Preventive medicine最新文献

Objective: E-cigarettes (ECs) may reduce harm from combustible cigarettes (CCs), but their impact on hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) is unknown. We compared smoking cessation or EC switching versus continued smoking on HCC risk in CHB patients.

Methods: This retrospective cohort used Korean National Health Insurance data (2018-2023) on CHB patients who smoked at baseline. Participants were categorized as continued smokers (n = 86,338), quitters (n = 19,521), or EC switchers (n = 21,337). Secondary analysis included 83,540 with consistent behaviors.

Results: Over median follow-up of 4.93 years, 4184 developed HCC. Compared to continued CC smokers, both quitters (adjusted HR, 0.78; 95% CI, 0.70, 0.86) and ECs switchers (adjusted HR, 0.78; 95% CI, 0.70, 0.87) exhibited reduced HCC risk. Only 12% of EC switchers eventually quit smoking while 61% of initial quitters remained quit at follow-up. Persistent quitters showed greater HCC risk reduction (adjusted HR, 0.64; 95% CI, 0.52, 0.77) than persistent CCs-to-ECs switchers (adjusted HR, 0.73; 95% CI, 0.59, 0.89), though not significant.

Conclusions: Complete tobacco cessation should remain the primary strategy given superior behavioral sustainability, with no significant difference in HCC risk reduction versus EC switching.

Objective: Fine particulate matter (PM_2.5) is a major environmental risk factor for premature death. Although global studies have estimated its health burden, most focused on excess deaths. Evaluations remain limited regarding its impact on life expectancy, an intuitive measure. This study estimated the avoidable life expectancy loss attributable to long-term PM_2.5 exposure in Korea using cause-specific years of life lost (YLL) derived from national mortality data.

Methods: Modeled annual PM_2.5 concentrations were used to calculate population-weighted exposures at the regional and national levels for 2010-2019 and 2023. Age- and sex-standardized YLL were computed by cause of death. Negative binomial mixed-effects models assessed associations between PM_2.5 and YLL. Excess YLL were estimated for reductions in PM_2.5 to target levels (5, 10, and 15 μg/m³) and converted into avoidable life expectancy loss per person using population size and national life expectancy at birth.

Results: PM_2.5 was significantly associated with YLL from all-cause, non-accidental, circulatory, ischemic heart disease, stroke, chronic obstructive pulmonary disease, and lung cancer mortality. Meeting the World Health Organization guideline (5 μg/m³) could have prevented 0.32 years of life expectancy loss in 2023, with regional disparities persisting (0.24-0.45 years).

Conclusions: Continued reductions in PM_2.5 could yield life expectancy gains.

Objective: The compounded impact of racialization and rurality on risk of severe maternal morbidity (SMM) remains underexplored. We aimed to examine how residence in rural neighborhoods may shape differential SMM risk by racial marginalization.

Methods: Data were from all live births in California born at 20-45 weeks' gestation between 1997 and 2019 (N = 10,681,950). Census-tract (neighborhood) rurality was defined using Rural-Urban Commuting Area codes. We used race/ethnicity stratified generalized estimating equation models accounting for neighborhood clustering, sociodemographic factors, clinical characteristics, and neighborhood poverty to estimate risk ratios (RR) of SMM comparing those residing in rural versus urban neighborhoods. Population attributable fractions (PAF%) were also calculated to estimate the contribution of rural residence to SMM risk.

Results: Residing in rural compared to urban neighborhoods was associated with increased risk of SMM for each racial/ethnic group in fully adjusted models. Associations were strongest among Pacific Islander individuals (RR = 1.63; 95% Confidence Interval (CI): 1.19,2.24) and weakest among White individuals (RR = 1.04; 95% CI: 1.00,1.09). The highest PAFs were observed for American Indian/Alaska Native (PAF% = 6.30; 95% CI: 2.01,10.63) and Pacific Islander (PAF% = 1.84; 95% CI: 0.43,3.32) individuals.

Conclusions: Findings highlight the need for targeted interventions that alleviate rural-urban disparities in maternal health within the context of racial marginalization.

Objectives: To evaluate the effects of interrupting sedentary behavior on postprandial metabolic outcomes in healthy adults.

Methods: We systematically searched seven databases (PubMed, Embase, Scopus, Cochrane, Web of Science, SPORTDiscus, and CINAHL Complete) from inception to June 6, 2025, for eligible randomized controlled trials. Primary outcomes included total and incremental areas under the curve for glucose, insulin, and triglycerides. Study quality (Cochrane Risk of Bias version 2) and overall evidence quality (Grading of Recommendations, Assessment, Development, and Evaluations) were assessed. Data were pooled using random-effects meta-analysis in Stata 18.0, with effects expressed as standardized mean difference (SMD) and 95% confidence interval (95% CI).

Results: Seventeen randomized controlled trials comprising 337 healthy adults were included. Meta-analysis showed that interrupting sedentary behavior significantly reduced glucose incremental area under the curve (SMD = -0.35; 95% CI: -0.56, -0.15) and insulin incremental area under the curve (SMD = -0.37; 95% CI: -0.56, -0.18), but had no significant effect on total area under the curve for glucose, insulin, and triglycerides, nor on the incremental area for triglycerides.

Conclusions: Interrupting sedentary behavior improves postprandial metabolism by specifically reducing the spike in blood glucose and insulin after a meal, without affecting overall metabolic exposure or lipid levels.