conducted across more than 70 countries for both cultivation and food/feed use. To date, none have identified increased risk relative to conventional varieties. This article analyzes three decades of GM crop approvals, highlighting the consistency of scientific assessment processes. Fourteen crops underwent 692 cultivation and 1,891 food-release assessments for herbicide tolerance, while insect resistance accounted for 523 cultivation and 1,396 food-release assessments, largely involving Bacillus thuringiensis (Bt). The findings underscore that GM crops are equivalent in risk to conventional varieties, supporting reliance on established international scientific expertise, particularly in resource-constrained regions.
3. A quasi-experimental crossover study on student engagement and performance in a gamified team-based learning module in physiology.
主题：流行病学
期刊：Medical education online
发表日期：2026-Dec-31
内容状态：待评估
为什么值得看：包含可供初筛的摘要；仅作为选题线索，不代表证据质量结论。
PURPOSE: Gamification is widely adopted in medical education, but recent systematic reviews reveal ambiguous effects on learning outcomes. It remains unclear whether engagement translates to learning or whether game mechanics impose extraneous cognitive load. This quasi-experimental crossover study investigated gamification’s impact on student performance and engagement in Team-Based Learning.
METHOD: 250 first-year MBBS students at a tertiary medical college (2024-2025) participated in two physiology modules (Central Nervous System, Endocrinology) using either traditional or gamified Group Readiness Assurance Tests (GRAT) in a crossover design. Primary outcomes were Individual Readiness (IRAT) and Application Exercise (AE) scores; secondary outcomes were engagement and satisfaction.
RESULTS: Primary outcomes (IRAT and AE scores) did not differ significantly between formats. However, learning trajectory analysis revealed a potential mitigating trend: in Endocrinology, traditional groups showed significant IRAT-to-AE decline (-3.3 percentage points, p = 0.030, d = 0.19), whereas gamified groups’ decline was non-significant (-1.9 pp, p = 0.124, d = 0.13).During the GRAT intervention phase, traditional teams outperformed gamified teams in Endocrinology (p = 0.006, d = 1.04), but not CNS (p = 0.43). Qualitative feedback was overwhelmingly positive (90% of responses), praising engagement and teamwork, though 13% cited time pressure as stressful.
CONCLUSIONS: Gamification may enhance engagement and may provide a motivational buffer against performance decline in challenging content. This suggest gamification is a context-sensitive design choice requiring careful calibration to balance motivational benefits against cognitive costs.
4. Non-prescription antibiotic dispensing in community pharmacies in jordan: a simulated patient study.
主题：流行病学
期刊：The Libyan journal of medicine
发表日期：2026-Dec-31
内容状态：待评估
为什么值得看：包含可供初筛的摘要；仅作为选题线索，不代表证据质量结论。
Inappropriate antibiotic use in community settings is a major contributor to antimicrobial resistance, particularly in low- and middle-income countries where regulatory enforcement may be inconsistent. Community pharmacies are a critical interface between health systems and the public; however, real-world dispensing practices remain insufficiently characterized in many settings. This study evaluated the prevalence, behavioral drivers, and clinical quality of non-prescription antibiotic dispensing in Jordanian community pharmacies using a simulated patient methodology.A cross-sectional simulated patient study was conducted across 200 community pharmacies in Jordan. A standardized encounter involving a three-stage progressive escalation protocol assessed dispensing behavior under increasing patient demand. The primary outcome was antibiotic supply without a valid prescription. Secondary outcomes included clinical assessment, counseling, referral behavior, and antibiotic class supplied. Multivariable logistic regression was used to identify predictors of non-prescription dispensing and adequate clinical assessment.Antibiotics were dispensed without prescription in 162 encounters (81.0%; 95% CI, 75.6-86.4). During the initial symptom-based presentation, 110 pharmacies (55.0%) supplied antibiotics. Among pharmacies that initially declined, a direct antibiotic request resulted in additional dispensing in 44.4% of cases, while subsequent patient insistence led to further supply in 24.0%, producing a cumulative prevalence of 81.0%. Independent pharmacies (adjusted odds ratio [AOR], 2.48; 95% CI, 1.23-5.02) and rural locations (AOR, 2.02; 95% CI, 1.01-4.03) were associated with higher dispensing odds. History-taking occurred in 49.4% of dispensing encounters, allergy screening in 14.2%, and no counseling was provided in 29.0%. Broad-spectrum agents represented 73.5% of dispensed antibiotics.Non-prescription antibiotic dispensing remains widespread in Jordan and is influenced by patient pressure and practice characteristics. Strengthened regulatory enforcement, professional training, and public awareness interventions are urgently needed.
5. Pregnant women’s experiences during a public health emergency: A cross-sectional analysis of the COVID-19 Pregnancy Risk Assessment Monitoring System COVID-19 supplement.
主题：生物统计与研究设计
期刊：Public health in practice (Oxford, England)
发表日期：2026-Dec
内容状态：待评估
为什么值得看：包含可供初筛的摘要；仅作为选题线索，不代表证据质量结论。
OBJECTIVES: The COVID-19 pandemic was associated with increased maternal morbidity and mortality, with racially minoritized women having worse outcomes than other women in the United States. However, there is little understanding of pandemic-specific stressors that may contribute to disparate outcomes. Thus, this analysis provides descriptive statistics of COVID-19 pandemic related factors among a sample of women who recently gave birth in the United States that can inform future public health disaster preparedness.
STUDY DESIGN: Cross-sectional analysis of secondary data.
METHODS: Analysis of 2020-2021 Pregnancy Risk Assessment Monitoring System COVID-19 supplement data (weighted n = 453,231) identified five pandemic experience factors through factor analysis: family household stressors, housing instability, COVID prevention measures, COVID household exposure, and external exposure. Prevalence of each factor was estimated overall and by demographic factors.
RESULTS: Family household stressors affected 42.1% of women, including increased anxiety (48.5%) and job loss (29.9%). Housing instability impacted 11.3%, while 35.2% struggled accessing prevention supplies. Significant disparities emerged: Black and Hispanic women experienced highest family stress rates (48.5%, 48.0%); American Indian/Alaska Native women faced greatest housing instability (21.6%). Younger, unmarried women and those with lower education, Medicaid enrollment, or pre-existing vulnerabilities experienced disproportionate burdens.
CONCLUSIONS: Findings necessitate targeted emergency preparedness protocols prioritizing pregnant women’s social support infrastructure, including housing assistance programs, expanded childcare services, and guaranteed access to prevention resources. The pandemic exacerbated maternal health disparities, with marginalized communities bearing the greatest burden. Medicaid expansion and culturally-responsive interventions should be implemented to support vulnerable populations during public health crises.
