Microb Genom. 2026 Jun;12(6). doi: 10.1099/mgen.0.001763.
NO ABSTRACT
PMID:42313461 | DOI:10.1099/mgen.0.001763
Category: Nevin Manimala
J Clin Hypertens (Greenwich). 2026 Jun;28(6):e70284. doi: 10.1111/jch.70284.
ABSTRACT
During exercise, fine hemodynamic adjustments are essential to ensure adequate energy supply. Although cyclic treadmill exercise has been widely studied, isometric exercise with Handgrip (HG) has gained relevance in conditioning and rehabilitation contexts, yet data on the acute hemodynamic effects of combining these modalities remain scarce. In this context, the present study tested the hypothesis that isometric contraction with HG modifies the hemodynamic responses of Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), and Double Product (DP) during cyclic treadmill exercise. A clinical trial was conducted with 40 young, active or irregularly active men, using a crossover design in which three protocols were applied: protocol 1 without HG, protocol 2 with HG at 30% of handgrip strength (HGS), and protocol 3 with HG at 60% of HGS. The exercise sessions were performed on a treadmill and consisted of four blocks of 2 min at 50% of heart rate reserve, followed by 1 min at 30%. Statistical analysis was carried out using Kruskal-Wallis and Friedman tests with appropriate post hoc procedures. The results demonstrated that protocols 2 and 3 significantly increased SBP and DBP compared to protocol 1 (p < 0.05), while DP was significantly higher only in protocol 3 (p < 0.01). Heart rate increased throughout exercise in all protocols (p < 0.05), with no differences between them. Additionally, HG did not modify the hemodynamic response during recovery. Overall, HG promotes increases in SBP, DBP, and DP during treadmill exercise without altering HR.
PMID:42313450 | DOI:10.1111/jch.70284
J Antimicrob Chemother. 2026 Jun 3;81(7):dkag217. doi: 10.1093/jac/dkag217.
ABSTRACT
OBJECTIVES: Quantification of prescription of antimicrobial agents and use of paediatric outpatient services before, during and after the COVID-19 pandemic.
METHODS: We conducted a population-based study using Norwegian linked health registries and Japanese claims (2018-2023). Paediatric antibiotic prescription rates, broad-spectrum use, and proportion of antibiotic prescriptions with prior presumed bacterial infection diagnoses were analysed monthly, overall and by age groups and sex. Interrupted time series analyses were performed to evaluate pandemic-related changes, expressed in rate ratio (RR) and its CI, using March 2020 as the interruption point and the pre-pandemic trend/level as reference.
RESULTS: Data on 5.5 million children and 19.5 million antibiotic prescriptions were analysed. Before the pandemic, antibiotic prescribing was higher in Japan (120-200/1000 children/month) than in Norway (10-20/1000). At pandemic onset, rates fell by 45% in Norway (RR = 0.55; 95% CI, 0.45-0.67) and by 53% in Japan (RR = 0.47; 95% CI, 0.41-0.55), then by 2023 had returned to expected levels. Broad-spectrum antibiotic use was much higher in Japan (70%) compared with Norway (10%) before the pandemic. However, Norway experienced a sharp 20% increase whereas Japan remained largely unchanged post-pandemic. The proportion of prescriptions with a prior presumed bacterial diagnosis was between 50% and 65% before the pandemic then decreased modestly by 5%-10% at pandemic onset, followed by gradual rebound in both countries.
CONCLUSIONS: The COVID-19 pandemic significantly altered paediatric antibiotic prescribing in both countries. Sustained antibiotic stewardship efforts are needed to ensure appropriate paediatric antibiotic use in the post-pandemic era.
PMID:42313421 | DOI:10.1093/jac/dkag217
J Antimicrob Chemother. 2026 Jun 3;81(7):dkag216. doi: 10.1093/jac/dkag216.
ABSTRACT
BACKGROUND: We previously demonstrated in a randomized controlled trial that antibiotic prescribing feedback to family physicians reduced antibiotic use. However, that trial did not evaluate for patient harms from potential under-prescribing of antibiotics.
