Tag: pubmed

Front Public Health. 2025 Oct 14;13:1650147. doi: 10.3389/fpubh.2025.1650147. eCollection 2025.

ABSTRACT

BACKGROUND: To analyze the equity of the current allocation of health human resources using statistical data on health resources in the Yangtze River Delta region.

METHODS: The Gini coefficient quantifies the level of distributional equality, the Theil index assesses the source of inequality, and the health resource agglomeration degree (HRAD) measures the accessibility of health resources, combining the three methods to evaluate the equity of the current allocation of health human resources in the Yangtze River Delta region. Furthermore, trend analysis of fairness indicators was conducted using regression models.

RESULTS: Human resources for health in the Yangtze River Delta region have been increasing between 2014 and 2022. The Gini coefficient and Theil index in the Yangtze River Delta region are more equitable in terms of the distribution of healthcare resources based on population and gross domestic product (GDP) rather than geographical region. In Anhui Province, HRAD and HRAD/PAD (population agglomeration degree) were both less than 1. In Zhejiang Province, HRAD for health technicians and registered nurses was less than 1.

CONCLUSION: Human resources for health and healthcare ratios in the Yangtze River Delta region have continued to grow. However, the equity of health resources allocated based on population and economic factors is superior to that allocated based on geographical factors, and the equity of health resource concentration remains to be improved. To address this equity issue, it is necessary to comprehensively consider various factors such as population, geography, and GDP, and formulate corresponding measures accordingly.

PMID:41164836 | PMC:PMC12558889 | DOI:10.3389/fpubh.2025.1650147

Front Public Health. 2025 Oct 14;13:1591186. doi: 10.3389/fpubh.2025.1591186. eCollection 2025.

ABSTRACT

The increasing efforts among public health researchers to examine the connections between police violence and health outcomes has resulted in growing discoveries about the implications for both direct and vicarious exposure as well as disparities by race and ethnicity. To date, the conceptualization of police violence and health has largely focused on single causes and/or mechanisms at one point in time and focused on individuals most proximal to impact. However, the prevailing conceptualizations are limited in scope. They are relatively linear, do not account for multiple dimensions of harm, and are void of temporal factors that span across communities and generations-all factors that are sustained by forms of structural racism. We offer a reconceptualization guided by the Public Health Critical Race Praxis (PHCRP), a public health offshoot of Critical Race Theory, that offers public health professionals a framework and semi-structured process for centering racism in their analyses and implications of police violence on health. Our conceptualization is supported by multiple case studies, and we conclude with concrete recommendations for public health professionals to draw on as strategies to address police violence and advance health equity.

PMID:41164835 | PMC:PMC12558832 | DOI:10.3389/fpubh.2025.1591186

Front Public Health. 2025 Oct 14;13:1615781. doi: 10.3389/fpubh.2025.1615781. eCollection 2025.

ABSTRACT

BACKGROUND: Evidence on frontline implementation of integrated HIV/TB prevention in resource-limited, ethnic minority regions remains limited. Liangshan Yi Autonomous Prefecture in Southwest China carries a dual HIV/TB burden. This study explored healthcare workers’ experiences with China’s Integrated Prevention and Control of Four Diseases (IPC4D) policy to identify barriers and enablers of service integration.

METHODS: A qualitative phenomenological study was conducted from July to December 2024. 37 semi-structured interviews were held with purposively sampled healthcare workers across prefectural CDCs, infectious disease hospitals, county hospitals, and township health centers. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed following Braun and Clarke’s six-phase framework. Reflexive memos and triangulation across facility levels, professional roles, and ethnic groups enhanced study rigor.

RESULTS: Four themes emerged. First, policy-driven progress: participants reported greater governmental support, increased resource inputs, and modest improvements in public awareness. Second, structural barriers: chronic underfunding of TB services, workforce shortages, and burnout weakened integration. Third, the multi-sectoral “1 + M + N + P” model-local government leadership (“1”), township centers (“M”), village doctors and maternal-child health staff (“N”), and public security departments (“P”)-expanded service reach but also generated task overload, cultural-linguistic challenges, and inter-sectoral friction. Fourth, urban-rural divergence: township providers faced more severe infrastructure gaps and patient non-adherence, often driven by stigma and financial constraints.

CONCLUSION: The IPC4D policy demonstrates potential to reduce HIV/TB disparities in Liangshan, yet sustained progress requires dedicated TB financing, culturally competent workforce training, rational task redistribution, and stigma-reduction strategies that leverage Yi community networks. These findings provide practical insights for adapting integrated disease-control policies in other high-burden, resource-constrained settings.

