Tag: pubmed

J Appl Physiol (1985). 2026 Apr 14. doi: 10.1152/japplphysiol.01212.2025. Online ahead of print.

ABSTRACT

Fractal dynamics characterize healthy human gait, with stride-interval fluctuations exhibiting long-range correlations generated by intrinsic locomotor control. These correlations diminish when gait is synchronized to an external metronome, often accompanied by curvature in detrended fluctuation analysis (DFA) scaling, but whether this reflects suppression of intrinsic structure or a scale-dependent reorganization of control remains unclear. Here, we identified a delayed-correction mechanism capable of reproducing the characteristic curvature of DFA scaling during metronome walking. We reanalyzed treadmill data from twelve healthy men (1.1 m/s, 20 min) under free walking (FW) and metronome walking (MW). Stride intervals were extracted from foot-switch measurements and evaluated using DFA. As expected, FW showed a near-linear DFA profile, whereas MW exhibited pronounced curvature, indicating reorganization of temporal structure across scales. To test the mechanism underlying this curvature, we constructed difference series from FW stride intervals and compared their DFA profiles with those of MW. Guided by simulation results predicting curvature emergence under delayed error correction, we systematically varied the differencing lag (j = 1-30). Both empirical and simulated analyses showed that MW-like curvature emerged when the current stride was corrected using information from approximately six earlier strides, with statistical analyses supporting an optimal range of 4-8 strides. These findings indicate that metronomic cueing does not simply eliminate fractal (long-range temporal) structure of gait but reorganizes gait dynamics through the superposition of two control processes: long-range fractal structure and a short-range, multi-stride delayed error correction loop.

PMID:41979889 | DOI:10.1152/japplphysiol.01212.2025

J Spinal Cord Med. 2026 Apr 14:1-10. doi: 10.1080/10790268.2026.2650949. Online ahead of print.

ABSTRACT

CONTEXT: Life satisfaction (LS) is associated with health and longevity but decreases after spinal cord injury (SCI). Yet, little is known about changes in LS over time, many years after SCI.

OBJECTIVES: To assess changes in LS over six years among older adults aging with long-term SCI, determine how changes in LS are associated with sex, age, injury characteristics, and with changes in secondary health conditions (SHCs), activity limitations, marital status and vocational situation.

DESIGN: Longitudinal cohort study from the Swedish Aging with Spinal Cord Injury Study (SASCIS).

SETTING: Community settings, Sweden.

PARTICIPANTS: Seventy-eight individuals (32% women), mean age 68 years, mean time since injury 31 years, injury levels C1-L3, AIS A-D.

OUTCOME MEASURES: The Life Satisfaction Questionnaire (LiSat-11), consisting of life as a whole and ten different life domains.

RESULTS: Over six years, there were no statistically significant changes in self-rated LS at the group level, but some variability at the individual level. To stop working was associated with increased LS, whereas none of the included variables were associated with decreased LS. A majority of the participants were dissatisfied with life as a whole and with five of the ten life domains, particularly with sexual life, somatic health, and self-care.

CONCLUSIONS: Our findings indicate stability in global and domain-specific LS over time in older adults aging with long-term SCI. Giving up work can be beneficial for LS in this population as they age. The low LS in several life domains calls for attention in the long-term follow-up after SCI.

PMID:41979885 | DOI:10.1080/10790268.2026.2650949

JAMA Netw Open. 2026 Apr 1;9(4):e264917. doi: 10.1001/jamanetworkopen.2026.4917.

ABSTRACT

IMPORTANCE: Medicaid beneficiaries-particularly those with mental health (MH) conditions, substance use disorder (SUD), and alcohol use disorder (AUD)-frequently use emergency departments (EDs). Timely primary care follow-up can reduce high 30-day ED revisit rates for these conditions; however, primary care follow-up after such ED visits remains understudied.

OBJECTIVE: To examine rates of 30-day condition-concordant primary care follow-up for MH, SUD, and AUD after ED visits related to these conditions and identify characteristics associated with condition-concordant primary care follow-up.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study retrospectively analyzed 2022 Medicaid claims data from beneficiaries residing in Washington State who had at least 1 ED visit during the study period. Data were analyzed between March and May 2025.

EXPOSURE: ED visits for MH conditions, SUDs, or AUD.

MAIN OUTCOMES AND MEASURES: The primary outcome was primary care follow-up for MH conditions or SUDs within 30 days following ED visits for those diagnoses (condition-concordant primary care follow-up), and the secondary outcome was condition-concordant primary care follow-up for AUD within the same time frame. Multivariable logistic regression with marginal effects was used to assess associations between beneficiary characteristics and probability of primary care follow-up.

