Tag: pubmed

Health Serv Res. 2026 Apr;61(2):e70112. doi: 10.1111/1475-6773.70112.

ABSTRACT

OBJECTIVE: To create and validate a measure of state-level, average daily Medicaid nursing home spending rates using publicly available data sources.

STUDY DESIGN: We created a new state-level measure of average daily Medicaid nursing home payment rates, calculating Medicaid spending per day divided by estimated Medicaid days. We compared this new measure to existing benchmarks in 2004 and 2019 and estimated correlations (Pearson and Spearman rank coefficients).

DATA SOURCES AND ANALYTIC SAMPLE: To create the new measure, we used data from Brown University’s Long-Term Care Focus website and the Medicaid Long-Term Services and Supports Annual Expenditure Report, covering nursing home spending and characteristics from most states.

PRINCIPLE FINDINGS: The measure of state-level average daily Medicaid nursing home spending demonstrated strong positive correlations with both historical data (Pearson [r] = 0.70, Spearman rank [ρ] = 0.80) and government-published estimates (r = 0.68, ρ = 0.63).

CONCLUSIONS: The new, validated measure offers a reliable and transparent method for comparing Medicaid nursing home payment rates across states using only publicly available data. Importantly, this approach enables timely, cross-state comparisons without the need for restricted or proprietary data, improving transparency and removing barriers to policy evaluation.

PMID:41937205 | DOI:10.1111/1475-6773.70112

Confl Health. 2026 Apr 5. doi: 10.1186/s13031-026-00789-y. Online ahead of print.

ABSTRACT

BACKGROUND: Civilians suffer greatly from mortality as a result of armed conflicts.The magnitude of family members’ deaths and their perceived causes in households in war-affected settings of Tigray region of Ethiopia has not been investigated.

METHODS: This study was part of a large integrated cross-sectional survey conducted in selected 13,915 households from 19 districts.The data analysis was done using STATA 17 versions software packages.We have fitted all the possible count regression models to discover the best fitted model. Log-likelihood, Akaike Information Criteria (AIC), and Bayesian Information Criteria (BIC) were also used to compare various candidate models. We found that the robust Poisson regression model better fits the mortality data. Adjusted Incidence Rate Ratio (AIRR) with 95% confidence intervals (CI) at P < 0.05 was used to establish the statistical significance in multivariable robust Poisson regression to assess the association between independent variables and the out come variable.

RESULTS: In this study, from the total 13,915 participants, 5% (n = 699) of them experienced civilian family members’ war-associated death.Households with a disabled member (AIRR = 2.46; 95%CI: 1.80, 3.39), displaced from home (AIRR = 0.60; 95%CI: 0.50, 0.74,five and more family size (AIRR = 1.09; 95%CI: 1.04-1.14) and widowed marital status (AIRR = 3.72; 95%CI: 2.89-4.81),, and semi-urban place of residence (AIRR = 0.49; 95CI: 0.30, 0.82) were associated with the outcome variable .

CONCLUSION: Civilian family members’ death report in this study is high. Large family size, widowed marital status, not displacing from home, having a disabled member of the family, and rural residences were the identified factors associated with civilian’s death. In the context of the cessation of hostilities following the Pretoria Peace Agreement, sustained efforts from the government, humanitarian organizations, and the international community are essential .

PMID:41937193 | DOI:10.1186/s13031-026-00789-y

Health Serv Res. 2026 Apr;61(2):e70111. doi: 10.1111/1475-6773.70111.

ABSTRACT

OBJECTIVE: To examine whether the November 2022 Massachusetts Dental Loss Ratio ballot initiative was associated with an increase in dental service prices.

DATA SOURCES AND ANALYTIC SAMPLE: We used quarterly price data from the Fluent DentaBase commercial claims dental database. Data was aggregated by state and quarter. We extracted data for Massachusetts and five comparison states: Connecticut, Maryland, New Jersey, New York, and Rhode Island from Quarter 1, 2022 through Quarter 2, 2025.

STUDY DESIGN: To account for the small number of states in our study, we used a pre-intervention unit-demeaning difference-in-differences estimator. We estimated cross-sectional regressions to estimate the average treatment effect on the treated over the entire post-intervention period after Quarter 4, 2022 and quarter-specific treatment effects. Exact inference was used to ascertain statistical significance of policy effects.