PMID:41164833 | PMC:PMC12558838 | DOI:10.3389/fpubh.2025.1615781

Front Public Health. 2025 Oct 14;13:1592366. doi: 10.3389/fpubh.2025.1592366. eCollection 2025.

ABSTRACT

OBJECTIVES: This study aimed to verify the hypothesis that the improvement in the subjective assessment of population health in certain European countries after the COVID-19 pandemic was driven by the mortality of the majority of vulnerable citizens with the worst health status.

METHODS: We extended the trend of the share of the oldest age group and compared it with the observed fraction, thereby identifying the “missing population.”

RESULTS: We observed a substantial deficit in the population of the oldest age group, especially in countries where people tend not to age well.

CONCLUSION: The temporary improvement in population health indicators, as measured by Healthy Life Years (HLY), during the pandemic in some countries was most likely an artifact resulting from the mortality of the majority of vulnerable individuals with poor health status. It is unlikely that this apparent improvement reflects healthier lifestyles or genuine gains in the efficiency or resilience of health systems during the pandemic. Therefore, the interpretation and use of HLY values from the COVID-19 period in Europe should be carefully reconsidered and further validated.

PMID:41164832 | PMC:PMC12558791 | DOI:10.3389/fpubh.2025.1592366

Precis Radiat Oncol. 2025 Jun 28;9(3):167-176. doi: 10.1002/pro6.70022. eCollection 2025 Sep.

ABSTRACT

BACKGROUND: When validating intracranial multi-lesion CyberKnife M6/S7 plans with SRSmapcheck, setting the array to a fixed 0° measures only one target dose distribution, leaving the other lesions unmeasured. Moreover, the CyberKnife treatment planning system does not support roll verification tools, and testing confirms that X-sight fiducial marker guidance is incompatible with free array roll. A novel method and workflow are required to validate multi-lesion plans with random positions.

METHODS: A geometric model was established based on the relationship between SRSmapcheck and the tumor location. For two tumors spaced 77 mm apart (each 20 mm in diameter, or one 40 mm apart and the other infinitesimally small), the corresponding array roll angle interval was approximately 15.05°. The SRSmapcheck and StereoPHAN computed tomography (CT) images were acquired at 15° intervals, starting at 0°, and preprocessed into phantom plans for verification. A total of 101 intracranial multi-lesion plans were verified using the fixed 0° and pre-set roll angle methods to optimize the dose distribution, particularly in high-dose and rapidly varying areas. A two-sample test compared the results of the 0° versus pre-set roll angle verification and assessed the performance under different criteria to determine suitable criteria for pre-set roll angle verification.

RESULTS: The equivalent diameter of the 296 tumors ranged from 5 to 45 mm (average: 21.86 mm). Each plan had an average of 2.97 lesions. Using the pre-set roll angle method, 2.34 targets were assessed on average (89.83% of lesions had diameters ranging from 10 to 40 mm), compared to 1.32 targets on average in 0° plans. Statistically significant differences occurred at 2 mm/1% and 2 mm/2% in the γ analysis, showing that plan pass rates were stable between the fixed 0° and pre-set roll angle methods. Relaxing either the distance to agreement or dose deviation significantly increased the pass rates during pre-set roll angle verification, whereas cross-transforming criteria had minimal impact. For pre-set roll angle methods, it is recommended to use 1 mm/1% (action limit: 86.0% ± 13.3%) and 1 mm/2% (action limits: 91.6% ± 7.9%) for γ analysis.

CONCLUSION: SRSmapcheck with the pre-set roll angle method can verify intracranial multi-lesion CyberKnife plans by measuring multiple targets in a single validation and comparing the 1 mm/1% and 1 mm/2% γ analysis criteria.

PMID:41164809 | PMC:PMC12559907 | DOI:10.1002/pro6.70022

Precis Radiat Oncol. 2025 Aug 23;9(3):177-184. doi: 10.1002/pro6.70025. eCollection 2025 Sep.

ABSTRACT

OBJECTIVE: Radiation recall pneumonitis (RRP) is a localized inflammatory reaction occurring in previously irradiated lung regions, typically triggered by certain anticancer agents. In clinical settings, we have observed that COVID-19 infection may also act as a precipitating factor for RRP. However, its true incidence and possible risk factors remain poorly defined.

METHODS: Lung cancer patients who received radiotherapy and were diagnosed with COVID-19 between November 2022 and February 2023 were included. RRP was defined as pulmonary changes limited to the previously irradiated regions, occurring at least 6 months after radiotherapy. Patients medical records and radiation dose distribution data were analyzed to identify potential contributing factors to RRP.

