Tag: pubmed

JAMA Netw Open. 2026 Jul 1;9(7):e2624095. doi: 10.1001/jamanetworkopen.2026.24095.

ABSTRACT

IMPORTANCE: Food insecurity is associated with worse cardiovascular health. There is variation in state Supplemental Nutrition Assistance Program (SNAP) eligibility and administration policies that influence participation rates, but how such policies impact cardiovascular mortality is not known.

OBJECTIVE: To evaluate the association of SNAP-related policies with county-level cardiovascular mortality rates.

DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, using state-level SNAP policy data from the US Department of Agriculture, a SNAP policy index was created (range, 0-10), with higher values denoting adoption of policies associated with higher SNAP participation. Mortality data from the National Center for Health Statistics and population data from the Census Bureau were used to calculate county-level, age-adjusted, cardiovascular mortality rates for adults aged 20 years and older.

EXPOSURES: Changes in an index of state SNAP policies from 2006 to 2019.

MAIN OUTCOMES AND MEASURES: The primary outcome was county-level cardiovascular mortality rates. Using the g-computation procedure, a robust causal inference method, and a marginal structural model, the association between changes in the SNAP policy index and county-level cardiovascular mortality rates was estimated. Mortality rates were also estimated under different potential trajectories for the SNAP index.

RESULTS: Between 2006 and 2019, there were a total of 11 409 251 cardiovascular deaths among adults in 3127 US counties (5 713 305 deaths [50.1%] occurred among women; 9 266 123 deaths [81.2%] among adults aged ≥65 years). The median (IQR) SNAP policy index value increased from 3.7 (2.7-4.2) to 7.1 (5.6-7.5). After accounting for differences in demographic and economic factors, a 1-point absolute increase in the SNAP policy index was associated with a 1.02% (95% CI, 0.47%-1.60%; P < .001) lower county cardiovascular mortality rate. If all states had followed a high-generosity SNAP policy trajectory, compared with if they had followed a low-generosity trajectory, an estimated 46 123 (95% CI, 28 587-65 096) fewer adult cardiovascular deaths are estimated to have occurred in 2019.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of SNAP policies and cardiovascular mortality, an index of policies that can increase SNAP participation was associated with statistically significantly lower cardiovascular mortality rates. Adoption of such policies may play a role in improving cardiovascular health among lower-income adults.

PMID:42475094 | DOI:10.1001/jamanetworkopen.2026.24095

JAMA Netw Open. 2026 Jul 1;9(7):e2624114. doi: 10.1001/jamanetworkopen.2026.24114.

ABSTRACT

IMPORTANCE: Shifts in the demographic composition of US military veterans underscore the need for updated population-based estimates of suicidal thoughts and behaviors (STBs) to accurately characterize suicide risk in this population.

OBJECTIVE: To update prevalence estimates of and factors associated with STBs among US military veterans and to examine mental health treatment utilization among veterans with a history of STBs, stratified by use of the Veterans Health Administration as a primary source of health care.

DESIGN, SETTING, AND PARTICIPANTS: Population-based cross-sectional study of US military veterans drawn from the 2025 to 2026 National Health and Resilience in Veterans Study.

MAIN OUTCOMES AND MEASURES: Past 2-week and past-year suicidal ideation (SI), lifetime planning, and lifetime suicide attempt(s).