PRINCIPAL FINDINGS: Allowed prices for dental procedures increased 5.2% (95% CI: 2.3%-8.0%), and the insurer discount applied to submitted charges declined 2.8 percentage points (95% CI: -5.3 to -0.19 percentage points) relative to the comparison states.

CONCLUSIONS: Prior to full implementation of the dental loss ratio requirement in 2025, dental insurers in Massachusetts increased reimbursement to dentists to possibly meet the required dental loss ratio threshold.

PMID:41937189 | DOI:10.1111/1475-6773.70111

BMC Health Serv Res. 2026 Apr 6. doi: 10.1186/s12913-026-14470-w. Online ahead of print.

ABSTRACT

BACKGROUND: Strengthening health systems to accommodate the growing need for palliative care is a global priority. Currently, one in eight older adults in India requires palliative care with complex healthcare needs. The interaction of older adults with these needs with public and private healthcare providers is unknown. This study aims to determine the patterns of public and private healthcare utilisation and their disparities among older adults with palliative care needs.

METHODOLOGY: A cross-sectional study design was employed using the Wave-1 data of the LASI. Using the SPICT-LIS, 2903 older adults with palliative care needs were identified for the analysis. The primary outcome variable, i.e. the utilisation of the type of health facilities for outpatient visits and hospitalisation, was summarised as descriptive statistics. The Chi-square and Kruskal-Wallis tests were employed to identify the association between background characteristics and the utilisation of different facilities. Additionally, multivariate logistic regression (Odds Ratio) was performed to determine the factors associated with utilisation of private facilities.

RESULTS: The utilisation of private facilities (60.3%) was higher than that of public facilities (23%) and other facilities (16.6%) for outpatient care. Similarly, hospitalisation in private health facilities was the highest (58.3%), followed by public (39.7%) and other facilities (1.9%). Disparities in the utilisation of private facilities based on wealth status, caste, food insecurities and geographical regions were observed for both outpatient care and hospitalisation. A higher level of satisfaction with private facilities compared to public health facilities was observed in terms of waiting time, being treated respectfully, providing clear explanations, maintaining privacy during conversations, and cleanliness.

CONCLUSION: Older adults with palliative care needs used private healthcare facilities significantly more than public ones for outpatient care and hospitalisation. Their use of private facilities was also linked to disparities based on socio-economic status. Addressing gaps in public health service provisions is crucial to achieving universal health coverage for older adults with palliative care needs. Public-private partnerships, social welfare schemes, and expanded health insurance could help reduce these disparities.

PMID:41937173 | DOI:10.1186/s12913-026-14470-w

BMC Med. 2026 Apr 6. doi: 10.1186/s12916-026-04841-9. Online ahead of print.

ABSTRACT

BACKGROUND: Evidence regarding a preventive impact of antiviral medication for influenza on hospitalization or mortality among non-severe cases is scarce. The objective of this study was to assess the association between the use of antiviral medications in non-hospitalized patients with influenza and their subsequent hospitalization and mortality.

METHODS: This multi-center retrospective cohort study used TriNetX, a global database to assess the clinical impact of antiviral medications (oseltamivir, laninamivir, zanamivir, peramivir, and baloxavir) for influenza among non-hospitalized patients. The outcomes included hospitalization, emergency department visit, intensive care unit (ICU) admission, and mortality between 3 and 30 days following influenza diagnosis with the 2-day window period between diagnosis and antiviral administration. Propensity score matching with a 1:1 ratio was conducted to estimate the risk ratio (RR).

RESULTS: A total of 1,016,581 patients with influenza were identified. After matching, 426,275 patients from each cohort were compared. The antiviral-treated group was associated with lower risks of hospitalization (RR 0.91; 95% confidence interval 0.85-0.95; p < 0.001); emergency department visits (RR 0.80; 95% CI 0.79-0.82; p < 0.001), ICU admission (RR 0.84; 95% CI 0.73-0.97; p = 0.016); and mortality (RR 0.60; 95% CI 0.47-0.77; p < 0.001). The sensitivity analysis revealed that the statistical significance in hospitalization was maintained by replacing the 2-day window period with 0 days (RR 0.82; 95% CI 0.79-0.84; p < 0.001). The sensitivity analysis limited to those aged 2 to 64 years without any high-risk comorbidities in the antiviral-treated group compared to the antiviral-untreated group showed fewer outcome events for hospitalization (RR 0.76; 95% CI 0.68-0.85; p < 0.001); ED visit (RR 0.68; 95% CI 0.65-0.71; p < 0.001); and ICU admission (RR 0.48; 95% CI 0.30-0.78; p = 0.002).