6. Small rodents, huge impact: A scoping review of European Apodemus species in the ecology of directly transmitted, environmentally mediated, and interface-associated zoonotic pathogens.
主题：生物统计与研究设计
期刊：One health (Amsterdam, Netherlands)
发表日期：2026-Dec
内容状态：待评估
为什么值得看：包含可供初筛的摘要；仅作为选题线索，不代表证据质量结论。
European Apodemus rodents host zoonotic pathogens across wildlife, agricultural and peri-urban interfaces, but the evidence remains fragmented. We conducted a PRISMA-guided scoping review of English-language, peer-reviewed primary studies published during 2000-2025 reporting positive Apodemus-specific evidence for zoonotic viral or bacterial pathogens in Europe. Europe PMC, PubMed, Web of Science and CABI Digital Library were searched, with supplementary citation searching. Of 4051 pathogen-specific records screened, 166 eligible pathogen-specific article records were retained, representing 141 unique publications and 241 pathogen-study records. We charted pathogen, host, geography, diagnostic method, evidence type and ecological determinants. Evidence was strongest for Hantaviridae and Leptospira spp.; moderate or context-dependent for Arenaviridae, Poxviridae, Francisella tularensis, Yersinia spp., Campylobacter spp., Escherichia coli and Staphylococcus aureus; and sparse or principally detection-oriented for Astroviridae, Coronaviridae, Paramyxoviridae, Clostridioides difficile and Mycobacterium spp. Reported determinants included host traits and abundance, seasonality, resource pulses, habitat and land use, rainfall, temperature, humidity, flooding and synanthropic exposure. Substantial heterogeneity in study design, assays, host identification, denominators and ecological covariates precluded pooled prevalence or effect synthesis. Detection or seropositivity was therefore not interpreted as proof of reservoir competence. European Apodemus species are best regarded as potential reservoirs in selected systems and, more broadly, as ecological interface hosts connecting wildlife, environmental, livestock, peri-urban and human-exposure pathways. One Health surveillance should integrate host monitoring and identification with pathogen diagnostics, environmental indicators, veterinary reporting, public-health data and human-exposure surveillance at shared spatial and temporal scales.
7. Dynamics of an SEIRV endemic model: effects of reinfection.
主题：流行病学
期刊：Journal of biological dynamics
发表日期：2026-Dec-31
内容状态：待评估
为什么值得看：包含可供初筛的摘要；仅作为选题线索，不代表证据质量结论。
The threshold interpretation of R0 can fail to describe elimination in epidemic models with imperfect vaccination and reinfection. We study an SEIRV model in which vaccinated individuals remain partially susceptible and recovered individuals may be reinfected. The main novelty is an explicit threshold account of how reinfection can sustain endemic equilibria even when the vaccinated-population reproduction number satisfies R0<1. We derive the disease-free equilibrium, R0, and a sufficient condition for convergence to the disease-free state, showing why local disease-free stability and global elimination are distinct. We reduce the endemic-equilibrium problem to a scalar equation and identify a reinfection threshold β2∗ determining the local direction of bifurcation at R0=1. When β2>β2∗, we prove a lower critical threshold R0C<1 separating elimination from subcritical endemic persistence. We also give an efficient-vaccine approximation and general numerical algorithm for computing R0C. Simulations using an illustrative Omicron-era parameterisation show how these thresholds organise the model dynamics.
8. Using the Normalization Process Theory to study facilitators and barriers to sustainable implementation of artificial intelligence-based diabetic retinopathy screening in Rwanda.
主题：生物统计与研究设计
期刊：Dialogues in health
发表日期：2026-Dec
内容状态：待评估
为什么值得看：包含可供初筛的摘要；仅作为选题线索，不代表证据质量结论。
BACKGROUND: The rising incidence of diabetes and its complications, particularly diabetic retinopathy (DR), in sub-Saharan Africa presents a significant public health challenge, compounded by a lack of skilled human resources. Artificial intelligence (AI)-based screening offers a promising way to address this burden. Understanding the integration of such complex interventions from research to routine clinical practice is crucial for sustainability.
METHODS: A qualitative study design was employed using the Normalization Process Theory (NPT) framework, which supports the evaluation of whether an innovation will be sustainable in everyday practice by analysing how new practices become embedded into routine work. Clinical staff and patients involved in AI-based DR screening at three clinics in Kigali, Rwanda were interviewed using an NPT-based questionnaire through semi-structured interviews and focus groups. Verbal consent was obtained for recording and transcription. Interview data were thematically analysed, with codes generated to align with the four NPT constructs: coherence, cognitive participation, collective action, and reflexive monitoring.
FINDINGS: In total, nine clinical staff members and 67 patient participants were interviewed. Participants reported a coherent understanding of the program’s purpose, value, and benefits. They valued the technology for its ability to address the gap between the scarcity of competent healthcare providers and the growing burden of DR. Challenges identified related to workload, division of labour, initial patient distrust of AI, and restrictive organizational policies regarding operator access.
INTERPRETATION: The NPT framework proved valuable for analysing the implementation of this complex intervention, providing insights into user perceptions and generating actionable recommendations for enhancement. While positive adoption was observed, further research is needed to fully understand the intervention’s long-term impact on health outcomes such as visual preservation and treatment success.
FUNDING: Fundus cameras were donated by Topcon. The company had no input into the design and/or analysis of the study.
9. Retention of fellows to the faculty at a research-intensive academic medical center: a mixed-methods study.
主题：流行病学
期刊：Medical education online
发表日期：2026-Dec-31
内容状态：待评估
为什么值得看：包含可供初筛的摘要；仅作为选题线索，不代表证据质量结论。
BACKGROUND: As clinical practice provides >50% of medical schools’ revenue, research-intensive medical schools often seek to retain fellows with clinical-care interests. Fellows’ considerations when deciding whether to stay at research-intensive institutions where they trained remain understudied. We sought to identify experiential factors associated with faculty-position offers and decisions of fellows in training.
METHODS: We conducted a mixed-methods study using a survey and semi-structured interview. We invited 471 fellows training in all clinical departments at our institution to complete an anonymous survey between April and June 2021 to examine their level of agreement (strongly disagree [1] to strongly agree [7]) with positive training and mentoring experiences and their academic-medicine career goals in association with being offered a position and, if offered, accepting or declining. After survey completion, we invited fellows for interviews about their decision-making to seek, accept, or decline post-fellowship faculty-positions as well as what our institution could do to encourage fellows to accept offered positions.