RESULTS: Among 2636 veterans (mean [SD] age, 62.4 [16.2] years; 2349 [88.5%] male), the prevalence of past 2-week SI was 13.4% and past-year SI was 14.0%, with past 2-week SI significantly higher in 2025 to 2026 than in 2019 to 2020 (13.4% vs 9.0%; z = 5.69; P < .001). In contrast, prevalence estimates of lifetime suicide planning (8.0% vs 7.3%; z = 1.06; P = .29) and suicide attempts (4.9% vs 3.9%; z = 1.97; P = .048) were similar to those observed in 2019 to 2020. After adjustment for sociodemographic and military characteristics, factors most strongly associated with past 2-week SI based on relative importance analyses included functional disability (odds ratio [OR], 1.10; 95% CI, 1.04-1.16), lifetime major depressive disorder (OR, 2.22; 95% CI, 1.63-3.02), and lifetime posttraumatic stress disorder (OR, 1.53; 95% CI, 1.09-2.13). Factors most strongly associated with past-year SI included functional disability (OR, 1.09; 95% CI, 1.07-1.11), lifetime major depressive disorder (OR, 2.33; 95% CI, 1.72-3.16), and lifetime posttraumatic stress disorder (OR, 1.62; 95% CI, 1.17-2.25). Factors most strongly associated with lifetime suicide planning included lifetime posttraumatic stress disorder (OR, 2.61; 95% CI, 1.82-3.76), lifetime major depressive disorder (OR, 2.61; 95% CI, 1.84-3.71), and younger age (OR, 2.11; 95% CI, 1.36-3.28). Factors most strongly associated with lifetime suicide attempts included greater adverse childhood experiences (OR, 1.39; 95% CI, 1.29-1.51), lifetime major depressive disorder (OR, 3.76; 95% CI, 2.31-6.10), and functional disability (OR, 1.04; 95% CI, 1.02-1.07).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of US military veterans, results suggest that SI was more prevalent in 2025 to 2026 relative to estimates from 2019 to 2020, whereas the prevalence of suicide planning and attempts remained stable. Younger and female veterans appear to carry disproportionate risk for STBs. Targeting key risk factors in vulnerable subpopulations may help mitigate suicide risk.

PMID:42475092 | DOI:10.1001/jamanetworkopen.2026.24114

JAMA Netw Open. 2026 Jul 1;9(7):e2624175. doi: 10.1001/jamanetworkopen.2026.24175.

ABSTRACT

IMPORTANCE: Previous studies suggest that spouses of individuals with dementia may be at increased risk of developing dementia, but evidence regarding subgroup variation and absolute risk remains limited.

OBJECTIVE: To examine whether spouses of individuals with dementia have an increased risk of developing dementia and to assess whether this association is modified by demographic, socioeconomic, and family context factors.

DESIGN, SETTING, AND PARTICIPANTS: This nationwide population-based cohort study used Taiwan’s National Health Insurance Research Database from 1998 to 2022, with follow-up through 2022. To address prior limitations of small sample size and limited subgroup evaluation, spouses of individuals with incident dementia were identified and matched 1 to 4 to unexposed controls by birth year, sex, income, and urbanicity. The analysis was conducted between July 15, 2025, and May 15, 2026.

EXPOSURE: Spousal exposure to incident dementia.

MAIN OUTCOMES AND MEASURES: Incident all-cause dementia, Alzheimer disease, and vascular dementia. Hazard ratios (HRs) and 5-year absolute risk differences were estimated using Cox regression and g-computation.

RESULTS: The matched cohort included 955 105 individuals, with 118 904 exposed women and 72 117 exposed men as well as 475 616 unexposed women and 288 468 unexposed men. The largest proportion were aged 65 to 74 years at cohort entry, for women (47 084 [39.6%]) and men (28 477 [39.5%]). Spouses of individuals with dementia had a higher risk of all-cause dementia than unexposed spouses. For women, the HR was 1.74 (95% CI, 1.70-1.78), with a 5-year adjusted risk difference of 2.75 percentage points (pp) (95% CI, 2.63-2.87 pp). For men, the HR was 1.69 (95% CI, 1.64-1.73), with a 5-year adjusted risk difference of 3.49 pp (95% CI, 3.30-3.69 pp). Similar patterns were observed in analyses of Alzheimer disease and vascular dementia. Relative risks were more prevalent at younger ages, whereas absolute risk differences increased with age. For all-cause dementia, the association was attenuated among individuals with higher income or more children. Associations were otherwise broadly similar across sex and urbanicity.

CONCLUSIONS AND RELEVANCE: In this cohort study of married individuals in Taiwan, spouses of individuals with dementia had a higher risk of dementia than unexposed spouses. The association varied across family and socioeconomic contexts, highlighting the relevance of household context in dementia risk assessment.

PMID:42475091 | DOI:10.1001/jamanetworkopen.2026.24175

J Magn Reson Imaging. 2026 Jul 20. doi: 10.1002/jmri.70459. Online ahead of print.

ABSTRACT

BACKGROUND: Progressive supranuclear palsy (PSP) is both an underdiagnosed and a frequently misdiagnosed disorder. To remedy these diagnostic limitations, MRI has been used to investigate brain morphology to differentiate PSP from Parkinson’s disease (PD) and multiple system atrophy (MSA). However, while nigrostriatal degeneration and tau aggregation are prominent in PSP, and result in iron accumulation and atrophy in the region, substantia nigra (SN) atrophy remains an underexplored diagnostic marker.