CONCLUSIONS: Antiviral treatment was negatively associated with hospitalization, ICU admission, and mortality. The results need to be interpreted with caution, given limitations.

PMID:41937170 | DOI:10.1186/s12916-026-04841-9

J Eat Disord. 2026 Apr 5. doi: 10.1186/s40337-026-01598-7. Online ahead of print.

ABSTRACT

BACKGROUND: Anorexia nervosa (AN) is a severe psychiatric disorder with high chronicity, particularly affecting adolescents. Existing treatments for adolescents do not always lead to full recovery. Recently, the developmentally adapted Maudsley Model of Anorexia Nervosa Treatment for Adolescents (MANTRa) has emerged as a promising alternative, warranting investigation into its outcome predictors.

METHODS: This secondary analysis is based on data from a multi-center cohort study conducted in several Austrian clinical settings. The study included 92 participants aged 13-21 years diagnosed with AN who received MANTRa (n = 45) or treatment-as-usual (TAU, n = 47). Statistical analyses focused on identifying baseline predictors and moderators of treatment success (change in eating disorder symptomatology) for the MANTRa and TAU groups at end-of-treatment and 18-month-follow-up. In addition to univariate linear regression models associating various predictor variables (BMI, eating disorder severity, depressive symptoms, weight suppression, illness duration, age of onset, motivation for change, and personality traits) with the long-term eating disorder outcome, we used a cluster analysis approach to categorize patients into high vs. low illness severity and “favorable” vs. “unfavorable” treatment motivation/personality profiles. Differences between clusters regarding treatment outcome were explored further.

RESULTS: In the MANTRa group, none of the examined baseline variables significantly predicted outcomes at 18-month follow-up in univariate models. In contrast, in the TAU group, higher initial eating-disorder psychopathology and lower motivation were associated with poorer outcomes. In MANTRa, there was a trend suggesting that patients with both high and low baseline illness severity, as well as those with unfavorable and favorable motivation/personality profiles, demonstrated sustained symptom reduction. By contrast, in the TAU group, sustained improvements were observed primarily among patients with low baseline illness severity and a favorable motivation/personality profile, whereas those with high illness severity and an unfavorable profile tended to show less benefit.

CONCLUSIONS: These results provide preliminary evidence for MANTRa as an effective, individualized treatment for adolescents with AN, including those exhibiting severe pathology, low baseline motivation and personality traits, e.g. low self-directedness, high harm avoidance and low cooperativeness. Future randomized controlled trials comparing MANTRa with established treatments are warranted to validate these findings and refine patient selection criteria.

TRIAL REGISTRATION: The original trial was registered at clinicaltrials.gov (Identifier NCT03535714).

PMID:41937155 | DOI:10.1186/s40337-026-01598-7

BMC Med. 2026 Apr 6. doi: 10.1186/s12916-026-04829-5. Online ahead of print.

ABSTRACT

BACKGROUND: Sarcopenia, the age-related loss of skeletal muscle mass and function, has been linked to adverse health outcomes. Cross-sectional associations have been observed between skeletal and cardiac muscle mass and function in healthy, community-dwelling older adults during normative aging. Further longitudinal studies on the skeletal muscle-cardiac axis during aging are needed to inform the temporal patterns and impact of these associations.

METHODS: We analyzed data from participants from the Baltimore Longitudinal Study of Aging. Individual longitudinal rates of change (random slopes) of echocardiography-derived cardiac function, appendicular lean mass (ALM), and maximal handgrip strength (HGS) were estimated with linear mixed-effects models. The associations between baseline measurements and rates of change (_Change) were examined using Pearson correlation and multiple linear regression. Continuous variables are expressed as mean ± standard deviation (SD).

