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In May 2022, a global outbreak of mpox (formerly known as monkeypox) was declared an international public health emergency. During this time, healthcare workers scrambled to respond to the outbreak amidst a lack of resources, knowledge gaps and pressures related to COVID-19. This period posed a risk of heightened moral distress, defined as distress arising from a situation in which a healthcare worker knows the right thing to do but is externally constrained from doing so. An international survey of healthcare workers was developed to understand their experiences of responding to mpox, including open-text questions regarding moral distress. Drawing on thematic analysis of these open text responses, this paper conceptualises the forms of distress experienced by health workers as 'outbreak distress'-an emotional and psychological response to the synergistic effects that arise from stressed systems, uncertainty and stigma that characterise many, and especially new, infectious disease outbreaks. In the context of pandemic preparedness, outbreak distress represents a novel concept for understanding additional pressures on healthcare systems in future unknown and re-emerging outbreaks.

Background: Tuberculosis screening is recommended for people living with HIV. The QuantiFERON-TB test measures the cell-mediated response against M. Tuberculosis. The Gold-In-Tube measures the response of CD4+ T-cells, often leading to indeterminate results. The new Gold-Plus (QFT-GP) also measures CD8+ T-cells response, thus reducing uncertainties. However, studies on people living with HIV, that would benefit from a test independent from CD4+ T-cells, are scarce.

Objective: This study addresses this gap by evaluating the performance of QFT-GP specifically in a large cohort of people living with HIV in a low TB-endemic setting.

Methods: We retrospectively evaluated the frequency of indeterminate QFT-GP tests in a cohort of people living with HIV with at least one test. We collected demographic data, CD4+ and CD8+ T-cell count at nadir and at the time of testing, and history of prior TB infection or treatment. We correlated the QFT-GP results to the CD4+ T-cell count.

Results: Six hundred and ninety five patients were included (males/females 72.5/27.5%), median age was 51 ± 14 years. Only 1,2% of tests were indeterminate, and there was no association with the CD4+ or CD8+ T-cell count at the moment of the test or at the nadir.

Conclusions: QFT-GP has few indeterminate results, even in patients with a low CD4+ T-cell count.

This work examines the dynamics of a discrete-time plankton interaction model, in which phytoplankton generate toxins and are vulnerable to external contamination. The model includes a Holling Type-II predation response and uses a piecewise constant argument approach to break it up into smaller pieces. This keeps the ecological realism of the continuous system while making it possible to study complex discrete-time behaviors. Our focus is on the formation of Neimark-Sacker bifurcation, a phenomena associated with the initiation of quasi-periodic oscillations in population densities. We show how toxin buildup and outside contamination can make plankton populations unstable, which could cause blooms to happen in an irregular way, using stability analysis and numerical simulations. The results show how useful discrete-time models are for capturing rapid changes in ecosystems, such damaging algal blooms. They also give ideas for managing ecosystems and reducing blooms.

Background: Oral food challenges are indicated when food allergies cannot be confirmed by clinical history or investigations, such as blood or skin-prick tests. However, few studies have examined adults' experiences of oral food challenges.

Methods: Semi-structured, individual interviews were conducted with 18 adults who had undergone an oral food challenge at a UK hospital.

Results: Three main themes were identified using thematic analysis, describing experiences before, during, and after testing: "A limited and scared life," "facing fear and uncertainty in a safe environment," and "living with revised boundaries." Prior to the test, participants described a life characterized by fear of reactions, hypervigilance, planning and restrictive diets, limiting social participation. During testing, participants experienced an emotional rollercoaster, confronting something previously avoided, which could potentially cause a severe reaction. After testing, participants reported reduced fear and uncertainty following clarification of their allergies, leading to greater freedom, and for those who tested negative, a return to viewing food as a source of pleasure, rather than fear.

Conclusions: Oral food challenges reduce fear and uncertainty surrounding allergies, providing clarity about which foods trigger reactions. Greater availability of oral food challenges would enable adults with suspected allergies to live less restricted and more enjoyable lives.

In 2015, the United Nations integrated adolescents as a unique category into the Sustainable Development Goals, a recognition the World Health Organization expanded in 2017 with the introduction of the Global Accelerated Action for the Health of Adolescents. This paper examines the emergence of the 'adolescent subject' in global health. Adolescence is a modern concept embedded in Western views that is not universally applicable, hence raising issues in global health practice by embodying a colonial legacy in using categories that may not align with all cultural contexts. Moreover, the paper explores a critical gap in global health research: while the majority of the world's adolescents reside in low- and middle-income countries, most adolescent health research is conducted in high-income settings. This disparity is due, in part, to a lack of funding for adolescent research and barriers like parental consent requirements that prevent adolescents from participating in research. This exclusion inadvertently silences some adolescents' voices and restricts their opportunities for research engagement, perpetuating an epistemic injustice in global health data production. The paper calls for a concerted effort to develop measures to inclusively engage adolescents in global health research, aiming for a fair and representative inclusion of adolescent perspectives.

Background: The frailty index (FI), reflecting cumulative health deficits, is a strong predictor of adverse outcomes in older adults. However, its prognostic value for mortality among patients with testosterone deficiency (TD) remains unclear.

Methods: We analyzed 1,688 adults with TD from three NHANES cycles (2011-2016) with mortality follow-up through 2019. FI was constructed using a 49-item deficit model. Survival differences were evaluated with Kaplan-Meier curves, and survey-weighted Cox models assessed the association between FI and all-cause mortality. Restricted cubic splines and threshold analyses explored dose-response relationships. Mediation analysis examined the role of the platelet-to-HDL-C ratio (PHR).