OBJECTIVES: To evaluate the safety of an antibiotic audit and feedback intervention.
METHODS: We performed a post hoc secondary analysis of a randomized controlled trial that compared an intervention group, who received a mailed antibiotic prescribing peer comparison feedback letter, compared with a control group who did not receive a letter. The initial trial was limited to patients aged 65 years or older due to availability of pharmacy claims data. The primary outcome was an emergency department visit or hospital admission for a bacterial infection. The outcome was assessed at 6 months post-intervention using administrative data claims data and multivariable linear regression models. The initial trial was registered (NCT04594200).
RESULTS: We included 4879 physicians-3909 intervention physicians and 970 control physicians. There were 37 345 severe infection events in the 6 month post-intervention period. The observed mean (SD) of all severe infection events per physician was 7.73 (12.42) for control and 7.64 (11.91) for intervention groups. The model-based adjusted mean difference was -0.23 (95% CI, -0.92 to 0.45; P = 0.505).
CONCLUSIONS: In this post hoc analysis of a randomized controlled trial comparing antibiotic prescribing feedback versus no feedback to physicians in primary care, there was no evidence of severe bacterial infection complications associated with reduced antibiotic prescribing. These findings support antibiotic peer comparison feedback as a safe and effective tool to reduce unnecessary antibiotic prescribing.
PMID:42313420 | DOI:10.1093/jac/dkag216
Account Res. 2026 Jun 18:2691602. doi: 10.1080/08989621.2026.2691602. Online ahead of print.
ABSTRACT
BACKGROUND: Predatory conferences (PCs) scam researchers by compromising them financially and professionally. This study presents the empirical development of the Pre-Attendance Conference Evaluator (PACE) to help academics assess a conference’s legitimacy.
MATERIALS AND METHOD: An expert group of six academics validated a preliminary list of PC traits. After identifying latent constructs through pilot testing, the list underwent four iterations based on statistical factor loadings to assess reliability, predictive validity, and concurrent validity. Later, confirmatory factor analysis included a battery of model-fit indices to assess the scale’s dimensionality.
RESULTS: Content validity ratio and semi-structured interviews reduced the number of PC traits from 70 to 29. Cronbach’s alpha and the Kaiser-Meyer-Olkin test indicated 15 items suitable for factor analysis. Parallel analysis of pilot-testing data from 800 conference-level observations revealed the scale’s unidimensionality. Eventually, 11 items showed strong factor loadings and a high fit across model indices. Concurrent validity assessed by 616 conference-level observations showed high correlations (rs = 0.73-0.80) with existing tools. High predictive validity (>0.9) and test-retest reliability (ICC = 0.47-0.68) indicated moderate-to-good temporal stability. The ROC analysis yielded a cutoff score of < 14 to deem a conference predatory.
CONCLUSION: PACE demonstrated acceptable validity and reliability as a tool for diagnosing potentially predatory conferences.
PMID:42313396 | DOI:10.1080/08989621.2026.2691602
JAMA Netw Open. 2026 Jun 1;9(6):e2618896. doi: 10.1001/jamanetworkopen.2026.18896.
ABSTRACT
IMPORTANCE: Military sexual trauma (MST) is associated with substantial psychiatric sequelae, but treatment options lack evidence-based protocols tailored to this specific trauma.
OBJECTIVE: To evaluate the efficacy of a MST-focused treatment using an 8-week virtual delivery format compared with an active control treatment to reduce symptoms of posttraumatic stress disorder (PTSD).
DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial compared Warrior Renew (MST-focused group) with Health and Wellness (active control group) at baseline, week 8 (after treatment), and week 16 (follow-up). The study was conducted at 2 Veterans Affairs health care systems in the Pacific Northwest region of the US. Participant enrollment occurred from July 19, 2023, to March 24, 2025. Veterans aged 18 to 75 years with a history of MST-related PTSD symptoms were recruited via informational letters, self-referral, and clinician referral. Participants were randomized 1:1 to the MST-focused group or active control group. Analysis of participants with baseline data was based on the intention-to-treat principle.