RESULTS: Among 1025 participants (66.6 ± 13.1 years, 47.8% male), the baseline mean HGS was 33.1 ± 11.0 kg, and ALM was 20.8 ± 5.3 kg; the mean left ventricular ejection fraction was 67.5 ± 9.7%, and LV mass (LVM) was 145.6 ± 50.4 g. With aging, HGS decreased by 0.36 kg/year (95% CI: -0.41, -0.31), ALM decreased by 25.1 g/year (95% CI: -34.7, -15.5), and LVM decreased by 0.730 g/year (95% CI: -0.998, -0.460). Both ALM_Change and HGS_Change were inversely correlated with advancing age ([r = -0.159 p < 0.001] and [r = -0.172 p < 0.001], respectively), while LVM_Change was not (p = 0.178). Adjusting for baseline, ALM_Change was significantly associated with LVM_Change independently of age, sex, and LVM (β = 0.287, p < 0.001, adj. R² = 0.663); the association persisted after adjustment for pulse pressure, mean arterial pressure, and body mass index. The interaction term sex*baseline-adjusted ALM_Change was statistically significant (p < 0.050). ALM_Change was also correlated with LVEF_Change (r = 0.102, p = 0.001), while HGS_Change was not significantly correlated with LVM_Change (p = 0.642).

CONCLUSIONS: Among community-dwelling normative aging adults, age-associated decline in skeletal muscle mass correlated with reductions in LVM and function, independently of age, sex, and hemodynamic loading conditions. Our findings suggest a skeletal muscle-cardiac axis characterized by parallel declines beginning in early aging, preceding cardiovascular disease. Further studies exploring cardiac and skeletal muscle aging-related declines may direct interventions to halt these adverse processes concurrently.

PMID:41937125 | DOI:10.1186/s12916-026-04829-5

Biomed Chromatogr. 2026 May;40(5):e70441. doi: 10.1002/bmc.70441.

ABSTRACT

American ginseng (Panax quinquefolium L.) is a traditional Chinese medicinal herb that has been used in China for hundreds of years. The significant hypoglycemic activity of American ginseng has made it widely used in health food as a valuable medicinal herb with homologous origin. However, its effect and mechanism of improving insulin resistance (IR) remain unclear. In the present study, an IR-HepG2 cells model induced by high concentrations of insulin was constructed and treated with ethanol extract of dried American ginseng (EDAG) at different concentrations to reveal the in vitro ameliorative effect of EDAG on IR by monitoring glucose consumption, glycogen content, triglyceride (TG) content, and total cholesterol (TC) content of the cells. The cell metabolite changes were tracked by liquid chromatography-mass spectrometry (LC-MS)-based metabolomics combined with multivariate statistical analysis, the metabolic biomarkers and related metabolic pathways were analyzed, and further elucidate its mechanism of action. The results showed that treatment with EDAG increased glucose consumption and glycogen content, and decreased intracellular TC and TG content in IR-HepG2 cells to different degrees. The results of cell metabolomics indicated that EDAG treatment reversed metabolic disorders by regulating sphingolipid metabolism, linoleic acid metabolism, and arginine and proline metabolism, etc. The present study explored the in vitro IR improvement mechanism of EDAG based on the LC-MS cell metabolomics approach, which confirms the great potential of LC-MS technology in the evaluation of drug efficacy and can be an effective tool for the related analysis of other Chinese herbal medicines.

PMID:41937114 | DOI:10.1002/bmc.70441

J Dairy Sci. 2026 Apr 3:S0022-0302(26)00309-7. doi: 10.3168/jds.2025-27865. Online ahead of print.

