Tag: pubmed

JAMA Psychiatry. 2025 Apr 2. doi: 10.1001/jamapsychiatry.2025.0318. Online ahead of print.

ABSTRACT

IMPORTANCE: Traumatic brain injury is common and occurs across all ages. Observational studies have shown that traumatic brain injury is associated with a wide range of mental disorders and suicide. Whether these associations represent a causal effect is, however, difficult to establish, and confounding by genetic liability for mental disorder may play a substantial role.

OBJECTIVE: To investigate whether observational associations between traumatic brain injury and mental disorder or suicide could be confounded by genetic liability for mental disorder.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study was conducted from October 2023 to January 2025. The study population consisted of the general population subcohort of the Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH) sample, which is a representative sample of the Danish population born between 1981 and 2008 that has been genotyped.

EXPOSURES: Polygenic risk scores (PRSs) for schizophrenia, bipolar disorder, depression, and attention-deficit/hyperactivity disorder (ADHD) calculated from the genotypes and genome-wide association summary statistics.

MAIN OUTCOMES AND MEASURES: The primary outcome was traumatic brain injury, operationalized via hospital diagnoses. The associations between PRSs for schizophrenia, bipolar disorder, depression, and ADHD, respectively, and traumatic brain injury were examined via Cox proportional hazards regression, yielding hazard rate ratios (HRRs) with 95% confidence intervals.

RESULTS: The final cohort consisted of a total of 40 274 individuals, of whom 19 802 (49.2%) were female. A total of 3341 (8.3%) of the cohort members (of whom 1464 [43.8%] were female and 1877 [56.2%] were male) experienced traumatic brain injury during follow-up. All 4 PRSs showed statistically significant positive associations with traumatic brain injury (PRS-schizophrenia: HRR, 1.06; 95% CI, 1.02-1.10; P = .002; PRS-bipolar disorder: HRR, 1.04; 95% CI, 1.00-1.08; P = .04; PRS-depression: HRR, 1.10; 95% CI, 1.06-1.14; P < .001; and PRS-ADHD: HRR, 1.12; 95% CI, 1.08-1.16; P < .001).

CONCLUSIONS AND RELEVANCE: The results of this cohort study suggest that confounding by genetic liability for mental disorder could explain some of the association between traumatic brain injury and mental disorder or suicide. Consequently, genetic liability for mental disorder should be factored into future studies of these associations to avoid overestimation of causality.

PMID:40172901 | DOI:10.1001/jamapsychiatry.2025.0318

JAMA Netw Open. 2025 Apr 1;8(4):e252875. doi: 10.1001/jamanetworkopen.2025.2875.

ABSTRACT

IMPORTANCE: The use of nurse overtime and agency nurses has increased in recent years, making it important to understand the opportunities and limits of these alternative staffing strategies on patient safety outcomes.

OBJECTIVE: To examine the association between overtime and agency nurse staffing hours and hospital patient safety.

DESIGN, SETTING, AND PARTICIPANTS: This quality improvement study used data from 70 US hospitals, from January 2019 through December 2022. Participants included patients and nurse staff across the 70 hospitals.

EXPOSURE: The use of overtime and agency nursing.

MAIN OUTCOMES AND MEASURES: The main outcomes were 10 of the US Agency for Healthcare Research and Quality’s patient safety indicators and their associations with regular, overtime, and agency nursing hours per patient day: pressure ulcers, iatrogenic pneumothorax, in-hospital fall with hip fracture, perioperative hemorrhage or hematoma, postoperative acute kidney injury requiring dialysis, postoperative respiratory failure, perioperative thromboembolism, postoperative sepsis, postoperative wound dehiscence, and accidental puncture or laceration. A baseline Poisson regression model and a structural breakpoint analysis were used to identify safety thresholds. Pairwise interactions between staffing intensity variables and hospital bed size were also included. Adjustments were made for the COVID-19 hospital census, patient case mix, and hospital characteristics.

RESULTS: The sample included 46 hospitals in the South, 20 in the West, and 4 in the Northeast; 48 hospitals were urban, 32 hospitals had fewer than 200 beds, 26 had between 200 and 399 beds, and 12 had 400 or more beds. The average use of nurse overtime and agency nurse hours exceeded safe thresholds for pressure ulcers by 140.0% for agency staffing and by 63.6% for overtime, representing a 6.44% increase associated with excess agency nurse hours and a 2.09% increase for excess use of overtime. There also was a statistically significant association of agency hours with postsurgery hemorrhage or hematoma rates, but no breakpoint threshold. There were no significant associations with other outcomes.

CONCLUSIONS AND RELEVANCE: These findings suggest that both nurse overtime and nurse agency hours are associated with increased rates of pressure ulcers, a measure that is one of the most sensitive to nursing care. In future research, hospitals could use their own data to track safe thresholds.

PMID:40172888 | DOI:10.1001/jamanetworkopen.2025.2875

JAMA Netw Open. 2025 Apr 1;8(4):e253018. doi: 10.1001/jamanetworkopen.2025.3018.