INTERVENTION: The MST-focused treatment targets themes of MST using cognitive and experiential strategies, including imagery reprocessing. The active control targets health and well-being, including behavioral engagement with weekly goals. Both treatments consisted of 8 weekly, 90-minute sessions delivered via telehealth in groups separated by sex.
MAIN OUTCOMES AND MEASURES: The primary outcome was change in PTSD symptom severity from baseline to week 8, which was measured by the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PCL-5) and the Posttraumatic Cognitions Inventory (PTCI). A linear mixed model was used to compare outcomes of the treatments at weeks 8 and 16.
RESULTS: Of the 191 veterans who consented, 140 (mean [SD] age, 50.6 [14.7] years; 71 males [50%]) completed baseline assessments and were included in the intent-to-treat analyses. Participants in the MST-focused group showed significant score improvements from baseline to week 8 on the PCL-5 (-7.97; 95% CI, -11.01 to -4.92; P < .001) and the PTCI (-19.99; 95% CI, -26.86 to -13.12; P < .001), which were maintained at week 16. Active control group participants also showed significant score improvements on the PCL-5 and PTCI; however, the MST-focused group demonstrated greater score improvements on the PTCI (-9.61; 95% CI, -18.98 to -0.25; P = .04) and the PTCI self-blame subscale (-3.10; 95% CI, -5.30 to -0.90; P = .006) compared with the active control group. Additionally, only participants in the MST-focused group exceeded a 10-point score threshold indicating meaningful change on the PCL-5 at week 16. Women in the MST-focused group demonstrated greater results on the PCL-5 over the control group (-5.90; 95% CI, -11.58 to -0.22; P = .04) at week 8. Both treatments had low dropout rates (around 11%).
CONCLUSIONS AND RELEVANCE: This randomized clinical trial showed that both treatments demonstrated efficacy in reducing PTSD symptoms, but the MST-focused treatment compared with the active control demonstrated greater improvements in posttraumatic cognitions. The results support the use of the MST-focused group treatment for PTSD symptoms associated with MST.
TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05776719.
PMID:42313385 | DOI:10.1001/jamanetworkopen.2026.18896
JAMA Netw Open. 2026 Jun 1;9(6):e2619372. doi: 10.1001/jamanetworkopen.2026.19372.
ABSTRACT
IMPORTANCE: Digital health services are expanding, yet community readiness for digital care varies widely. Without a validated, granular measure of readiness, health systems and policymakers cannot reliably enable targeted support or monitor equitable deployment.
OBJECTIVE: To develop and validate a reproducible census tract-level index of community digital health readiness integrating socioeconomic conditions, access to care, and digital connectivity.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional index development and validation study analyzed public data from 2018 to 2022. The Digital Health Index (DHI) was constructed from 21 indicators with equal weighting representing 3 domains: socioeconomic, health access, and connectivity. Content validity was assessed using a 2-round Delphi panel including 37 experts. Structural validity was assessed with exploratory and confirmatory factor analyses. Convergent validity was assessed against the Social Vulnerability Index (SVI), Area Deprivation Index (ADI), and Digital Divide Index (DDI). External validity was assessed using health care spending. Robustness was assessed using leave-one-out, weight-perturbation, and group-based cross-validation analysis. Data were analyzed between June 2023 and April 2026.
MAIN OUTCOMES AND MEASURES: Primary outcomes were validation metrics, including factor structure fit indices, correlations with established indices, association with health care spending per capita, and Delphi consensus rates for each indicator. Robustness outcomes included stability of tract rankings under indicator removal or weight changes.
RESULTS: The DHI was computed for 85 396 US census tracts across all 50 states. DHI scores correlated with SVI, ADI, and DDI scores (Spearman ρ = 0.61-0.84) but prioritized different low-readiness communities, with only 33% to 44% overlap between tracts in the highest DHI decile and those in the highest SVI, ADI, or DDI deciles. Health care spending showed similar inverse associations across indices. DHI rankings remained stable in sensitivity analyses. All 21 indicators met Delphi consensus criteria after 1 or 2 rounds.