RESULTS: We analyzed survey data from 168 (35.7%) fellows. Of 48 fellows who were offered faculty positions, 21 accepted and 27 declined; 56 fellows were not offered a position and 64 were too early in training to have received an offer. Fellows who were offered/accepted positions reported higher mean (SD) agreement with positive training (5.9 [1.2]; p < 0.02) and mentoring (6.1 [1.0]; p < 0.001) experiences and having academic-medicine career goals (5.8 [0.8]; p < 0.001) than fellows in other faculty-offer groups. In interviews, 24 fellows reported career goals and institutional resources as influencing decisions. Fellows described institutional opportunities for intervention, especially enhanced communication about institutional priorities and potential positions.
CONCLUSIONS: Clear communication with clinical fellows about their academic-medicine career goals and fellowship-training and mentoring experiences can inform decision-making about faculty offers and better equip institutional leaders to retain fellows who align with institutional needs.
10. Large language model use in dental education: a cross-sectional multi-country study.
主题：流行病学
期刊：Medical education online
发表日期：2026-Dec-31
内容状态：待评估
为什么值得看：包含可供初筛的摘要；仅作为选题线索，不代表证据质量结论。
BACKGROUND: Large language models (LLMs) are increasingly used in higher education, but multi-country evidence on dental students’ use, verification, and integrity practices is limited.
OBJECTIVE: To compare senior dental students’ LLM use, perceived time and academic impact, reliability judgements, verification practices, and integrity safeguards across five countries.
METHODS: An anonymous cross-sectional online survey was administered to final-year dental students in the United Arab Emirates (UAE), Jordan, Malaysia, Oman, and Brazil. Measures included tools used, frequency and motivations, learning activities, perceived time and academic impact, verification frequency and strategies, guideline awareness, and integrity safeguards. Analyses used Kruskal-Wallis and chi-square tests with Benjamini-Hochberg adjustment, effect sizes, Spearman correlations, and ordinal logistic models.
RESULTS: In total, 454 students participated (UAE 160, Jordan 101, Malaysia 75, Oman 62, Brazil 56; mean age 22.9; 74.9% female). ChatGPT predominated (95.9%), followed by Gemini, formerly Bard (18.0%), DeepSeek (16.4%), and Claude (7.4%). Tool diversity varied across country-based cohorts, with Oman showing greater multi-tool uptake. Use was frequent (several times/week 39.2%, daily 28.6%). Key motivations were saving time (73.0%), clarifying concepts (56.9%), and summarising (54.1%). Common activities included understanding complex concepts (75.3%), summarising lecture notes (70.0%), exam preparation (61.5%), and assignment research (53.2%); exam-time assistance was reported by 25.6%. Verification was ‘always’ 20.0% and ‘often’ 34.1%, varying across country-based cohorts, with Oman verifying less frequently than other cohorts. Guideline awareness was 40.3% overall (UAE 61.3% vs Brazil 8.3%). Integrity safeguards commonly involved paraphrasing (69.6%), citations (39.2%), and plagiarism checks (38.0%); disclaimers were uncommon (9.2%). LLM-use frequency correlated with broader academic use (ρ = 0.289) but not with integrity concern (OR = 0.963).
CONCLUSIONS: LLM use is widespread and heterogeneous across settings, including non-trivial higher-stakes use. Dental programmes should implement explicit training in verification, evidence traceability, and disclosure, supported by clear, enforceable guidance and assessment designs aligned with real-world LLM practices.
11. Comparative safety profiles of antibody-drug conjugates: a real-world analysis of monotherapy and combination regimens in solid tumors.
主题：流行病学
期刊：Drug delivery
发表日期：2026-Dec-31
内容状态：待评估
为什么值得看：包含可供初筛的摘要；仅作为选题线索，不代表证据质量结论。
The expanding clinical use of Antibody-Drug Conjugates (ADCs) necessitates a clearer understanding of their real-world toxicity profiles across diverse clinical settings. This retrospective pharmacovigilance study analyzed 19,697 adverse event (AE) reports for seven approved ADCs from the FDA Adverse Event Reporting System (FAERS) database (Q1 2004 to Q1 2025). Using disproportionality analysis validated by multivariable logistic regression, we identified safety signals for both monotherapy and combination regimens. The analysis revealed that toxicity profiles are strongly driven by an ADC’s molecular structure and treatment setting. Target-specific ‘on-target, off-tumor’ effects were prominent, linking Nectin cell adhesion molecule 4 (NECTIN-4) targeting to skin reactions, Trophoblast cell-surface antigen 2 (TROP2) to gastrointestinal toxicities, and both folate receptor α (FRα) and tissue factor (TF) to ocular disorders. Furthermore, payload and linker types drove distinct toxicities; topoisomerase I inhibitors were associated with increased respiratory toxicity and mortality, while non-cleavable linkers conferred a significantly stronger risk of hepatobiliary toxicity. Combination regimens not only amplified specific risks, such as endocrine disorders with immune checkpoint inhibitors (ICIs), but also fundamentally reshaped toxicity kinetics, accelerating AE onset with ICIs while significantly delaying it with other combinations. This real-world analysis confirms that ADC toxicities are highly specific to their molecular design and clinical context, highlighting that understanding these complex structural and kinetic interplays is essential for optimizing safety management in clinical practice.
12. Experiences of a postpartum depression prevention programme in a circumpolar setting: insights from pregnant women and healthcare providers.
主题：流行病学
期刊：International journal of circumpolar health
发表日期：2026-Dec-31
内容状态：待评估
为什么值得看：包含可供初筛的摘要；仅作为选题线索，不代表证据质量结论。
Supporting maternal mental health is a priority in circumpolar settings, where seasonality and constrained service availability can limit psychosocial support. This qualitative study explored pregnant women’s and healthcare providers’ experiences of a postpartum depression prevention programme and perspectives on integrating it into routine antenatal care in Arkhangelsk, Northwest Russia. Four focus group discussions with pregnant women (n = 17) and individual interviews with four healthcare providers were analysed using reflexive thematic analysis. Participants described the programme as providing trusting spaces for sharing, expert-led preparation for childbirth and the postpartum period, and brief individual follow-up after birth. Women reported greater confidence in identifying signs of vulnerability, articulating needs, and accessing support. Providers highlighted that these benefits depended on feasible scheduling, group formats, reusable materials, and coordinated delivery across professionals to avoid fragmentation. System-level factors (reach, retention, and cross-provider coordination) were seen as central for sustained uptake and routine integration. The findings suggest that the programme’s contribution lies in the interaction between participant experiences of support and the organisational conditions needeed to sustain them in routine antenatal care. Preventive perinatal mental health programmes in circumpolar contexts can strengthen preparedness and help-seeking when designed for relational participation and supported by coordinated service structures.