PURPOSE: To investigate the diagnostic utility of QSM-derived SN parameters for PSP.

STUDY TYPE: Retrospective.

POPULATION: 123 (59 Males/64 Females) PD patients, 48 (26 M/22 F) MSA patients, and 22 (11 M/11 F) PSP patients were included in the main dataset. MSA patients include 20 parkinsonian type (MSA-P) (11 M/9 F) and 18 cerebellar type (MSA-C) (9 M/9 F) of MSA with 10 undetermined subtype. The external validation set included 12 (6 M/6 F) healthy controls, 13 PD (7 M/6 F), and 10 PSP (6 M/4 F) patients.

FIELD STRENGTH AND SEQUENCE: 3 T, MPRAGE T₁-weighted imaging and multi-echo gradient echo imaging (mGRE) for QSM.

ASSESSMENT: Group level differences of SN volume, magnetic susceptibility, and susceptibility-to-volume ratio (SVR) among PSP, PD, and MSA groups, and these metrics’ differentiating power are measured. Bivariate logistic regression with T₁-based morphological markers alongside SN metrics is performed.

STATISTICAL TESTS: Mann-Whitney U test for group comparisons. Receiver operating characteristic analysis with bootstrapping. p < 0.05 after Bonferroni correction is defined as statistically significant result.

RESULTS: The SN SVR was significantly higher in the PSP group compared to the MSA group and the MSA-P group. Moreover, using pons measurements with SN SVR in a bivariate model resulted in the highest differentiation between the PSP and MSA groups (AUC = 0.88, 95% CI: [0.78-0.95]), particularly driven by the increased differentiation between the PSP and MSA-P groups (AUC = 0.88, 95% CI: [0.75-0.98]). External validation supported the generalizability of SN SVR, yielding 100% sensitivity and 80% specificity for differentiating PSP from HC and PD.

DATA CONCLUSION: QSM-based SN morphometry can complement T₁-weighted imaging for Parkinsonism assessment.

EVIDENCE LEVEL: 3.

TECHNICAL EFFICACY: Stage 2.

PMID:42475080 | DOI:10.1002/jmri.70459

Pain. 2026 Jul 20. doi: 10.1097/j.pain.0000000000004064. Online ahead of print.

ABSTRACT

Complex regional pain syndrome (CRPS) is a chronic, treatment-refractory neuropathic disorder associated with substantial functional impairment and socioeconomic burden. Although socioeconomic conditions have been implicated in vulnerability to chronic pain, evidence on the association between income dynamics and the risk of developing CRPS remains limited. Using the Korean National Health Insurance Service database, we conducted a nationwide cohort study including 3,437,021 adults in South Korea who underwent national health screening in 2012 and were followed through to 2022. Income-related indicators-including baseline income level, cumulative income exposure, income change, and income volatility during the 5 years preceding baseline-were assessed. Incident CRPS was identified using Korean Standard Classification of Diseases codes combined with registration in the Rare Intractable Disease program. Compared with the highest income quartile, individuals in the lowest income quartile had a higher CRPS risk (adjusted hazard ratio [aHR], 3.74; 95% confidence interval [CI], 3.07-4.56). Risk increased with longer duration of low-income status (aHR, 1.91; 95% CI, 1.48-2.45 for 5 vs 0 years) and decreased with longer duration of high-income status (aHR, 0.55; 95% CI, 0.44-0.70 for 5 vs 0 years). In addition, high-income volatility (highest vs lowest quartile aHR, 1.48; 95% CI, 1.23-1.78) and downward income changes (peak aHR, 1.84; 95% CI, 1.24-2.73) were independently associated with increased CRPS risk. These findings suggest that income dynamics represent an important socioeconomic risk factor for CRPS and highlight the relevance of longitudinal socioeconomic vulnerability in the development of disabling chronic pain conditions.

PMID:42475049 | DOI:10.1097/j.pain.0000000000004064

Psychol Methods. 2026 Jul 20. doi: 10.1037/met0000860. Online ahead of print.