CONCLUSIONS AND RELEVANCE: In this cross-sectional index development and validation study, a reproducible measure of community digital health readiness was constructed at the census tract level, integrating socioeconomic, access, and connectivity factors. The DHI may help health systems, public agencies, and researchers identify communities requiring support and track readiness over time as digital health and artificial intelligence initiatives expand.
PMID:42313384 | DOI:10.1001/jamanetworkopen.2026.19372
JAMA Netw Open. 2026 Jun 1;9(6):e2619396. doi: 10.1001/jamanetworkopen.2026.19396.
ABSTRACT
IMPORTANCE: Maternal mental health disorders are among the leading causes of maternal morbidity and mortality. In the US, the 2022 Supreme Court decision in Dobbs v. Jackson Women’s Health Organization and ensuing state-level abortion restrictions have raised concerns that such policies may worsen maternal health and mental health outcomes.
OBJECTIVE: To examine the association of the implementation of Texas Senate Bill 8 (SB8) abortion law, which banned abortions after embryonic cardiac activity in September 2021, with maternal mental health outcomes.
DESIGN, SETTING, AND PARTICIPANTS: This repeated cross-sectional study used a difference-in-differences (DiD) design with pooled data from the 2016 to 2023 National Survey of Children’s Health. The nationally representative sample included US mothers aged 18 to 49 years who lived with at least 1 child aged 0 to 17 years. Data were analyzed from April to October 2025.
EXPOSURE: Mothers residing in Texas represented the treatment group, and mothers in states without abortion bans (Alaska, Arizona, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Kansas, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, Vermont, Virginia, Washington, and Wyoming) served as the control group.
MAIN OUTCOMES AND MEASURES: The primary outcome was mothers’ self-reported fair or poor mental and emotional health. Logistic regression models, adjusted for child-, mother-, and household-level characteristics, were used to estimate changes in the probability of mental health outcomes for mothers coinciding with SB8 implementation. Similar models were estimated with maternal physical health and fathers’ mental health as outcomes for sensitivity analyses.
RESULTS: The sample included 4323 mothers in Texas (47.2% [95% CI, 45.1%-49.4%] aged 30-39 years) and 152 573 mothers in nonban states (47.1% [95% CI, 46.4%-47.7%] aged 30-39 years). Compared with mothers in nonban states, those in Texas experienced a statistically significant increase in the likelihood of reporting fair or poor mental health following SB8’s implementation (DiD estimate, 2.52 percentage points; 95% CI, 0.02-5.01 percentage points). The largest increases were observed among mothers of children with public insurance (DiD estimate, 7.06 percentage points; 95% CI, 0.83-13.29 percentage points). No significant outcomes were observed for mothers’ physical health outcomes or fathers’ mental health in the sensitivity analyses.
CONCLUSIONS AND RELEVANCE: In this repeated cross-sectional study, the implementation of an abortion ban in Texas was associated with a worsening of maternal mental health among reproductive-age mothers relative to mothers in states without such bans. These results underscore the association of abortion restrictions with maternal mental health and highlight the need to strengthen support in the post-Dobbs policy environment.
PMID:42313383 | DOI:10.1001/jamanetworkopen.2026.19396
JAMA Netw Open. 2026 Jun 1;9(6):e2619402. doi: 10.1001/jamanetworkopen.2026.19402.
ABSTRACT
IMPORTANCE: Syringe service programs (SSPs) deliver evidence-based harm reduction interventions to persons who inject drugs to reduce morbidity and mortality in this population, including syringe exchange, naloxone distribution, linkage to medications for opioid use disorder, and other services. In July 2025, a federal executive order threatened federal support for SSPs in the US.
OBJECTIVE: To estimate the potential long-term outcomes of halting federal funding for SSPs.
DESIGN, SETTING, AND PARTICIPANTS: This decision analytical model study used a closed cohort microsimulation model of the natural history of injection drug use and health outcomes among persons who inject drugs in the US from August 1, 2025, to August 2030. The model was populated with data from the Centers for Disease Control and Prevention’s National HIV Behavioral Surveillance system and published data to create representative cohorts of persons who inject drugs nationwide.