13. Early-life microbiota in the LIMIT cohort: unveiling meconium microbiota types beyond maternal lifestyle.
主题：流行病学
期刊：Gut microbes
发表日期：2026-Dec-31
内容状态：待评估
为什么值得看：包含可供初筛的摘要；仅作为选题线索，不代表证据质量结论。
INTRODUCTION: Early gut microbiota development plays an important role in lifelong human health, and meconium offers a unique matrix to understand prenatal microbial exposures. This study from the LIMIT cohort aimed at investigating associations between maternal pre-pregnancy body mass index (pre-BMI) and gestational weight gain (GWG), as well as other maternal lifestyle and environmental factors, with the structure of meconium microbiota at delivery.
METHODS: Two hundred pregnant women were enrolled during the pre-hospital care before birth at Fondazione IRCCS Policlinico San Matteo (Pavia), according to the inclusion/exclusion criteria. Mothers were grouped based on their GWG gain category according to the IOM guidelines. 168 meconium samples were analyzed using a targeted long-reads sequence approach. Bacterial 16S rRNA (V1-V8) amplicons were sequenced using the Oxford Nanopore PromethION platform. Supervised analyses assessed associations between maternal variables and bacterial diversity, while an unsupervised learning approach based on the Partitioning Around Medoids (PAM) clustering algorithm was applied to identify specific microbial clusters unrelated to the cohort’s metadata.
RESULTS: No significant associations were observed between GWG, pre-BMI or other lifestyle factors and overall microbial diversity. Unsupervised learning revealed five distinct meconium microbial clusters, i.e. “microbiota-types”, related to different taxonomic profiles, determined by the variations in specific bacterial species.
CONCLUSION: No significant influence of the studied variables was observed on meconium microbiota. However, the meconium microbial communities appear to organize into enterotype-like structures, highlighting the need for longitudinal studies to identify key determinants of early colonization.
14. Shelf help: what powers medical student subject exam performance in the United States.
主题：生物统计与研究设计
期刊：Medical education online
发表日期：2026-Dec-31
内容状态：待评估
为什么值得看：包含可供初筛的摘要；仅作为选题线索，不代表证据质量结论。
BACKGROUND: Following the change in 2022 of a scored United States Medical Licensing Examination (USMLE) Step 1 to a binary pass-fail grading system, greater emphasis has been placed on the Step 2 Clinical Knowledge (Step 2 CK) exam. Shelf or subject exams offered by the National Board of Medical Examiners (NBME) help prepare students for Step 2CK and therefore deserve the attention of clerkship directors. This paper reviews the literature pertaining to the factors that positively and negatively impact medical students’ performance on the shelf exams, including but not limited to performance in the pre-clinical years, clinical exposures, peer learning, active or team-based learning, length of clerkships, and order and number of previous shelf exams.
METHODS: The PubMed database was searched to identify studies describing factors influencing performance on shelf exam scores during medical school and strategies for improving shelf scores. Studies were identified through iterative searches using multiple keyword combinations related to NBME shelf examinations, NBME subject examinations, clerkship performance, academic achievement, and educational interventions. Inclusion criteria consisted of English-language studies published between 2005 and 2025 involving students at U.S. allopathic or osteopathic medical schools. The included studies were reviewed for relevance and methodological rigour, including consideration of study design, sample size, statistical analyses, and reported outcomes.
RESULTS: A robust pre-clinical education remains vital for success on NBME shelf examinations. Exam scores are also influenced by the number and order of previous exams. Increased clinical exposure, active learning, team-based approaches, and peer review sessions have not consistently shown improvements in performance.
CONCLUSIONS: This review underscores the importance of a foundational understanding of the basic sciences for student success on exams, while acknowledging that clerkship directors must balance their obligation to adequately prepare students for standardized testing with their mission to craft compassionate and competent future clinicians.
15. Metformin added to lifestyle intervention for physical function in older adults with obesity (DEMFOS trial): a randomised controlled trial.
主题：临床研究与数据方法
期刊：The lancet. Healthy longevity
发表日期：2027-Jul-01
内容状态：待评估
为什么值得看：包含可供初筛的摘要；仅作为选题线索，不代表证据质量结论。
BACKGROUND: Obesity in older adults is associated with functional decline and increased risk of disability. Lifestyle interventions improve physical function, but the role of metformin as an adjunct to lifestyle intervention in this population remains unclear. In this randomised clinical trial, we evaluated whether metformin enhances the effects of an intensive lifestyle intervention on physical function in older adults with obesity.
METHODS: The Diet and Exercise plus Metformin to Treat Frailty in Obese Seniors (DEMFOS) trial (ClinicalTrials.gov: NCT04221750 [completed]) was a randomised, placebo-controlled trial conducted at the Michael E DeBakey Veterans Affairs Medical Center and Baylor College of Medicine (Houston, TX, USA). Older adults (aged 65-85 years) with obesity (BMI ≥30 kg/m2) were randomly assigned to intensive lifestyle intervention (weight-management and exercise training) plus placebo, intensive lifestyle intervention plus metformin, or healthy lifestyle (diet education) plus metformin groups. The primary outcome was change in the modified physical performance test score at 6 months. The primary analysis was by intention-to-treat.
FINDINGS: Of 221 participants assessed for eligibility between March 30, 2021, and Dec 12, 2024, 114 were included in this study (mean age 72·8 years [SD 5·2]; 101 [89%] men and 13 [11%] women). 64 (56%) participants were White, 50 (44%) were Black, and 15 (13%) were Hispanic or Latino. Changes in physical performance test differed between groups (group-by-time interaction p<0·0001). At 6 months, physical performance test improvement was greater in the intensive lifestyle plus metformin group than in the healthy lifestyle plus metformin group (mean difference 2·5 points, 95% CI 1·2-3·8; p=0·0002), whereas there was no difference between the intensive lifestyle plus metformin and intensive lifestyle plus placebo groups (0·1 points, -1·2 to 1·4; p=0·92). Serious adverse events were infrequent and not attributed to the study interventions.
INTERPRETATION: Our findings suggest that in older adults with obesity undergoing intensive lifestyle intervention, metformin does not provide additional improvement in physical function. These results support prioritising lifestyle-based strategies to improve functional outcomes in this population.
FUNDING: US Department of Veterans Affairs.
16. State of the global tuberculosis epidemic: burden, progress towards WHO End TB Strategy targets and systemic challenges.