ABSTRACT

The ability of a student can be conceptualized as either a continuously varying entity (e.g., conventional analysis using dichotomous item response theory [IRT] models; Lord & Novick, 1968) or a bundle of latent classes (e.g., cognitive diagnostic models [CDMs]; Rupp et al., 2010; von Davier & Lee, 2019). This article builds on recent efforts to focus on predictive differences between measurement models in an attempt to examine the degree to which such approaches, which utilize quite distinctive notions regarding the nature of ability, produce different predictions of response behavior in the real world. We first present two simulation studies in which data are generated from variants of CDMs that differ in sample size, attribute hierarchical structures, and attribute estimation methods. We illustrate that, as we would expect given that they were used to generate data, CDM-based predictions uniformly outperform those of IRT models. We then compare the performance of CDM- and IRT-based approaches across 11 empirical data sets previously analyzed using CDMs. Our findings indicate that overfitting is a pervasive issue across CDM-based predictions, particularly with the generalized deterministic inputs, noisy “and” gate model. Furthermore, in no case does the CDM show superior performance when using the maximum a posteriori estimator, and only six out of 11 data sets show improved model fit for CDMs over the two-parameter logistic model when using the marginal mastery probabilities estimator. Researchers and practitioners may need to balance the diagnostic appeal of CDMs with the fact that their complexity can come at the cost of predictive accuracy. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

PMID:42475042 | DOI:10.1037/met0000860

Psychol Assess. 2026 Jul 20. doi: 10.1037/pas0001476. Online ahead of print.

ABSTRACT

Multi-informant assessments are considered the gold standard in the assessment of youth psychopathology. Although best practice dictates that this approach should extend to the assessment of youth involved in the justice system, few studies have examined the effect of multiple informants in a forensic context. Using a sample of 580 youth-caregiver dyads, we conducted a series of polynomial regressions to test whether statistical interactions between scores on the Youth Self-Report and scores on the Child Behavior Checklist (completed by caregivers) predicted psychiatric diagnoses. Psychiatric diagnoses were coded from the youth’s final forensic assessment report and included anxiety disorder, depressive disorder, conduct disorder, oppositional defiant disorder, and attention-deficit hyperactivity disorder. A significant interaction was found when modeling the effect of youth-caregiver reports of rule-breaking behavior on receiving a conduct disorder diagnosis, and when modeling the effect of youth-caregiver reports of aggressive behavior on receiving an attention-deficit hyperactivity diagnosis. No significant interactions were found when modeling the effect of youth-caregiver reports of internalizing symptomology on receiving an anxiety or depressive disorder diagnosis. Results suggest that youth and caregiver reports are integrated differently depending on whether the clinician is making an internalizing or externalizing spectrum diagnosis. Study implications for forensic assessments with multiple informants are discussed. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

PMID:42475031 | DOI:10.1037/pas0001476

J Relig Health. 2026 Jul 20. doi: 10.1007/s10943-026-02734-y. Online ahead of print.

ABSTRACT

Spiritual abuse is a form of harm in religious communities that disrupts positive social connections and causes negative health impacts. Without objective assessment methods, religious groups that are spiritually abusive can be difficult to identify. This study introduces spiritual safety-the ability to practice one’s spirituality without coercion, manipulation, or emotional abuse-as a measure for the risk of spiritual abuse in a faith-based organization. Sixty items were developed based on themes from the literature on spiritual abuse and psychological safety. The items were refined through content validity index and psychometrically validated across two separate studies with primarily North American Christian participants. In Study 1 (n = 331), exploratory factor analysis identified three underlying factors which were named psychological safety, leadership, and culture. Study 2 (n = 491) confirmed the three-factor structure using confirmatory factor analysis and validated a final 20-item version of the scale. The Spiritual Safety Scale (S-SAFE) demonstrated excellent reliability (α = 0.97), a strong correlation with individual psychological safety (r = 0.82), a strong negative correlation with PTSD symptomatology (r = – 0.56), and a moderate negative correlation with negative religious coping (r = – 0.43). Fit indices demonstrated good model fit (CFI = 0.95, TLI = 0.94, RMSEA = 0.07). ANOVA supported the statistical significance of scoring groups for healthy, unhealthy, and unsafe categories. The S-SAFE therefore offers a practical tool for assessing spiritual safety and risk of spiritual abuse in North American Christian communities.