RESULTS: This study included 859 043 Medicaid ED visit claims from 367 245 unique individuals in Washington (mean [SD] age, 41.7 [16.2] years); 496 775 claims (57.8%) were for women. Among the claims, 52 500 (6.1%) were for beneficiaries self-reporting as Alaska Native or American Indian, 48 103 (5.6%) as Asian or Pacific Islander, 89 548 (10.4%) as non-Hispanic Black, 476 968 (55.5%) as non-Hispanic White; and 173 996 (20.3%) as other race (17 928 [2.1%] did not provide or had missing information on race); 142 556 (16.6%) claims were for beneficiaries self-reporting as Hispanic and 678 961 (79.0%) as non-Hispanic (37 526 [4.4%] did not provide or had missing information on ethnicity). Condition-concordant primary care follow-up occurred after 18 722 of 131 704 MH condition- (14.2%), 11 353 of 101 684 SUD (11.2%)-, and 3675 of 33 196 AUD (11.1%)-related ED visits. All racial groups, and non-Hispanic White individuals in particular, had a higher probability of receiving condition-concordant primary care follow-up than non-Hispanic Black individuals (estimated marginal effects: MH, 4.47 [95% CI, 3.87-5.07] percentage points; SUD, 4.70 [95% CI, 4.12-5.27] percentage points; AUD, 4.00 [95% CI, 2.87-5.13] percentage points). Individuals experiencing homelessness had a significantly lower probability of receiving condition-concordant primary care follow-up (estimated marginal effects: MH, -2.74 [95% CI, -3.25 to -2.23] percentage points; SUD, -1.88 [95% CI, -2.33 to -1.44] percentage points; AUD, -1.86 [95% CI, 2.73 to -0.99] percentage points) compared with those not experiencing homelessness.

CONCLUSIONS AND RELEVANCE: In this cohort study of Medicaid beneficiaries in Washington, condition-concordant primary care follow-up after ED visits for MH conditions, SUDs, and AUD was infrequent. Observed racial and social differences suggest potential barriers to care access and coordination following ED visits. Tailored care coordination and outreach may be necessary to improve continuity of and access to primary care services among these populations.

PMID:41979881 | DOI:10.1001/jamanetworkopen.2026.4917

JAMA Netw Open. 2026 Apr 1;9(4):e264922. doi: 10.1001/jamanetworkopen.2026.4922.

ABSTRACT

IMPORTANCE: Extreme weather disasters leave behind long-lasting mental and physical health problems. Displacement related to climate change disproportionately impacts children, whose developmental stage leaves them particularly at risk to its devastating effects.

OBJECTIVE: To compare pediatric mental health needs and care for those in need between displaced households and other households.

DESIGN, SETTING, AND PARTICIPANTS: This repeated cross-sectional analysis with multivariable logistic regression models used data from the US Census Household Pulse Survey, a nationally representative dataset, from June 1, 2023, through September 31, 2024. The study included biweekly, individual-level data reported by individual adults for all members of their household.

EXPOSURE: Experience of displacement in the past year due to a natural disaster.

MAIN OUTCOMES AND MEASURES: Mental health needs were defined based on response to a question asking whether any children in the household needed mental health treatment, such as counseling or medication, in the past 4 weeks. Then the likelihood of receiving mental health treatment was examined for those who reported mental health needs.

RESULTS: Of the 324 466 households with children identified during the study period, 277 081 respondents (mean [SD) age, 42.7 [0.05) years; 162 288 [58.6%] female) were included in the analytic sample. This sample represents approximately 35 million US households with children. Among households with children, those that experienced displacement due to natural disaster had a significantly higher chance of reporting that the children needed mental health counseling or medication (odds ratio, 1.29; 95% CI, 1.12-1.48; P < .001). Among households with reported pediatric mental health needs, displaced households were more likely to report inadequate or no treatment, even after controlling for socioeconomic hardships (odds ratio, 0.55; 95% CI, 0.38-0.66; P < .001).

CONCLUSIONS AND RELEVANCE: The cross-sectional study found that displaced children experience more unmet mental health needs after natural disasters compared with nondisplaced children, which may negatively impact their long-term development. As climate change progresses, targeted research is urgently needed to understand how best to meet these needs.