主题：流行病学
期刊：The Lancet. Microbe
发表日期：2027-Apr-26
内容状态：待评估
为什么值得看：包含可供初筛的摘要；仅作为选题线索，不代表证据质量结论。
Mycobacterium tuberculosis remains the leading cause of death from a single infectious pathogen globally despite decades of effective chemotherapy. In 2024, an estimated 10·7 million people developed tuberculosis, including approximately 620 000 people living with HIV (PLHIV), and tuberculosis caused an estimated 1·23 million deaths overall, including approximately 150 000 deaths among PLHIV. Men accounted for more than half of the cases, and children represented a substantial burden, reflecting ongoing transmission and diagnostic gaps. Approximately a quarter of the world’s population has been infected with M tuberculosis, with immunological evidence of previous or current infection. This population includes groups at increased risk of progression to tuberculosis disease, particularly those with recent infection, HIV, undernutrition, young age, or other clinical and social vulnerabilities. Following 3 years of COVID-19-related setbacks, global tuberculosis incidence declined modestly (1%) from 2023 to 2024 but remains higher than in 2020 and far off-track to meet the 2025 WHO End TB Strategy milestones. Case detection improved to 8·3 million notifications (78% of estimated incident cases), supported by expanded molecular diagnostics; however, prevalence surveys continue to reveal substantial proportions of bacteriologically confirmed but asymptomatic tuberculosis, highlighting persistent transmission and missed diagnoses. 30 high-burden countries accounted for 87% of cases, led by India, Indonesia, the Philippines, China, Pakistan, Nigeria, the Democratic Republic of the Congo, and Bangladesh. M tuberculosis-HIV co-infection remains a major driver of mortality in sub-Saharan Africa. Drug-resistant tuberculosis threatens progress: of 390 000 estimated multidrug-resistant or rifampicin-resistant tuberculosis cases in 2024, only 42% initiated treatment, although treatment success improved to 71%. Tuberculosis-preventive treatment reached 5·3 million people, including 58% of PLHIV and 25% of eligible household contacts, well below global targets. Persistent undernutrition, poverty, HIV, diabetes, smoking, alcohol use, air pollution, migration, and conflict continue to shape tuberculosis epidemiology. With financing at only 27% of global targets, accelerated prevention, proactive case finding, social protection, and sustained political commitment are essential to eliminate tuberculosis.
17. A qualitative exploration of pregnant women’s awareness and utilization of the Australian dietary guidelines for pregnancy.
主题：卫生政策与真实世界证据
期刊：International journal of qualitative studies on health and well-being
发表日期：2026-Dec-31
内容状态：待评估
为什么值得看：包含可供初筛的摘要；仅作为选题线索，不代表证据质量结论。
PURPOSE: The Australian dietary guidelines for pregnancy advise on optimal maternal intake. However, previous literature demonstrates suboptimal adherence to guidelines, with no evidence of the experience of sourcing nor uptake of the dietary guidelines among pregnant women. We aimed to explore pregnant women’s knowledge of nutrition information, including the current Australian dietary guidelines for pregnancy.
METHODS: Nineteen pergnant women were recruited using convenient sampling. Semi-structured interviews were analysed thematically, underpinned by the Capability, Opportunity, Motivation and Behaviour (COM-B) model and Theoretical Domains Framework.
RESULTS: Three themes were identified. Women showed limited awareness and/or utilization of the dietary guidelines for pregnancy, partially due to the inconsistent opportunity to receive guidelines from maternity healthcare providers. When seeking advice independently, women’s capability to acquire pregnancy-related food knowledge was primarily dedicated to food safety and to identifying reliable advice from other non-evidence-based information. Women’s motivation to utilize the dietary guidelines for pregnancy is low, with the perception that the broad recommendations may not meet their diverse, individual nutritional needs.
CONCLUSIONS: To optimize pregnancy nutritional intake, multi-disciplinary efforts should be made to increase the awareness of the dietary guidelines for pregnancy and to support the delivery and uptake of dietary advice among pregnant women.
18. TRANSformative perspectives on endometriosis research policy, and practice: Insights from multidisciplinary focus groups.
主题：卫生政策与真实世界证据
期刊：Global public health
发表日期：2026-Dec-31
内容状态：待评估
为什么值得看：包含可供初筛的摘要；仅作为选题线索，不代表证据质量结论。
Transgender and gender diverse (TGD) people with endometriosis have unique health needs. Current health research, policy, and clinical practice are developed within a biomedical and cisheteronormative paradigm that structurally excludes the TGD community, whose health needs remain largely unmet. This study aims to set an agenda for future research in the fields of endometriosis and gender diversity and to make recommendations for policy and practice through focus group methods. Twenty community members and professionals gathered for a two-day event at the Brocher Foundation in Switzerland. The group was heterogeneous in terms of gender, age, race, ability status, and professional background. On the first day, the participants gave twelve plenary presentations. On the second day, two plenary sessions and three parallel discussions in subgroups were facilitated. The data were analyzed through content analysis. Three main categories were identified: research, policy, and practice. Future studies should center the experiences of TGD people embodying different intersecting identities through transdisciplinary and community-based methods. The effects of gender-affirming care on endometriosis and the adequacy of endometriosis treatments for TGD people need to be further investigated. The education of healthcare providers is crucial to improve clinical practice, as well as a shift in health policy beyond cisheteronormativity.
19. The effects of sexual counseling based on the EX-PLISSIT and BETTER models on female sexual function after assisted reproductive treatment failure: a randomized clinical trial.
主题：临床研究与数据方法
期刊：Journal of psychosomatic obstetrics and gynaecology
发表日期：2026-Dec-31
内容状态：待评估
为什么值得看：包含可供初筛的摘要；仅作为选题线索，不代表证据质量结论。
BACKGROUN AND OBJECTIVE: Women who experience assisted reproductive treatment failure may be at risk of developing sexual dysfunction. This study compared the effects of two different sexual counselling models, EX-PLISSIT and BETTER, on the sexual function of women after an unsuccessful assisted reproductive treatment.
METHODS: This randomized clinical trial included 66 infertile women, out of the 72 initially recruited following assisted reproductive treatment failure, who referred to the Infertility Clinic, Mashhad, Iran. The EX-PLISSIT and BETTER groups received sexual counselling individually in two online and two in-person sessions. Data were collected using a Female Sexual Function Index (FSFI). Data analysis was performed using SPSS 25 with a significance level of P = 0.05.
RESULTS: There was no statistically significant difference in the total score of sexual function and the scores of subscales of desire, arousal, lubrication, orgasm, sexual satisfaction and pain between the two groups before the intervention (P > 0.05). Both groups showed significant improvement post-intervention. Their total mean scores for sexual function, desire, sexual satisfaction, arousal and lubrication were all higher than pre-intervention. Additionally, their scores for pain were significantly lower after the intervention (P < 0.001).
CONCLUSION: Sexual counseling, using either the EX-PLISSIT or BETTER model, improved the sexual function of women who experienced a failed assisted reproductive treatment.