EXPOSURE: Cases in which total funding for SSPs was reduced by 11% and 80% were modeled. Within each case, 3 potential scenarios related to federal funding disruptions due to an executive order threatening funding for SSPs were modeled: (1) funding disruptions remain in place for 5 years, through August 2030; (2) funding returns to previous levels after 1 year, in August 2026; and (3) funding returns to 100% of previous levels in January 2029.
MAIN OUTCOMES: The primary outcome was 5-year all-cause and overdose mortality and nonfatal overdoses.
RESULTS: In a hypothetical study population of 3 694 500 persons who inject drugs (57.0% male; mean [SD] age, 49.5 [17.5] years), all-cause mortality increased by 0.1% (95% credible interval [CrI], 0-0.2%) to 5.0% (95% CrI, 0-0.8%), overdose mortality increased by 0.2% (95% CrI, -0.1% to 0.4%) to 6.9% (95% CrI, -4.3% to 14.4%), and nonfatal overdoses decreased by 0.1% (95% CrI, -0.2% to 0) to 4.2% (95% CrI, -7.8% to 0.1%) during 5 years across all scenarios. The worst-case scenario, in which there was sustained high levels of service disruption, resulted in 39 600 additional deaths and 15 600 additional overdose deaths among persons who inject drugs in the US. All-cause mortality and overdose mortality increased in most sensitivity analyses.
CONCLUSIONS AND RELEVANCE: In this decision analytical model study estimating the effects of reducing federal funding for SSPs, the findings suggest that mortality will increase among persons who inject drugs during the 5 years after loss of funding. Future studies are needed to understand clinical effects of funding changes.
PMID:42313382 | DOI:10.1001/jamanetworkopen.2026.19402
JAMA Netw Open. 2026 Jun 1;9(6):e2619409. doi: 10.1001/jamanetworkopen.2026.19409.
ABSTRACT
IMPORTANCE: Mild traumatic brain injury (mTBI) is associated with greater risk of musculoskeletal injury (MSKI). However, it is unclear whether mTBI is associated with risk of subsequent MSKI among US service members (SMs) with extended follow-up and whether this varies between male and female individuals.
OBJECTIVE: To test the association of mTBI with subsequent MSKI in a large study population of SMs with extended follow-up.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included SMs with mTBI and propensity score-matched controls who joined between 2016 and 2020 across all branches of the US military and had medical record data until 2023. Data were analyzed from December 2024 to October 2025.
EXPOSURE: Medical record-derived mTBI.
MAIN OUTCOME AND MEASURES: mTBIs and MSKI events were identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes. To test associations of mTBI with subsequent overall MSKI, Cox proportional hazards and Aalen additive hazards models were fit to estimate relative and absolute effect sizes, respectively. Testing was completed for moderation by sex. All models were adjusted for demographic and military-relevant characteristics.
RESULTS: The mean (SD) age of the 26 784 participants (13 392 with mTBI and 13 392 controls without mTBI) was 20.0 (2.8) years, and 4585 (17.1%) were female. During 34 156 person-years of follow-up, there were 14 330 MSKI events. Compared with no mTBI, mTBI was associated with a greater hazard of subsequent MSKI (hazard ratio [HR], 2.24; 95% CI, 2.16-2.32). On the absolute scale, mTBI, compared with no mTBI, was associated with an additional 258 MSKI events per 100 000 person-days (Aalen additive hazard = 2.58 × 10-3; SE, 1.17 × 10-6). Although there was no significant interaction in associations of mTBI with subsequent MSKI by sex (P for interaction = .37), mTBI was associated with greater hazard of MSKI in models among female SMs only (HR, 2.28; 95% CI, 1.92-2.70), and in models among male SMs only (HR, 2.20; 95% CI, 2.11-2.29).
CONCLUSIONS AND RELEVANCE: In this cohort study of US SMs, mTBI was associated with greater hazard of subsequent MSKI on the relative and absolute scales. Female SMs had a greater hazard of MSKI, but there was no significant moderation by sex for associations between mTBI and MSKI. Findings can inform patient counseling on MSKI risk following mTBI.
PMID:42313381 | DOI:10.1001/jamanetworkopen.2026.19409