PMID:41979880 | DOI:10.1001/jamanetworkopen.2026.4922

JAMA Netw Open. 2026 Apr 1;9(4):e266838. doi: 10.1001/jamanetworkopen.2026.6838.

ABSTRACT

IMPORTANCE: In 2023, the American Heart Association Cardiovascular-Kidney-Metabolic Scientific Advisory Group introduced the Predicting Risk of Cardiovascular Disease Events (PREVENT) equations, a race-free, sex-specific model for cardiovascular disease (CVD) risk prediction in adults aged 30 to 79 years. While initial validations showed strong performance, their reliability under missingness conditions remains unclear.

OBJECTIVE: To evaluate discrimination and calibration of the PREVENT equations in an electronic health record (EHR) cohort and assess robustness to missingness.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used Duke University Health System, a health network encompassing tertiary hospitals, regional hospitals, and primary care practices across North Carolina, EHR data from March 2014 to December 2024 with up to 8 years follow-up. Patients without baseline CVD with sufficient data to calculate PREVENT risk were included. Two cohorts were defined: a relaxed cohort, allowing for missing laboratory and vital sign data with race-sex median imputation, and a strict cohort, restricted to those with complete records. Data were analyzed from October 2024 to June 2025.

EXPOSURES: Published PREVENT equations alongside locally fitted Cox proportional hazards, discrete-time neural network, and recalibrated PREVENT models.

MAIN OUTCOMES AND MEASURES: The primary outcomes were estimated 5-year risk of incident CVD and assessed discrimination (C-index) and calibration (expected vs observed event rates) at 5 years by race, sex, and socioeconomic subgroups. The local adaptation via Duke retraining was compared with machine learning-based recalibration of PREVENT scores.

RESULTS: The study included 406 230 patients in the relaxed cohort (239 764 females with a mean [SD] age of 49 [20] years and 166 466 males with a mean [SD] age of 49 [20] years; 16 291 Asian [4.0%], 107 114 Black [26.4%], and 256 403 White [63.1%]) and 127 151 patients in the strict cohort (71 086 females with a mean [SD] age of 54 [13] years and 56 065 males with a mean [SD] age of 53 [12] years; 8210 Asian [6.5%], 29 033 Black [22.8%], and 83 515 White [65.7%]). PREVENT showed strong discrimination in both cohorts (C-index, 0.77 for both males and females in the strict cohort vs 0.75 for males and 0.77 for females in the relaxed cohort), indicating robustness to missing data. Calibration ratios were higher in the strict cohort, indicating more risk underestimation in the relaxed cohort. Local adaptations minimally affected discrimination and modestly improved calibration.

CONCLUSIONS AND RELEVANCE: In this cohort study, the PREVENT equations showed strong discrimination and generalizability, including with missing laboratory and vital sign data when imputation was applied, supporting reliable CVD risk identification and ranking in routine practice.

PMID:41979878 | DOI:10.1001/jamanetworkopen.2026.6838

JAMA Netw Open. 2026 Apr 1;9(4):e267024. doi: 10.1001/jamanetworkopen.2026.7024.

ABSTRACT

IMPORTANCE: Identification of health care access-related factors associated with lower rates of cancer screening may help inform targeted interventions to mitigate barriers and ameliorate screening disparities.

OBJECTIVE: To examine the multifaceted obstacles associated with screening for breast, cervical, colorectal, lung, and prostate cancer in a diverse population.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study included longitudinal data from the National Institutes of Health’s All of Us (AoU) Research Program (2017-2023). Nonincarcerated individuals aged 18 years or older residing in the US were eligible to participate by enrolling either online or through 1 of approximately 67 health care organizations. Identified participants within the AoU Research Program met US Preventive Services Task Force screening criteria for breast, colorectal, cervical, lung, or prostate cancer. Data were analyzed from October 2024 to January 2026.

MAIN OUTCOMES AND MEASURES: Participants self-reported whether 9 potential barriers delayed their medical care in the past year. Multivariable-adjusted odds ratios were estimated for the association between each barrier, the barrier burden, as well as for patterns of interrelated barriers identified using factor analysis and adherence to cancer screening recommendations.