PMID:42474978 | DOI:10.1007/s10943-026-02734-y

J Patient Rep Outcomes. 2026 Jul 20. doi: 10.1186/s41687-026-01149-3. Online ahead of print.

ABSTRACT

BACKGROUND: Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare, chronic disease that significantly affects quality of life (QoL). Despite improved survival, many patients experience persistent symptoms and complex care needs. Patient-reported data on QoL and perceived care quality remain limited, particularly in Italy. This study aimed to assess health-related QoL and patient-perceived care quality among Italian EGPA patients and to identify distinct patient profiles through cluster analysis to inform personalized, multidisciplinary care strategies.

METHODOLOGY: We conducted a cross-sectional, 77-item online survey among adult EGPA patients (self-reported diagnosis) between December 2024 and January 2025. The survey, developed with APACS APS (Associazione Pazienti con Sindrome di Churg-Strauss), was distributed via the SurveyMonkey platform. It included validated instruments: SF-36 for health-related QoL and PACIC (with PACIC-5As) for perceptions of chronic care. Additional demographic, clinical, and disease impact data were collected. Descriptive statistics and group comparisons were performed. SF-36 and PACIC domains were analyzed using principal component analysis (PCA), followed by k-means clustering to identify patient subgroups.

RESULTS: Seventy-two patients completed the survey (mean age 56; 65% female; median disease duration 7 years; 84.7% on biologics; 41.7% on glucocorticoids). SF-36 scores showed moderate QoL impairment (mean PCS 56.3 ± 24.6; MCS 59.3 ± 24.1), with lower QoL among females, divorced/separated individuals, and those with neurological involvement. Paresthesia had the greatest impact, affecting multiple QoL domains and daily functioning (p < 0.05). PACIC scores reflected moderate perceptions of care (2.8-3.5), with lowest scores in “Goal Setting” and “Care Coordination.” PACIC-5As scores were low (mean 2.3), indicating suboptimal collaborative care. Cluster analysis identified three profiles: (1) poor QoL with high healthcare engagement (n = 12); (2) best QoL and care ratings (n = 38); (3) intermediate health status but lowest PACIC scores (n = 22), reflecting perceived lack of support. Differences across clusters were statistically significant (p < 0.001).

CONCLUSIONS: Italian EGPA patients report impaired QoL and only moderate care quality, with notable heterogeneity in experiences. Personalized, multidisciplinary approaches are needed, especially for patients who feel under-supported despite moderate disease activity.

PMID:42474947 | DOI:10.1186/s41687-026-01149-3

J Occup Rehabil. 2026 Jul 20. doi: 10.1007/s10926-026-10416-5. Online ahead of print.

ABSTRACT

PURPOSE: Many people diagnosed with cancer are of working age and experience challenges returning to and retaining-paid work. Existing interventions to support return to work have shown mixed effectiveness, and their cost-effectiveness is often unknown. The STEPS work participation program, based on the Stages of Change, aims to support employed cancer survivors in work resumption and retention. This study evaluated its cost-effectiveness compared to usual care.

METHODS: An economic evaluation was conducted alongside a 12-month multi-center randomized controlled trial in the Netherlands. Employed cancer survivors were randomized to STEPS (n = 123) or usual care (n = 116). Quality-adjusted life years (QALYs) were estimated using the EQ-5D-5L questionnaire. Costs were assessed from a societal perspective. Analyses followed the intention-to-treat principle, were conducted using seemingly unrelated regression adjusted for baseline utility and costs, with uncertainty assessed using bootstrapping.

RESULTS: Participants in the STEPS group accrued marginally more QALYs than those receiving usual care (adjusted mean difference: 0.004; 95%CI: – 0.018 to 0.025), but this difference was neither statistically significant nor clinically relevant. Total societal costs were higher in the STEPS group than in usual care, with an adjusted mean difference of €2933 (95%CI: – €2735 to €8600). The probability of STEPS being cost-effective compared to usual care was 0.17 at a willingness-to-pay of €20,000/QALY, increasing only to 0.21 at €80,000/QALY. Sensitivity analyses confirmed these findings.

CONCLUSION: The STEPS program cannot be considered cost-effective compared to usual care and is therefore not recommended for implementation in its current form.

PMID:42474940 | DOI:10.1007/s10926-026-10416-5