20. Mental health first aid in the workplace: a reflexive thematic analysis of UK workers’ experiences.
主题：临床研究与数据方法
期刊：International journal of qualitative studies on health and well-being
发表日期：2026-Dec-31
内容状态：待评估
为什么值得看：包含可供初筛的摘要；仅作为选题线索，不代表证据质量结论。
BACKGROUND: Mental Health First Aid (MHFA) is used in workplaces to improve mental health literacy, reduce stigma, and promote help-seeking. This paper explores how employees perceive and engage with MHFA in work settings.
METHODS: This qualitative study was embedded within the EMPOWER cluster randomised controlled trial (Atanda et al., 2020). Twenty-four participants, including Mental Health First Aiders, recipients of MHFA support, employees, and senior managers, took part in semi-structured interviews. Guided by a relativist epistemological position, data were analysed using reflexive thematic analysis.(Atanda et al., 2020).
FINDINGS: Three themes were identified: (1) ambiguity surrounding the purpose of MHFA; (2) uncertainty and scepticism regarding the role and effectiveness of MHFA (subthemes: Anticipated Stigma, MHFA not addressing core concerns affecting staff well-being); and (3) risks to personal relationships following disclosure. Participants questioned the purpose, boundaries, and organisational value of MHFA, contributing to reluctance to engage. Disclosure decisions were shaped by concerns about stigma, confidentiality, and potential impacts on workplace relationships and career progression.
DISCUSSION: The findings suggest MHFA is most effective when part of a broader organisational commitment to employee wellbeing. Clarifying MHFA’s purpose, addressing workplace stigma, and tackling organisational sources of distress may improve engagement and strengthen mental health initiatives.
CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov NCT04311203. Registered on 17 March 2020, protocol published in 2020.
21. Challenges to Achieving Universal Health Coverage Through Public Financial Management Reforms: Insights from the Implementation of Single Nodal Agency Reform in India.
主题：卫生政策与真实世界证据
期刊：Health systems and reform
发表日期：2026-Dec-31
内容状态：待评估
为什么值得看：包含可供初筛的摘要；仅作为选题线索，不代表证据质量结论。
Public Financial Management (PFM) reforms are being increasingly recognized for their potential to enhance health financing systems and advance progress toward Universal Health Coverage (UHC). Although theoretical frameworks have outlined the pathways through which PFM reforms operate, empirical evidence on their effectiveness in specific low- and middle-income country (LMIC) contexts remains limited. This paper examines the reform of the Single Nodal Agency (SNA) system in India, aimed at improving budget execution in centrally funded schemes, including the flagship health sector scheme, the National Health Mission (NHM). The study analyzes the gains and challenges associated with the reform and highlights the institutional features that are critical to its effectiveness. The study draws on an assessment of SNA implementation in two Indian states, Bihar and Odisha, using qualitative evidence from key informant interviews conducted across multiple administrative levels between February 2023 and February 2024. This was supplemented with data provided by state finance departments and NHM implementing agencies. Results indicate that the reform has achieved its intended gains in cash management, expenditure transparency, and improved alignment of central fund releases with scheme expenditures at the sub-national level. However, weak budget credibility, coupled with constraints in digital connectivity and limited personnel capacity to manage financial transactions, is likely to exacerbate inequities in access to scheme funds. The increased emphasis on spending has heightened compliance pressures on fund utilization, while attention to actual health system outcomes remains limited. In sum, a conducive institutional environment is essential for reaping benefits through PFM reforms in LMICs.
22. From giant components to communities: community-level insights for prioritizing interventions within large clusters of HIV-1 transmission networks.
主题：流行病学
期刊：Infectious Disease Modelling
发表日期：2027-Mar
内容状态：待评估
为什么值得看：包含可供初筛的摘要；仅作为选题线索，不代表证据质量结论。
Large clusters in HIV-1 molecular networks contain a substantial proportion of people living with HIV and dominate local epidemics; however, their large size and complex structure pose a challenge for effective public health interventions. We developed an analytical framework to partition the large cluster into small groups for precise intervention. In the HIV-1 CRF07_BC molecular transmission network in Guangzhou, China (2008-2020), a giant component (681 members) was partitioned into 34 communities with dense internal and sparse external links. All 378 inter-community links involved high-centrality members from Community 1 (P < 0.001) and phylogenetic analysis identified Community 1 as the most likely ancestral source of the giant component (marginal probability = 0.989). Exponential random graph models (ERGMs) revealed significant homophily effect among members with specific characteristics in the giant component and its large communities, highlighting potential outbreaks within specific subgroups. Partitioning giant components into communities may be a promising approach to help develop community-level interventions and could improve the effectiveness of interventions targeted at large clusters.
23. Local governance and health equity: Practical reflections from Chinese crisis governance.
主题：卫生政策与真实世界证据
期刊：Global public health
发表日期：2026-Dec-31
内容状态：待评估
为什么值得看：包含可供初筛的摘要；仅作为选题线索，不代表证据质量结论。
This study examines mass testing in three Chinese cities since 2020 as a ‘stress test’ for local governance. It analyses the governance performance of Shenzhen, Nanjing and Wuxi in terms of efficiency, equity and community resilience. Using Melbourne’s pandemic lockdown as a reference case, it discusses the underlying mechanisms linking different governance approaches to health equity outcomes. The study adopts a nested governance framework to examine how governance capacities and policy logics operate across different local contexts. The results indicate that Chinese cities can efficiently complete mass testing within a few days, but face pressures related to health equity and community resilience. Melbourne’s lockdown governance emphasised participation and institutional transparency, but advanced policies at a relatively slower pace. This study recommends building a dynamic governance mechanism that better balances efficiency and equity.
24. Ecological restructuring of the nonbacterial fecal microbiome in obesity across human cohorts.
主题：可复现研究与开放科学
期刊：Gut microbes
发表日期：2026-Dec-31
内容状态：待评估
为什么值得看：包含可供初筛的摘要；仅作为选题线索，不代表证据质量结论。
Obesity is a complex metabolic disorder increasingly linked to alterations in the gut microbiome. While most research has focused on bacterial communities, the contribution of nonbacterial components including viruses, archaea, and eukaryotic microorganisms remains insufficiently characterized. Here, we performed a multicohort analysis to investigate the role of the nonbacterial gut microbiome in obesity across three independent human cohorts. Using compositional analyses adjusted for key covariates and network based approaches, we identified consistent multikingdom alterations associated with obesity. Individuals without obesity showed a reproducible enrichment of methanogenic archaea, particularly Methanobrevibacter smithii and Methanobrevibacter millerae, whereas individuals with obesity were characterized by increased abundance of bacteriophages from the class Caudoviricetes. In an elderly cohort, eukaryotic taxa such as Blastocystis spp. were additionally associated with the without obesity group. These patterns were largely consistent across cohorts and robust to sex stratification. Beyond taxonomic differences, ecological network analyses revealed substantial reorganization of microbial interactions in obesity. The identity and composition of hub taxa differed significantly between obesity and without obesity networks across all cohorts, indicating a shift in the taxa occupying central ecological roles. Notably, these differences were observed even when similar microbial kingdoms were represented, underscoring the importance of species-level resolution. Collectively, our findings demonstrate that obesity is associated with coordinated compositional and ecological alterations across the nonbacterial gut microbiome. This multikingdom perspective expands current understanding of microbiome dysbiosis in metabolic disease and highlights the archaeome and virome as potential contributors to host metabolic health.