ABSTRACT

The study aimed to determine whether ADG of Holstein heifers at various stages of rearing affects 1st and 2nd lactation performance. Data on BW of heifers were obtained from 3 independent dairy operators (operator A, B and C) and used to calculate ADG from birth until weaning (all operators), from weaning until 180 d of age (all operators), from 180 until 360 d of age (operator A and C), and from 360 until 410 d of age (operator A). Data sets included: 1583 records for the 1st and 1290 records for the 2nd lactation for operator A; 886 records for the 1st and 664 records the 2nd lactation for operator B; and 1190 records for the 1st and 675 records for the 2nd lactation for operator C. Subsequently, BW records were used to calculate ADG for each phase of rearing and used in a 2-step data analysis. In the first step, ADG was regressed against the 1st and 2nd 305-d lactation milk yield, 1st and 2nd 305-d lactation protein yield and 1st and 2nd 305-d lactation fat yield to test for a linear and quadratic relationship between those variables. In the second step, a statistical model was built which evaluated linear and quadratic impact of ADG, year and season of birth, year and season of calving, calving age, and dam parity (primi- or multiparous) on 1st and 2nd 305-d lactation milk, protein and fat yield. In both steps of analysis, pedigree data were used to correct phenotypic values for genetic effect. With increasing ADG preweaning (step 1), the 305-d milk yield in 1st lactation increased linearly for operator A and C but not for operator B, whereas 305-d milk yield in the 2nd lactation increased quadratically for operator A, linearly for operator C but no association was found for operator B. With increasing ADG from weaning until 180 d of age, the 305-d milk yield in 1st lactation increased linearly for all 3 operators, but the 305-d milk yield in 2nd lactation increased linearly for operator B and C, but not for operator A. With increasing ADG from 180 until 360 d of age, the 305-d milk yield in the 1st lactation decreased linearly for operator A but no association was found for operator C. With increasing ADG from 360 until 410 d of age (operator A), the 305-d milk yield in the 1st lactation decreased linearly. When other effects were included in the statistical model (step 2), the association of ADG with 305-d milk yield in the 1st and 2nd lactation found in step 1 of analysis oftentimes changed. This include direction or shape of the relationship, or its significance. Although some associations remained statistically significant, large variability around estimates suggests a substantial influence of unaccounted effects. Moreover, while with increasing ADG the 305-d milk yield increased, milk component yield in some instances decreased, or no association could be found. In summary, the relationship between ADG of heifers at different stages of growth and future milk and milk component yield differed substantially between operators, being either linear (both positive and negative), curvilinear or not significant, which makes clear conclusions difficult.

PMID:41937081 | DOI:10.3168/jds.2025-27865

J Dairy Sci. 2026 Apr 3:S0022-0302(26)00315-2. doi: 10.3168/jds.2025-28004. Online ahead of print.

ABSTRACT

Yogurt is a commonly consumed nutritious and healthy food and is an excellent carrier of prebiotics and probiotics. However, the survival of probiotics in the gut with the presence of gastric and intestinal juices and bile fluid is the main challenge. Hence, the yogurt formulation must be modified to resist the unhospitable environment of the gut and assist the probiotics in their survival. One strategy to overcome this limitation is the incorporation of prebiotics into probiotics containing yogurt. Prebiotics are mostly non-digestible food ingredients that assist in the survival, proliferation, and activity of beneficial microorganisms in the gut. Supplementation of yogurt with hemp seed protein concentrate (HP) and carrot powder (CP) as prebiotics may give sufficient protection to probiotics to survive in the human gut. We investigated the viability of probiotics in goat milk yogurt that was supplemented with plant-based prebiotics during 28-d storage at 4°C and in vitro simulated gastrointestinal transit. The basic mix for the yogurts had 82.85% milk, 10.68% powdered goat milk, and 6.47% sugar. Additionally, the mix was supplemented with CP (0.6%, T1), HP (2.5%, T2), and a combination of 0.6% CP and 2.5% HP (T3). A control (T0) yogurt without plant-based ingredients was also prepared. The mix was heated to 80°C for 30 min, cooled, and then inoculated with 2% of activated starter culture (YF-L812) and 2 probiotics (3% Bifidobacterium animalis BB-12 and 3% Lactobacillus acidophilus LA-5; Chr Hansen). Then the mixes were incubated at 43°C until the pH reached 4.4 to 4.6. The effects of plant-based prebiotics and probiotics on physicochemical properties such as composition, pH, acidity, water-holding capacity (WHC), and microbial counts of yogurts were studied. The addition of prebiotics and probiotics did not have any negative impact on the composition, WHC, lipid oxidation, firmness, antioxidant activity, and total phenolic content of yogurts. The presence of HP in yogurts significantly increased the viability of L. acidophilus LA-5 (LA) during storage. The prebiotics in yogurts did not affect (P > 0.05) the viability of Bifidobacterium animalis BB-12 (BB-12) during storage. The HP containing treatments in the presence of 0.3% bile salts positively affected the viability of Bifidobacteria in vitro simulated transit time and their counts exceeded 6 log cfu/g, which is the minimum required number for health benefits. The counts of LA in the HP containing treatments with 0.3% bile salts was one log lower than the threshold minimum.

PMID:41937079 | DOI:10.3168/jds.2025-28004