RESULTS: The study included 140 patients who underwent thoracic radiotherapy with a minimum six-month interval before COVID-19 diagnosis. Among these, 62 patients (44.2%) developed RRP, and 45% of these experienced grade ≥ 2 pneumonitis. No radiotherapy dose-related factors were significantly associated with RRP. However, statistical analysis showed that RRP incidence was significantly associated with baseline T-stage (P = 0.034) and the time interval from radiotherapy completion to COVID-19 infection (P < 0.001).

CONCLUSIONS: A 44.2% incidence of COVID-19-related RRP was identified, which is notably higher than previously reported. While radiotherapy dosimetry did not correlate with RRP risk, baseline T-stage and timing of COVID-19 infection after radiotherapy were significantly associated with its occurrence.

PMID:41164806 | PMC:PMC12559899 | DOI:10.1002/pro6.70025

Clin Ophthalmol. 2025 Oct 24;19:3933-3939. doi: 10.2147/OPTH.S545977. eCollection 2025.

ABSTRACT

PURPOSE: To evaluate the visual performance, refractive stability, and glistening-free clarity of the Clareon^® monofocal intraocular lens (IOL) implanted using the AutonoMe^® automated delivery system in a real-world North American setting.

PATIENTS AND METHODS: A prospective, single-arm study was conducted at a single Canadian site involving 46 patients, or 85 eyes, undergoing cataract surgery with Clareon^® IOL implantation. Eligible participants were ≥22 years old with best-corrected distance visual acuity (BCDVA) of 0.3 logMAR or worse, targeted for emmetropia, and had <1.0 D of preoperative astigmatism. Exclusion criteria included retinal disease, glaucoma, amblyopia, corneal pathology, and prior intraocular or corneal surgery. Manifest refraction, uncorrected (UDVA), best-corrected (BCDVA), and low-contrast visual acuity (LCVA) were assessed at 1, 3, and 12 months postoperatively. Glistenings were graded using the Miyata scale at 3 and 12 months.

RESULTS: No statistically significant changes were observed in manifest refraction, UDVA, or BCDVA between 1 and 3 months (p > 0.05). At 3 months, the mean spherical equivalent was +0.09 D, with low residual astigmatism (-0.33 D). Mean logMAR UDVA and BCDVA were 0.13 and 0.02, respectively. LCVA was 0.04 logMAR. No glistenings were observed at either 3 or 12 months in any patient. Refractive and visual outcomes remained stable over time, with no device-related complications reported.

CONCLUSION: The Clareon^® IOL demonstrated excellent refractive accuracy, stable visual performance, and sustained optical clarity with no glistenings up to one year postoperatively. Its compatibility with the AutonoMe^® delivery system supports its utility as a reliable option for cataract surgery.

PMID:41164804 | PMC:PMC12560656 | DOI:10.2147/OPTH.S545977

Vasc Health Risk Manag. 2025 Oct 24;21:889-894. doi: 10.2147/VHRM.S559706. eCollection 2025.

ABSTRACT

INTRODUCTION: A greater association of systemic arterial hypertension with worse prognosis in patients hospitalized with COVID-19 was described. Early in the pandemic, concerns were raised that the use of angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) could lead to unfavorable outcomes.

OBJECTIVE: To evaluate whether there is an association between the use of the ACEi and ARB medications with unfavorable outcomes in hypertensive patients hospitalized with COVID-19.

METHODS: This is a descriptive and retrospective study, collecting data through electronic medical records of patients with COVID-19 admitted to a University Hospital in 2020. Demographic data, use of ACEi or ARB medications, comorbidities, and outcomes, defined by the use of invasive ventilatory support (IVS), renal failure with progression to renal replacement therapy, and death were evaluated.

RESULTS: 700 medical records were analyzed, 374 were of hypertensive individuals. The mean age of the patients was 66 ± 14 years, 51% were male, and 89% were white. There was a significantly higher prevalence of hospital discharge among patients who received ACEi/ARB compared to those who did not take these medications, (p-value = 0.027). There was no statistically significant difference in the use of ACEi/ARB for IVS (p-value = 0.062) and for renal replacement therapy (p-value = 0.587).

CONCLUSION: The use of ACEi/ARB drugs is not associated with worse outcomes in individuals with COVID-19. The present study demonstrated lower mortality rate associated with the use of these classes of drugs, similar to recent studies.

PMID:41164788 | PMC:PMC12560647 | DOI:10.2147/VHRM.S559706

Open Forum Infect Dis. 2025 Oct 8;12(10):ofaf634. doi: 10.1093/ofid/ofaf634. eCollection 2025 Oct.