RESULTS: In total, 160 691 participants were eligible for cancer screening including 42 908 participants in the breast (median age at last follow-up, 60 [IQR, 52-67] years; 100% female), 45 791 in the cervical (median age at last follow-up, 46 [IQR, 35-56] years; 100% female), 55 986 in the colorectal (median age at last follow-up, 66 [IQR, 57-73] years; 63% female), 3358 in the lung (median age at last follow-up, 66 [IQR, 59-72] years; 53% female), and 12 648 in the prostate cancer (median age at last follow-up, 63 [IQR, 59-66] years; 100% male) screening cohorts. Out-of-pocket costs, nervousness about seeing clinicians, and inability to get time off work were the most cited barriers. Participants reporting 3 or more barriers to care had significantly lower screening rates compared with those who reported no barriers for all cancer types, ranging from 18% (odds ratio [OR], 0.82; 95% CI, 0.76-0.88) for colorectal cancer to 32% (OR, 0.68; 95% CI, 0.46-0.97) for lung cancer. Three latent factors were consistently identified across cancer sites reflecting cost concerns, logistical barriers (eg, transportation), and competing obligations (eg, time off work). In multivariable analyses, cost concerns were associated with odds of screening for breast cancer (OR, 0.73; 95% CI, 0.66-0.80), cervical cancer (OR, 0.80; 95% CI, 0.73-0.87), and colorectal cancer (OR, 0.85; 95% CI, 0.77-0.94) and logistical barriers for breast cancer (OR, 0.75; 95% CI, 0.63-0.89), cervical cancer (OR, 0.78; 95% CI, 0.65- 0.93), and colorectal cancer (OR, 0.78; 95% CI, 0.65-0.94).

CONCLUSIONS AND RELEVANCE: In this cohort study of participants eligible for cancer screening, barriers to access and barriers related to cost concerns and logistics were associated with lower screening rates. Policies and interventions must target multiple dimensions of access simultaneously to increase cancer screening.

PMID:41979877 | DOI:10.1001/jamanetworkopen.2026.7024

Int J Surg Pathol. 2026 Apr 14:10668969261422683. doi: 10.1177/10668969261422683. Online ahead of print.

ABSTRACT

BackgroundPhyllodes tumors (PT) are fibroepithelial breast lesions with variable clinical behavior and histological features that frequently overlap with those of fibroadenomas. Accurate differentiation is critical, as PT may exhibit aggressive behavior. However, their distinction is particularly challenging in core needle biopsy, especially for benign and borderline PT, due to the limited amount of tissue provided by this technique. This meta-analysis investigates histological features that improve the distinction between fibroadenomas and PT in core needle biopsies.MethodsWe searched databases for studies comparing the core needle biopsy histologic features of lesions diagnosed as fibroadenoma or PT in the follow-up histopathological evaluation of the surgical specimen.ResultsWe included 14 studies, comprising 1413 patients. The PT group exhibited significantly higher rates of infiltrative margins (OR 6.06; 95% CI 2.13-17.22; P < .01), peri-epithelial stromal accentuation (OR 3.66; 95% CI 1.62-8.24; P < .01), stromal fragmentation (OR 6.93; 95% CI 2.66-18.04; P < .01), stromal overgrowth (OR 5.06; 95% CI 2.46-10.38; P < .01), cellular atypia (OR 9.04; 95% CI 5.15-15.89; P < .01), mitotic activity (OR 11.88; 95% CI 5.26-28.87; P < .01), and stromal hypercellularity (OR 9.67; 95% CI 5.58-16.78; P < .01). However, no statistically significant differences were found between the groups regarding the presence of adipose tissue within the lesion (OR 2.69; 95% CI 0.78-9.23; P = .12) or the presence of intracanalicular pattern (OR 1.02; 95% CI 0.55-1.92; P = .94). PTs were more frequent among older patients (MD 2.88; 95% CI 0.85-4.91; P < .01) and were larger (MD 1.07; 95% CI 0.79-1.35; P < .01).

PMID:41979873 | DOI:10.1177/10668969261422683

Drug Saf. 2026 Apr 14. doi: 10.1007/s40264-026-01673-7. Online ahead of print.

ABSTRACT

INTRODUCTION: Antipsychotic-associated sexual adverse drug reactions (ADRs) are well known in clinical practice, although efforts to understand differences between antipsychotics and distinct types of sexual ADRs are limited.

OBJECTIVE: The aim of this study was to assess and prioritize the profile of each antipsychotic regarding sexual ADRs reporting, and to account for potential confounders.

METHODS: We used VigiBase^® to conduct a case/non-case study using a customized clinically guided search strategy of antipsychotic-related sexual ADRs. The reporting odds ratio (ROR) and Bayesian information component (IC) with relevant 95% confidence intervals (95% CIs) were used as disproportionality measures to identify signals of disproportionate reporting (SDRs). Antipsychotics were compared with all other drugs and with thiazides (positive control). Sensitivity analyses included non-serious reports, excluding patients with potentially confounding co-medication(s), excluding adolescent and elderly patients, and including cases with co-reported hyperprolactinemia. Analyses were stratified by sex. Antipsychotics were ranked in terms of clinical priority using qualitative and quantitative criteria.