Results: Frail participants exhibited significantly higher mortality risk than non-frail individuals (log-rank P < 0.001). Per 1-SD increase in FI, mortality risk rose by 76% (HR = 1.76, 95% CI: 1.57-1.96, P < 0.001). Threshold analysis showed a sharp increase in mortality when FI exceeded 0.095, approximating the conventional pre-frailty cut-off. PHR mediated 8.46% of the FI-mortality association.

Conclusion: Higher FI was independently associated with increased all-cause mortality in TD patients, partly mediated by PHR. These findings highlight the prognostic significance of frailty and suggest PHR as a potential marker for personalized risk stratification and targeted intervention.

The pathogenesis of autoimmune thyroiditis (AIT) is intricately linked to immune dysregulation, endocrine imbalance, and gut microbiota dysbiosis. The immune system drives autoimmune attacks against thyroid tissue through Th1/Th2 cell imbalance, Treg dysfunction, and excessive release of proinflammatory cytokines. Thyroid hormone regulation primarily occurs via the hypothalamic-pituitary-thyroid (HPT) axis. Elevated levels of TPOAb and TgAb in AIT patients can lead to hypothyroidism by affecting the HPT feedback loop. Thyroid hormone regulation of immune cell metabolism and differentiation, in turn, affects immune homeostasis, forming a bidirectional regulatory network. Recent studies further reveal that the gut microbiota influences systemic immune tolerance by regulating intestinal barrier integrity and metabolites (e.g. short-chain fatty acids and secondary bile acids). Abnormal abundance of specific genera (e.g. Bacteroides and Prevotella) can promote the production of thyroid autoantibodies (TPOAb/TgAb), and increased intestinal permeability caused by microbiota dysbiosis may facilitate cross-reactivity between microbial antigens and thyroid antigens. Furthermore, the gut microbiota indirectly regulates thyroid function through the HPT axis. This review aims to summarize the current knowledge regarding the specific molecular mechanisms of gut microbiota-immune-endocrine interactions in AIT, offer important references for researching the treatment directions of AIT.

Objective: To analyze the effects of melatonin on angiogenesis in cultured granulosa cells from women undergoing in vitro fertilization, comparing those with female-factor versus male-factor infertility.

Methods: Granulosa cells were obtained from 47 women undergoing in vitro fertilization treatment, including 31 women with female-factor (FFG) and 16 women with male-factor infertility (MFG). Cells from both groups were cultured and divided into four treatment conditions for 96 h: a) control (culture medium without melatonin); b) vehicle (melatonin diluent-ethanol); c) 0.1 µM melatonin; and d) 10 µM melatonin. Expression of 84 genes involved in angiogenesis signaling pathway was analyzed by real-time PCR.

Results: Cultured granulosa cells from both groups expressed aromatase and melatonin receptors. In both groups, cell proliferation peaked at 72 h when exposed to 10 µM melatonin. Of the 84 analyzed genes, three showed significant differential mRNA expression. In the MFG, melatonin at 10 µM upregulated VEGF-B mRNA expression in granulosa cells but downregulated PDGFA and HGF mRNA expression, in contrast to the higher expression of these genes in the FFG under identical conditions.

Conclusion: Melatonin differentially modulates angiogenesis-related gene expression in granulosa cells, indicating that its effects may depend on infertility type and melatonin dose in women undergoing in vitro fertilization.

Aim: "Empathy" is a key concept in dementia care and considered important to improve the quality of care. However, how empathy should be promoted among dementia care nurses remains unclear. Thus, this study aimed to clarify the role of nurses' empathy in caring for people with dementia.

Methods: Certified nurse specialists in gerontological and dementia nursing were recruited as participants using snowball sampling. Data were collected from seven participants in March 2023 through focus-group interviews and analyzed qualitatively and inductively.

Results: Six categories related to care experiences were formed using fifty-six codes in five stages. The categories were as follows: i) Turn toward each other, considering personal diversity; ii) Actively approach them by understanding and acknowledging their thoughts; iii) Experience feelings of warmth after comprehending their personalities; iv) Experience an emotional resonance with them; v) Sharpen own senses to deeply understand their experiences; and vi) Work as a team to provide the most suitable care.

Conclusion: The results demonstrated that empathy is a key element in the interactions between nurses and people with dementia that contributes to more harmonious relationships. These findings can be used to educate nurses on dementia care, which may help reduce nurses' burnout.

Interleukin (IL)-37 is one of the "youngest" IL-1 family members and one of the few molecules exerting anti-inflammatory activity. Upon inflammasome activation, the cytokine precursor is converted into its mature form, which acts intracellularly as a nuclear transcription factor, impairing the production of pro-inflammatory cytokines, and extracellularly by forming the IL-37/IL-18Rα/IL-1R8 complex, favoring IL-1R8 inhibitory signaling with immunosuppressive function. IL-1R8, which is mostly expressed in a number of cell types, negatively regulates both IL-1R/TLR signaling, blocking the NF-kB/JNK pathway and the production of pro-inflammatory cytokines. Owing to its ability to inhibit both innate and adaptive immunity, IL-37 has been reported to control inflammation in many chronic disorders, including cancer. IL-37 impairs the proliferation and migration of tumor cells, mediates anti-angiogenetic mechanisms, and favors immunoregulation in the tumor microenvironment (TME). This review aims to provide a current overview of IL-37 genetic and biological features and of its active interaction with IL-1R8, inducing anti-inflammatory effects on the immune system and affecting cancer cell dynamics in the TME. Moreover, it analyzes the rare pro-tumoral effects of IL-37 in some tumors and discusses their possible mechanisms. It concludes that, due to its strong anti-inflammatory property, IL-37 can be considered a potential regulator in the pathogenesis of a variety of cancers, slowing tumor progression through multiple pathways and providing valuable information for tumor immune target therapy.