Tag: pubmed

Rev Saude Publica. 2026 Mar 20;60:e14. doi: 10.11606/s1518-8787.2026060007205. eCollection 2026.

ABSTRACT

OBJECTIVE: To describe the socioeconomic profile and activity of street vendors, as well as the profile of food sales, according to industrial processing, in the vicinity of private schools in Brazilian state capitals.

METHODS: Cross-sectional study with street vendors in the immediate vicinity of a national probability sample of Brazilian private schools. Elementary and/or high schools participating in the Food Marketing in Brazilian Schools Study were included. A previously validated questionnaire was applied to characterize workers, infrastructure and food availability. Food was classified according to the NOVA system. Comparisons between macro-regions (North, Northeast, Central-West, Southeast, and South) and sizes of point of sale (smallest: 1-3 items; intermediate: 4-13 items; largest: ≥ 14 items) were evaluated using the Kruskal-Wallis test.

RESULTS: The informal food and beverage trade in the immediate vicinity of 2,180 private schools was mapped, totaling 699 street vendors. There was a predominance of men (57.8%), black people (68.8%), those with completed secondary education (35.8%), and those who worked informally (91.4%), in carts and stalls, due to a lack of opportunity in the formal market (52.5%). The median number of ultra-processed items was about twice that of in natura, minimally processed, or processed foods and preparations based on them (2.17; 95%CI 1.90-2.45). Larger outlets concentrated more ultra-processed foods in all regions, except in the Northeast, where this predominance already occurred in intermediate-sized outlets (3.32; 95%CI 2.88-3.75). The lowest ratio of ultra-processed foods was observed in the South (0.21; 95%CI 0.05-0.37) and the highest in the Northeast (3.32; 95%CI 2.88-3.75).

CONCLUSION: Street vending around Brazilian private schools reflects structural inequalities and expands commercially in the supply of ultra-processed foods to children and adolescents. We recommend its inclusion as an inseparable component in the evaluation of the school food environment, to support policies that reconcile income generation and the promotion of healthy eating.

PMID:41880458 | DOI:10.11606/s1518-8787.2026060007205

Rev Saude Publica. 2026 Mar 20;60:e13. doi: 10.11606/s1518-8787.2026060007306. eCollection 2026.

ABSTRACT

OBJECTIVE: To identify the sociodemographic and clinical variables that influenced the daily costs of children and adolescents who stayed overnight in Type III Centro de Atenção Psicossocial Infantojuvenil (CAPSij – Child and Adolescent Psychosocial Care Center) or in hospital reference or emergency and urgent care from the perspective of society in the year 2023.

METHODS: This is a retrospective cost analysis. Direct and indirect costs were collected. A mixed technique was used to measure costs, prioritizing the micro-costing approach and the bottom-up method for valuation. Factors influencing costs were evaluated using univariate statistical models.

RESULTS: The study included 399 users. The average total cost was R$ 6,704.38 (US$ 1,149.99) and the average daily cost was R$ 1,097.97 (US$ 188.33). There was statistical significance in the correlation between daily cost and age, race, diagnostic subgroup, referral to the service, and reason for seeking care. The variable with the greatest positive variation in daily cost was seeking care for drug use (R$ 125.82; US$ 21.58), while the variable with the greatest negative variation in daily cost was being referred by another service (R$ 139.86; US$ 23.99).

CONCLUSIONS: To make more efficient use of available resources, it is up to the child and adolescent mental health care network to invest in the early care of children and adolescents, especially those who are most vulnerable and who may have problems with drug use, and to increasingly encourage coordination between services.

PMID:41880457 | DOI:10.11606/s1518-8787.2026060007306

Rev Bras Enferm. 2026 Mar 20;78(6):e20240605. doi: 10.1590/0034-7167-2024-0605. eCollection 2026.

ABSTRACT

OBJECTIVES: to identify factors associated with the presence of emotional disorders and the quality of life of nursing professionals who provided care to patients with COVID-19.

METHODS: a quantitative study was conducted between February and March 2021, with a convenience sample of 11,477 nursing professionals from Brazilian institutions. The Self-Reporting Questionnaire-20 and the World Health Organization Quality of Life-bref were administered.

RESULTS: in the sample (86.24% women, mean age 33.27 years), female professionals belonging to a risk group for COVID-19, who worked in hospitals with a shortage of personal protective equipment, suffered verbal or physical aggression on public transportation, or were isolated from their families, presented higher levels of emotional disorders measured by the Self-Reporting Questionnaire-20 and reduced quality of life in all World Health Organization Quality of Life-bref domains.

CONCLUSIONS: personal and institutional work conditions have impacted the mental health and quality of life of Brazilian nurses.