25. Longitudinal modelling of microbiome subcommunities reveals parity-dependent dynamics during pregnancy and postpartum.
主题：临床研究与数据方法
期刊：Gut microbes
发表日期：2026-Dec-31
内容状态：待评估
为什么值得看：包含可供初筛的摘要；仅作为选题线索，不代表证据质量结论。
BACKGROUND: Dysregulation of maternal adaptations to pregnancy due to high pre-pregnancy BMI (pBMI) is associated with worsened health outcomes for mothers and children. The role of the gut microbiome in these adaptations remains unclear.
METHODS: Stool samples were collected from pregnant participants (n = 52) enrolled in the Be Healthy in Pregnancy study (NCT01689961) during first, second, and third trimesters, and 6-months postpartum, along with samples from their infants at 6 months of age. Following 16S rRNA gene sequencing, we implemented time-aligned LDA (TALDA) using a time-weighted sampling strategy with exponentially decaying weights to construct time-proximal cohorts, applied LDA to each cohort independently, and aligned resulting topics using the alto R package. Infant samples were analyzed using standard LDA.
RESULTS: Seven distinct subcommunities were identified, one of which represented perineal contamination and was excluded from further analysis. Remaining subcommunities had distinct taxonomic definitions which remained stable throughout pregnancy (mean cross-cohort stability 0.899) while subcommunity proportions within individuals varied. Multiparous individuals showed greater shifts in subcommunity proportions during early pregnancy, while primiparous individuals displayed progressively increasing shifts with the largest changes during the transition from pregnancy to postpartum. High pBMI was associated with reduced microbiome remodelling, particularly among multiparous individuals. In exploratory analyses, maternal SCFA-producing subcommunity abundance at late pregnancy was positively associated with infant Bifidobacterium-dominated subcommunity proportions at 6 months, while pBMI > 25 was independently associated with lower infant Bifidobacterium.
CONCLUSION: TALDA effectively distinguished between stable subcommunity definitions and dynamic subcommunity proportions, revealing that the microbiome maintains functional organization while subcommunity proportional contributions shift over the course of pregnancy and postpartum. These maternal dynamics may have intergenerational consequences through their influence on infant gut colonization. This work demonstrates that maternal factors modify microbiome trajectories and supports the existence of an ecological memory of pregnancy history within the maternal gut microbiome.
26. Towards standardized gut microbiota diagnostics: normobiosis beyond geographical borders.
主题：可复现研究与开放科学
期刊：Gut microbes
发表日期：2026-Dec-31
内容状态：待评估
为什么值得看：包含可供初筛的摘要；仅作为选题线索，不代表证据质量结论。
Defining clinically meaningful reference states of the human gut microbiota remains a major barrier to the clinical translation of microbiome testing, largely due to variability across populations. We aimed at evaluating whether dysbiosis can be identified in a standardized, geography-independent manner, using a composite, system-level microbiome diagnostic framework. We performed a retrospective observational analysis of 831 adult stool samples collected from healthy individuals and patients with inflammatory bowel disease, irritable bowel syndrome, or other chronic inflammatory conditions across seven countries. In addition, U.S. National Institute of Standards Technology (NIST) human fecal reference materials were analyzed. Dysbiosis was assessed using a fixed microbial marker panel and composite distance metrics anchored to a clinically validated healthy Scandinavian reference population, using GA-map® Dysbiosis Test as an exemplar of this diagnostic framework. The diagnostic framework reproducibly identified normobiosis and dysbiosis across geographically distinct populations (USA, Canada, Germany, Italy, and the UK). Severe dysbiosis was detected with high specificity (93.6%) and positive predictive value (90.2%), independent of subjects’ country of origin. Healthy individuals showed highly comparable dysbiosis index distributions across regions. These findings demonstrate that clinically useful dysbiosis diagnostics do not require geographically tailored reference populations and support the feasibility of standardized, geography-independent microbiome diagnostics for clinical application.
27. Rethinking vaccine mandates through the lens of penalties and incentives: A 7S framework approach.
主题：卫生政策与真实世界证据
期刊：Global public health
发表日期：2026-Dec-31
内容状态：待评估
为什么值得看：包含可供初筛的摘要；仅作为选题线索，不代表证据质量结论。
Conceptually, current definitions of vaccine mandates involve two key elements: the requirement to be vaccinated and sanctions for non-compliance. However, during COVID-19, governments frequently introduced vaccine mandates in contexts where people were already denied access to work, travel, and social activities due to lockdowns and restrictions. This important context disrupts the standard operation of vaccine mandates. Accordingly, this paper explores COVID-19 vaccine mandates in New South Wales (Australia), France, Israel, Malaysia, Singapore, and Vietnam, where mandates primarily served as incentives to restore basic rights to travel, work, and access public spaces, that were restricted during the pandemic. Through document analysis and key informant interviews, the paper examines how governments employed this “removal and restoration” model and explores how mandate policy instruments create incentive structures. In discussing the implications of mandates in relation to lockdowns and restrictions, and the perception of mandates as “coercive offers”, the paper proposes a revised conception and a 7S vaccine mandate framework by adding synergy and sustainment to the existing 5S model. It concludes by outlining the significance of this revised conception and framework for vaccine mandate policy research, design, and communication.
28. Effects of serotonergic pharmacological manipulation on exercise performance and central fatigue: a systematic review and three-level meta-analysis.
主题：临床研究与数据方法
期刊：Journal of the International Society of Sports Nutrition
发表日期：2026-Dec-31
内容状态：待评估
为什么值得看：包含可供初筛的摘要；仅作为选题线索，不代表证据质量结论。
BACKGROUND: Exercise-induced fatigue is a complex, non-pathological state that acutely limits physical performance, and the serotonergic (5-HT) system has been proposed as an important modulator of its central components. This systematic review and meta-analysis aimed to clarify the effects of serotonergic pharmacological manipulation on exercise-related outcomes.