RESULTS: We included 5195 cases of antipsychotic-related sexual ADRs (43.1% serious, median time to onset of 61 days, 36.1% physician-reported). Several SDRs emerged in males (erectile dysfunction [3487 reports; ROR 2.49, 95% CI 2.40-2.57]; priapism [2372 reports; ROR 15.55, 95% CI 14.82-16.32]) and females (decreased libido [373 reports; ROR 1.61, 95% CI 1.46-1.79]) for all antipsychotic classes, except for muscarinic antagonists in females (ROR 0.64, 95% CI 0.55-0.73; IC – 0.65, 95% CI – 0.86 to – 0.45). In both sexes, the highest number of reports were for risperidone, aripiprazole and olanzapine. The SDRs disappeared in the sensitivity analysis including only non-serious cases and cases with co-reported hyperprolactinemia. Sexual ADRs for all antipsychotics were classified as of moderate priority, with the exception of fluspirilene (low priority).

CONCLUSIONS: Notwithstanding limitations, including inability to infer causality, these findings raise the hypothesis that sexual ADRs could be a class effect of antipsychotics, yet possibly reversible, in both women and men.

REGISTRATION: The protocol is registered to the Open Science Framework: https://osf.io/96eq7 .

PMID:41979819 | DOI:10.1007/s40264-026-01673-7

Psychon Bull Rev. 2026 Apr 14;33(4):137. doi: 10.3758/s13423-026-02875-x.

ABSTRACT

Novel strings of letters (i.e., pseudowords) lack established meaning(s), yet they may still evoke systematic, distributional signals that influence human behavior. Here, we tested whether distributional determinants of word memorability generalize to these novel strings. To do so, we leveraged a word-embedding model that was able to represent in a vector space not only attested words but also unmapped strings as bags of character n-grams. A ridge model trained on item-level word memorability norms learned a linear mapping from 300-dimensional embeddings to recognition memorability and achieved strong out-of-fold performance. We then applied this model zero-shot to predict memorability for 2,100 phonotactically legal pseudowords, whose baseline predictability was captured by orthographic and frequency features. Adding the zero-shot distributional score significantly improved the baseline model. These findings show that distributional representations derived from subword statistics carry mnemonic information that is not reducible to orthographic familiarity, and that novel strings are interpreted within a shared representational space learned from language experience. More broadly, they support the view that memorability is an intrinsic attribute predictable from representational information, even in the absence of learned meanings.

PMID:41979777 | DOI:10.3758/s13423-026-02875-x

Arch Osteoporos. 2026 Apr 14;21(1):67. doi: 10.1007/s11657-026-01699-5.

ABSTRACT

PURPOSE: This study aimed to reevaluate a simple radiographic measurement, the cortical thickness index (CTI), using standard plain radiographs to investigate its association with the presence of hip fracture in older persons.

METHODS: The study group (SG) consisted of 46 patients (35 females, 11 males) aged 65 years and older who presented to the emergency department with hip fractures. Two control groups were formed: One comprising 46 older persons aged 65 years and older (CG-G) and another of young adults aged 20-30 (CG-YA), both referred to the outpatient clinic and had available plain hip radiographs. CTI was measured for all participants by the first author. Additionally, two observers independently measured CTI to assess intraobserver and interobserver agreement.

RESULTS: Intraobserver and interobserver agreement was almost perfect based on Cohen’s kappa classification ( $\kappa$ > 0.8). The mean CTI for the SG was 0.389 ± 0.05, while the mean CTI for the CG-G was 0.571 ± 0.048, and for the CG-YA was 0.585 ± 0.048. A statistically significant difference was found between the SG and both CG-G and CG-YA groups (p < 0.001). No significant difference was observed between CG-G and CG-YA (p > 0.05). A CTI threshold of 0.485 demonstrated high discriminative ability for distinguishing older persons with hip fracture from those without fracture, yielding a sensitivity of 97.83% and a specificity of 95.65%.

CONCLUSION: CTI is significantly reduced in older persons with hip fracture. As a quick and accessible measurement on standard radiographs, CTI may assist clinicians in distinguishing individuals with hip fracture from those without fracture in outpatient settings.

PMID:41979765 | DOI:10.1007/s11657-026-01699-5