PMID:41880455 | DOI:10.1590/0034-7167-2024-0605

Rev Bras Enferm. 2026 Mar 20;78(6):e20240576. doi: 10.1590/0034-7167-2024-0576. eCollection 2026.

ABSTRACT

OBJECTIVES: to analyze the sexual behavior of individuals who tested positive for HIV and were treated at Testing and Counseling Centers, according to sociodemographic characteristics.

METHODS: this was a cross-sectional study conducted in Ribeirão Preto, São Paulo, Brazil, between 2018 and 2021. Data were collected from patient records, including sociodemographic and sexual behavior variables, which were dichotomized as high vs. low/moderate risk.

RESULTS: a total of 214 individuals were included, of whom 111 (51.9%) exhibited high-risk sexual behavior: having a steady or casual partner, having six or more partners, having relationships with both men and women, sometimes/never using condoms and lubricants, and having anal sex. No association was identified between high-risk sexual behavior and sociodemographic variables.

CONCLUSIONS: high-risk sexual behavior was observed among individuals living with HIV without a specific profile, requiring public policies that encourage the adoption of safe sex practices and reduce virus transmission.

PMID:41880454 | DOI:10.1590/0034-7167-2024-0576

Chem Res Toxicol. 2026 Mar 25. doi: 10.1021/acs.chemrestox.5c00459. Online ahead of print.

ABSTRACT

In recent years, the rapid increase in the production and environmental release of synthetic organic chemicals has raised serious concerns about their potential adverse effects on human health and the environment. Repeated exposure to such substances can lead to significant toxicological effects, underscoring the importance of early and reliable hazard assessment. However, experimental determination of repeated-dose toxicity (RDT) is costly, time-consuming, and constrained by ethical considerations. In this study, we developed various classification-based predictive models to evaluate the subchronic RDT potential of chemicals after oral exposure. We compiled data from eChemPortal and J-CHECK databases. The data set contains two study-derived effect levels: NOAEL (no observed adverse effect level) and LOAEL (lowest observed adverse effect level), for which separate models have been developed. A key strength of this data set is that all studies followed standardized OECD test guidelines (407, 408, and 422) and were conducted under good laboratory practice (GLP) conditions, ensuring regulatory relevance and high data reliability. Multiple machine learning algorithms were systematically evaluated, and the best models were selected using a multicriteria analysis based on the sum of ranking differences (SRD) technique. The final selected models achieved accuracies on the training sets ranging from 0.665 to 0.902, while the test sets showed accuracies ranging from 0.642 to 0.682. We also conducted a substructure analysis to identify the key substructures involved in the toxicity. This analysis revealed eight structural motifs, with chlorine- and amine-group-containing aromatic systems being particularly significant. The final developed models were experimentally validated using chemical substances provided by Global Product Compliance (GPC) Europe AB. Additionally, the models were applied to the Pesticides Properties DataBase (PPDB) to screen for pesticides with potential toxicity upon repeated exposure. To facilitate accessibility and regulatory application, the final models have been implemented in both a Python-based tool and a web application. Scientific contribution: this study presents predictive models as alternatives to traditional animal testing for assessing the subchronic oral repeated-dose toxicity (RDT) of chemicals. Our models demonstrate strong statistical performance, indicating their suitability for further application, as supported by experimental validation. These models could be used for preliminary hazard screening or weight-of-evidence evaluations. An additional advantage is that these models were developed using data that were tested in accordance with internationally harmonized test protocols, thereby enhancing their acceptance for regulatory decision-making.

PMID:41880451 | DOI:10.1021/acs.chemrestox.5c00459

Braz Oral Res. 2026 Mar 20;40:e010. doi: 10.1590/1807-3107bor-2026.vol40.010. eCollection 2026.

ABSTRACT

The aims of this retrospective radiographic study were to assess the occurrence of dental anomalies in children and patients with disabilities and to investigate the association of these anomalies with pre-, peri-, and post-natal medical history. A total of 289 panoramic radiographs of children (0-14 years) and patients with disabilities (including all age groups) were used to identify developmental dental anomalies, and information was collected from medical records for statistical analysis. Data were expressed as relative frequency (percentage). The chi-square test, Fisher’s exact test, relative risk calculation, and the Mann-Whitney test were used for statistical comparisons with a significance level of 5%. Occurrence of dental alterations was 50.34% in children and 37.50% in patients with disabilities. Agenesis was the most common alteration (24.14% in children and 30.55% in patients with disabilities). The study found a relative risk of 2.6 for agenesis in children with a history of prematurity (p = 0.02). The variable “performing medical treatment” was a risk factor for the presence of dental alterations in children. The age and the medical conditions of the patients with disabilities varied greatly, with neurological diseases being the most prevalent disability. However, the health history of mothers during pregnancy was not associated with dental alterations in patients with disabilities (p > 0.05). Developmental dental anomalies were frequently observed in both groups, with agenesis being the most common condition. Prematurity was identified as a predictive factor for agenesis.