METHODS: Following PRISMA guidelines, we systematically searched PubMed, Scopus, Web of Science, Cochrane Central, and SportDiscus from inception to August 2025. Randomized controlled trials examining the effects of serotonergic pharmacological manipulation on exercise-related outcomes in healthy adults were included. Study selection, data extraction, and risk-of-bias assessment using RoB 2.0 were conducted independently. Pooled effects were synthesized using three-level random-effects models, and the certainty and robustness of the evidence were examined in additional analyses.
RESULTS: Twenty-one randomized controlled trials involving 248 healthy adults were included in the systematic review, of which 19 studies involving 229 participants were included in the meta-analysis. In the primary models, serotonergic pharmacological manipulation was associated with small reductions in evoked motor response (Hedges’ g = -0.24, 95% CI -0.46 to -0.02), time-domain EMG (Hedges’ g = -0.18, 95% CI -0.33 to -0.02), heart rate (Hedges’ g = -0.17, 95% CI -0.34 to -0.01), and blood glucose (Hedges’ g = -0.50, 95% CI -0.89 to -0.11). Voluntary activation showed a borderline negative pooled estimate (Hedges’ g = -0.20, 95% CI -0.40 to 0), whereas ratings of perceived exertion showed a positive but statistically uncertain pooled estimate (Hedges’ g = 0.63, 95% CI -0.01 to 1.28). Resting twitch torque showed a small positive pooled effect (Hedges’ g = 0.12, 95% CI 0.04 to 0.19), whereas superimposed twitch torque, maximal voluntary contraction, prolactin, lactic acid, and time to task failure did not show clear overall effects.
CONCLUSIONS: Overall, this meta-analysis indicates that serotonergic pharmacological manipulation has outcome-specific effects on exercise-related fatigue rather than a single uniform influence across domains. The most consistent primary-model signals were found for evoked motor response, time-domain EMG, heart rate, and blood glucose, whereas overt performance and perceptual outcomes remained more variable. By integrating evidence across different serotonergic interventions and exercise paradigms, these findings improve our understanding of how 5-HT-related mechanisms may contribute to central fatigue during exercise.
29. Efficacy and safety of doravirine/islatravir for HIV-1: a GRADE-assessed systematic review and meta-analysis of randomized controlled trials.
主题：临床研究与数据方法
期刊：HIV research & clinical practice
发表日期：2026-Dec-31
内容状态：待评估
为什么值得看：包含可供初筛的摘要；仅作为选题线索，不代表证据质量结论。
BACKGROUND: The combination of doravirine and islatravir (DOR/ISL) is a novel two-drug regimen for HIV-1. Early development faced challenges due to dose-dependent immunological signals. We aimed to synthesize the evidence on the efficacy and safety of DOR/ISL across all treatment-experience categories, specifically evaluating the impact of islatravir dosage (0.25 mg vs 0.75 mg) on clinical and immunological outcomes.
METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) following PRISMA guidelines. We searched PubMed, Embase, Cochrane Library, and Google Scholar from inception through April 2026. Primary outcomes were virological suppression (<50 copies/mL) and mean change in CD4+ T-cell count at week 48. Data were pooled using random-effects models. Islatravir dose was evaluated as a pre-specified moderator. Quality was assessed using Cochrane RoB 2.0 and certainty of evidence was graded using the GRADE approach.
RESULTS: Seven RCTs (n = 3,600 participants) were included. At Week 48, DOR/ISL showed non-inferior suppression rates (RR 1.01 [95% CI 0.99-1.02]; p = 0.516; moderate-certainty evidence) and a statistically significant reduction in virological failure risk (RR 0.55 [0.33-0.92]; p = 0.022) compared to active control. Overall CD4+ gain was lower with DOR/ISL (MD -34.55 cells/μL; low-certainty evidence); however, a profound moderator effect of dose was observed (p < 0.0001). The 0.75 mg dose was associated with significant CD4+ and lymphocyte declines, whereas the approved 0.25 mg dose was immunologically neutral. DOR/ISL was weight-neutral compared to bictegravir/emtricitabine/tenofovir alafenamide (MD -0.25 kg [-0.66 to 0.16]; low-certainty evidence).
CONCLUSION: DOR/ISL 100/0.25 mg once daily achieved virological suppression comparable to standard-of-care ART regimens and was associated with lower rates of virological failure compared with active comparators. The immunological safety concerns observed in early trials were successfully resolved by dose optimization. These findings support the use of DOR/ISL (IDVYNSO) as a potential treatment option for both treatment-naïve and virologically suppressed adults while emphasizing long-term safety surveillance.
30. Professional identity formation among participants in a longitudinal pediatric program for final year medical students: a qualitative case study.
主题：生物统计与研究设计
期刊：Medical education online
发表日期：2026-Dec-31
内容状态：待评估
为什么值得看：包含可供初筛的摘要；仅作为选题线索，不代表证据质量结论。
OBJECTIVE: To explore aspects of professional identity formation in participants of a longitudinal pediatric program for final-year medical students in the US.
INTRODUCTION: Many institutions have specialty-specific courses focused on the transition to residency, typically at the end of medical school. This study examines professional identity formation among participants of a longitudinal fourth-year Pediatric Concentration.
METHODS: Authors used a case study design for this qualitative research study using semi-structured interview questions based on a conceptual model of professional identity formation. Authors used purposeful sampling to identify study participants who were randomly selected from former students who completed the program between 2019 and 2021. Three interviewers independently conducted interviews with individual program participants. Thematic analysis with coder reliability was utilized for data analysis; two investigators independently coded and performed inter-rater reliability (IRR) on three sets of questions from transcriptions. After ensuring acceptable IRR, investigators coded the remaining questions and subsequently identified themes and sub-themes.
FINDINGS: Eleven former students completed interviews. Following initial independent coding, IRR for three questions was 80%. After coding the 11 interviews, investigators determined that code saturation was achieved. They subsequently identified six main themes: career development, interpersonal connection, personal growth, positive role models, skill-building, and supportive learning environment. Two cross-cutting themes were recognized throughout the data: sense of belonging and gaining confidence toward starting residency.
CONCLUSIONS: Participants in a longitudinal specialty-specific program in the final year of medical school experienced professional identity formation through a supportive learning environment fostering connection and personal growth while building skills, surrounded by positive role models. This community of practice cultivated a sense of belonging and helped participants gain confidence toward their residency and career. This longitudinal, specialty-specific approach to the final year of medical school may enhance professional identity formation for students entering all specialties and could facilitate transition to internship.