ABSTRACT

BACKGROUND: Long COVID is a heterogeneous post-infectious condition. Although patient-reported outcome (PRO) measures for diagnosis or therapeutic monitoring have been adapted from related complex chronic illnesses, no PRO has been validated specifically in Long COVID. The STOP-PASC randomized, placebo-controlled trial of nirmatrelvir/ritonavir (NMV/r) in adults with Long COVID showed no overall treatment effect. This exploratory analysis aimed to identify distinct symptom trajectories and clinical characteristics associated with improvement or worsening over time.

METHODS: We performed latent class trajectory modeling (LCTM) on PRO measures-including the Patient Global Impression of Severity (PGIS), Patient Global Impression of Change (PGIC), PROMIS domains, and core symptoms-among 155 randomized participants. Participants were followed for 15 weeks with serial symptom assessments. Trajectory groups were identified using Bayesian Information Criteria and characterized using descriptive statistics and absolute standardized differences.

RESULTS: LCTM revealed heterogeneity in symptom trajectories. Two groups emerged for PGIS (improving n = 17, persistent/severe n = 136) and PGIC (improving n = 130; worsening n = 22). PROMIS-Physical Function modeling identified four groups (improving, normal/mild, moderate, and severe), fatigue core symptom modeling identified three (improving; moderate; severe). Worsening groups had higher proportions of NMV/r-treated participants and greater prevalence of cardiovascular symptoms and low-dose naltrexone use. Improving groups had shorter time since infection and higher baseline physical function. No subgroup showed a clear benefit from NMV/r.

CONCLUSIONS: Distinct PRO trajectories reflect the clinical heterogeneity of Long COVID. NMV/r showed no clear benefit across subgroups. These findings emphasize the need for validated, Long COVID-specific PRO instruments and targeted therapeutic trials tailored to Long COVID subtypes.

PMID:41164784 | PMC:PMC12560753 | DOI:10.1093/ofid/ofaf634

Brain Commun. 2025 Oct 28;7(5):fcaf356. doi: 10.1093/braincomms/fcaf356. eCollection 2025.

ABSTRACT

Duchenne muscular dystrophy is a monogenic X-linked genetic disorder that is caused due to the absence of dystrophin. In addition to the skeletal and cardiac manifestations, challenges in executive function are pervasive and persistent, affecting a majority of young individuals with Duchenne muscular dystrophy. Executive function-related disability is linked to chronic stress, academic under-achievement and poor vocational attainment. Of the executive function domains, inhibitory control and working memory are disproportionately affected, and linked to academic under-achievement in Duchenne muscular dystrophy. Despite its consequential importance to the quality-of-life in affected individuals, the neural substrates underpinning working memory challenges are poorly understood in this disease. The dynamic interactions of bilateral dorsolateral prefrontal cortex as part of the frontoparietal network is critical for working memory. Atypical neural connectivity within the frontoparietal network may underlie the neural basis of working memory challenges in Duchenne muscular dystrophy. Effective (directional) connectivity analysis of brain functional MRI is an advanced analytical approach that quantitates the directionality and the nature (facilitatory or inhibitory) causal interactions between brain regions. The strength of effective connectivity in Hertz-stronger (facilitatory) versus weaker (inhibitory)-within the frontoparietal network was analysed using dynamic causal modelling in 11 right-handed male participants with Duchenne muscular dystrophy and 9 right-handed male neurotypicals while they completed an n-back working memory task. Participants also completed standardized neurocognitive assessments out-of-scanner. Age-corrected working memory scores were comparable in Duchenne muscular dystrophy (mean 100.0, standard deviation 16.0) and neurotypicals (mean 109.0, standard deviation 8.0) (P = 0.15). Task-based hypoactivation of frontoparietal-occipital regions was observed in Duchenne muscular dystrophy. The group difference in mean frontoparietal effective connectivity during the in-scanner n-back working memory tasks was statistically lower by Bayes factor of 3 in Duchenne muscular dystrophy, compared to neurotypicals. The right posterior parietal → dorsolateral prefrontal connectivity correlated negatively to out-of-scanner working memory performance in Duchenne muscular dystrophy. Median reaction times during the 0-back and 2-back working memory tasks were longer in Duchenne muscular dystrophy compared to neurotypicals, but the difference did not reach statistical significance (P = 0.2). Median reaction time during the 0-back fearful facial condition was longer in Duchenne muscular dystrophy compared to neurotypicals (P = 0.01). Our work implicates atypical task-based effective connectivity within the frontoparietal network and impaired perceptual processing in Duchenne muscular dystrophy. Dynamic neural network signatures can serve as mechanistic targets for pharmacological and non-pharmacological interventions to mitigate executive function impairment in Duchenne muscular dystrophy.

PMID:41164778 | PMC:PMC12560160 | DOI:10.1093/braincomms/fcaf356