PMID:41880449 | DOI:10.1590/1807-3107bor-2026.vol40.010

J Med Internet Res. 2026 Mar 25;28:e79363. doi: 10.2196/79363.

ABSTRACT

BACKGROUND: Stroke is a leading cause of long-term upper limb disability, severely impacting patients’ independence and quality of life. Robot-assisted therapy (RAT) has emerged as a promising, high-intensity rehabilitation alternative. However, conclusions from existing systematic reviews on its efficacy are inconsistent and often lack a holistic framework, limiting their use for guiding personalized clinical decisions.

OBJECTIVE: This study aims to systematically synthesize recent evidence on RAT for upper limb rehabilitation after stroke. Guided by the International Classification of Functioning, Disability and Health framework, it moves beyond singular outcomes to provide a multidimensional evaluation across body function, activity, and participation levels. The review aims to provide stratified guidance for clinical decision-making based on patient- and intervention-specific characteristics, thereby supporting evidence-based practice and informing future research.

METHODS: This study included systematic reviews and meta-analyses published from January 1, 2019, to December 26, 2025, comparing RAT with conventional therapy for upper limb rehabilitation after stroke. Overall, 6 databases, including PubMed, Web of Science, and Embase, were searched. Two reviewers (XZ and LZ) independently performed study selection, data extraction, and quality assessment using the AMSTAR 2 tool. The synthesis integrated outcome measures and subgroup analyses derived from the included studies.

RESULTS: This umbrella review included 21 meta-analyses encompassing 535 randomized controlled trials and 27,598 patients across acute, subacute, and chronic stroke stages. According to AMSTAR 2, 17 reviews were high quality, 3 moderate, and 1 critically low. The synthesis demonstrated that RAT was superior in improving upper limb motor function, but no statistically significant advantages were observed in activities of daily living compared to conventional therapy. Subgroup analyses revealed that treatment effects were influenced by stroke stage, upper limb motor impairment level, and robot type.

CONCLUSIONS: RAT is an effective intervention for improving upper limb motor function after stroke. However, its benefits are primarily observed at the level of body function, with limited evidence for long-term maintenance. The current evidence is constrained by significant outcome heterogeneity and methodological limitations inherent to umbrella reviews. Future research should validate these findings in broader clinical practice, focus on translating functional gains into sustained improvements in daily activities and participation, and include cost-effectiveness evaluations.

TRIAL REGISTRATION: PROSPERO CRD42024497183; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024497183.

PMID:41879816 | DOI:10.2196/79363

Am J Clin Oncol. 2026 Mar 25. doi: 10.1097/COC.0000000000001321. Online ahead of print.

ABSTRACT

OBJECTIVES: Solitary plasmacytoma is a rare plasma cell neoplasm with varying outcomes. This large IRB-approved retrospective analysis used the National Cancer Database (NCDB) to assess prognostic factors, treatment patterns, and overall survival (OS) among patients treated at Commission on Cancer-accredited facilities in the United States.

METHODS: Plasmacytoma patients (N=9427) from 2004 to 2020 were identified using the NCDB, excluding multiple myeloma. Descriptive statistics, Kaplan-Meier curves, and multivariate Cox regression analysis were used to evaluate survival outcomes by primary site, radiation dosage, and treatment modality. SAS version 9.4 was used to analyze the data.

RESULTS: Among 9427 patients, solitary plasmacytoma of bone (P-Bone) comprised 73% and extramedullary plasmacytoma (P-EM) 27%. Median OS was 106 months for P-Bone versus 146 months for P-EM (P<0.0001). Combined radiation therapy and surgery achieved the longest median OS (181 mo) versus surgery alone (137 mo) and radiation alone (116 mo; P<0.0001). OS increased with higher radiation dose: <35 Gy (46.6 mo) to ≥50 Gy (176.4 mo; P<0.0001). Among P-Bone sites, skull/mandible lesions showed the best outcomes (122.3 mo). Radiation doses of 45 to 49.9 Gy predominated across most sites.

CONCLUSIONS: This real-world study analyzes treatment patterns and overall survival in the largest plasmacytoma database to date. Combined surgery and radiation therapy show improved survival outcomes, emphasizing the need for personalized treatment approaches and the strength of combined modality therapy. Considering the primary bone site and radiation dosage aids prognostic assessment and treatment decision-making, contributing to plasmacytoma management and personalized care.

PMID:41879814 | DOI:10.1097/COC.0000000000001321

Glob Health Action. 2026 Dec;19(1):2647528. doi: 10.1080/16549716.2026.2647528. Epub 2026 Mar 25.

ABSTRACT

All Gulf Cooperation Council (GCC) countries have a multi-payer healthcare system that comprises governmental health coverage (GHC), funded by the government, and private health insurance (PHI), mainly sponsored by employers and purchased by individuals. Both are expected to influence healthcare utilization and contribute to system efficiency and patient well-being. This systematic review explored the determinants of PHI uptake and its association with healthcare service utilization in the presence of GHC in GCC countries. We systematically searched CINAHL, PubMed, Scopus, Web of Science, and Cochrane Library for peer-reviewed studies published between January 2012 and October 2022. Study quality was assessed using the Critical Appraisal Skills Programme (CASP) checklists for both quantitative and qualitative studies, following PRISMA guidelines. Twenty-six studies met the inclusion criteria. Determinants of PHI uptake were mapped to Andersen’s Behavioral Model of Health Services Use (BMHSU) and categorized into (1) predisposing factors (sex, age, marital status, and education), (2) enabling factors (employment/income and health system-related factors such as access and perceived service quality), and (3) need factors (health status, including chronic noncommunicable diseases). PHI uptake was positively associated with being male, married, highly educated, employed with a high income, and having chronic diseases. PHI was positively associated with healthcare utilization, particularly routine check-ups, preventive services, and the use of prescribed medicines. In GCC countries, PHI uptake is influenced by sociodemographic and socioeconomic characteristics, health status, and perceived service quality. PHI is also associated with higher healthcare utilization, underlining the need for evidence-informed policies that enhance equity and expand coverage.

PMID:41879796 | DOI:10.1080/16549716.2026.2647528

JAMA Netw Open. 2026 Mar 2;9(3):e262103. doi: 10.1001/jamanetworkopen.2026.2103.

ABSTRACT

IMPORTANCE: Patients with cancer face an increased risk of Clostridioides difficile infection (CDI) due to several factors, including chemotherapy and repeated health care exposures. However, recent national-level data characterizing the prevalence of CDI, associated clinical outcomes, and resource utilization in this population remain limited.

OBJECTIVE: To characterize the hospitalization-level prevalence, clinical outcomes, and health care resource utilization associated with CDI among hospitalized patients with cancer in the US.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from the National Inpatient Sample, a nationally representative database, to identify hospitalizations among adults with a diagnosis of cancer between January 1, 2016, and December 31, 2022. Hospitalizations with CDI were identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes. Data were analyzed from May to June 2025.

EXPOSURES: Presence of CDI as a primary or secondary diagnosis during the index hospitalization.

MAIN OUTCOMES AND MEASURES: The primary outcome was in-hospital, all-cause mortality. Secondary outcomes included need for kidney replacement therapy, mechanical ventilation, vasopressor support, and colonoscopy. Multivariable logistic regression was used to adjust for demographics, comorbidities, cancer type, and hospital characteristics.

RESULTS: Of 32 083 671 cancer-related hospitalizations (overall study population mean [SD] patient age, 69.4 [13.9] years; 16 050 025 [50.0%] male), 450 360 (1.4%) involved a diagnosis of CDI. Compared with hospitalizations without CDI, those with CDI involved older patients, a higher proportion of women, and higher prevalence of hematologic cancers, cirrhosis, solid organ transplant, bone marrow transplant, chronic kidney disease, and inflammatory bowel disease. Patients with CDI infection had higher in-hospital mortality (7.3% vs 4.5%; adjusted odds ratio [aOR], 1.62; 95% CI, 1.58-1.67) and greater use of critical care interventions. CDI was associated with higher rates of critical care interventions, including kidey replacement therapy (44.3 vs 20.4 per 1000 hospitalizations; aOR, 2.00; 95% CI, 1.92-2.08; P < .001), mechanical ventilation (68.1 vs 35.6 per 1000 hospitalizations; aOR, 1.89; 95% CI, 1.84-1.95; P < .001), and vasopressor use (25.6 vs 11.5 per 1000 hospitalizations; aOR, 2.11; 95% CI, 2.00-2.24; P < .001). Mortality among patients with CDI varied geographically, ranging from 6.4% (95% CI, 6.2%-6.5%) in the Midwest to 8.5% (95% CI, 8.3%-8.7%) in the Northeast.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of US oncologic hospitalizations, CDI occurred in 1 in 70 cancer-related hospitalizations and was associated with significantly increased mortality and resource utilization. These findings underscore the need for targeted prevention and early intervention strategies in this vulnerable population.

PMID:41879784 | DOI:10.1001/jamanetworkopen.2026.2103