ABSTRACT

IMPORTANCE: As more than 50% of Medicare beneficiaries are enrolled in Medicare Advantage (MA), understanding whether the treatment covered by MA vs traditional Medicare (TM) is comparable can aid in providing high-value care. As the majority of patients with cancer undergo radiotherapy, it is important to quantify TM and MA utilization in oncology.

OBJECTIVE: To analyze the primary type of radiotherapy technology used, treatment length, and estimated spending for MA patients with cancer undergoing radiotherapy compared with TM patients with cancer.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional study used 2018 Medicare claims data for TM and MA patients aged 65 years or older who received radiotherapy for 1 of 15 cancer types. Analyses were performed between May 1 and December 28, 2024.

EXPOSURES: Insurance type (MA vs TM), cancer type, age, dual-eligibility status, medical comorbidities, county, and radiotherapy center type.

MAIN OUTCOMES AND MEASURES: Primary type of radiotherapy technology used, treatment length, and estimated spending for 90-day radiotherapy episodes. Adjusted rates and odds ratios (ORs) were calculated to compare technology types and rate ratios (RRs) to compare treatment length and estimated spending between TM and MA episodes.

RESULTS: Of 31 563 treatment episodes among 30 941 patients, 22 594 (71.58%) were covered by TM (mean [SD] age, 74.76 [6.57] years; 50.76% among males) and 8969 (28.42%) were covered by MA (mean [SD] age, 74.51 [6.24] years; 51.78% among males). For radiotherapy episodes in patients with MA, adjusted analyses revealed lower odds of proton therapy use (52 [0.58% (95% CI, 0.34%-0.82%)] vs 373 [1.65% (95% CI, 1.50%-1.80%)]; OR, 0.36 [95% CI, 0.27-0.48]) and stereotactic radiotherapy use (1235 [13.77% (95% CI, 13.13%-14.41%)] vs 3391 [15.01% (95% CI, 14.61%-15.41%)]; OR, 0.87 [95% CI, 0.81-0.95]), higher odds of 2- or 3-dimensional radiotherapy use (3962 [44.17% (95% CI, 43.39%-44.96%)] vs 9584 [42.43% (95% CI, 41.93%-42.92%)]; OR, 1.13 [95% CI, 1.06-1.21]), greater mean treatment length (21.38 [95% CI, 21.14-21.61] vs 19.48 [95% CI, 19.33-19.62] treatments; RR, 1.10 [95% CI, 1.08-1.11]), and higher estimated radiotherapy spending ($8677.56 [95% CI, $8566.58-$8788.54] vs $8393.20 [95% CI, $8323.34-$8463.05]; RR, 1.04 [95% CI, 1.02-1.06]) compared with episodes in patients with TM.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, MA patients with cancer undergoing radiotherapy had higher estimated spending and greater mean treatment length than those covered by TM. Despite lower utilization of more expensive advanced treatment modalities, MA was not associated with cost savings. Whether MA meets the value proposition for radiation oncology requires further investigation.

PMID:40172887 | DOI:10.1001/jamanetworkopen.2025.3018

JAMA Netw Open. 2025 Apr 1;8(4):e254121. doi: 10.1001/jamanetworkopen.2025.4121.

ABSTRACT

IMPORTANCE: Ozone (O3) is the most frequently exceeded air pollutant standard in the US. While short-term exposure is associated with acute respiratory health, the epidemiologic evidence linking postnatal O3 exposure to childhood asthma and wheeze is inconsistent and rarely evaluated as a mixture with other air pollutants.

OBJECTIVES: To determine associations between ambient O3 and subsequent asthma and wheeze outcomes both independently and in mixture with fine particulate matter and nitrogen dioxide in regions with low annual O3 concentrations.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study consisted of a pooled, multisite analysis across 6 US cities using data from the prospective ECHO-PATHWAYS consortium (2007-2023). Included children had complete airway surveys, complete address histories from age 0 to 2 years, and a full term birth (≥37 weeks). Logistic regression and bayesian kernel machine regression (BKMR) mixture analyses were adjusted for child anthropomorphic, socioeconomic, and neighborhood factors.

EXPOSURES: Exposure to ambient O3 in the first 2 years of life derived from a validated point-based spatiotemporal model using residential address histories.

MAIN OUTCOMES AND MEASURES: The primary outcome was asthma and wheeze at ages 4 to 6 years; the secondary outcome was asthma and wheeze at ages 8 to 9 years. Outcomes were based on caregiver reports derived from a validated survey.

RESULTS: The analytic sample of 1188 participants had a mean (SD) age of 4.5 (0.6) years at the age 4 to 6 years visit and consisted of 614 female participants (51.7%) and 663 mothers who had a bachelor’s degree or higher (55.8%). The mean (SD) O3 concentration was 26.1 (2.9) parts per billion (ppb). At age 4 to 6 years, 148 children had current asthma (12.3%) and 190 had current wheeze (15.8%). The odds ratio per 2 ppb higher O3 concentration was 1.31 (95% CI, 1.02-1.68) for current asthma and 1.30 (95% CI, 1.05-1.64) for current wheeze at age 4 to 6 years; null associations were observed for outcomes at age 8 to 9 years, and for sensitivity covariate adjustment. BKMR suggested that higher exposure to O3 in mixture was associated with current asthma and wheeze in early childhood.

CONCLUSIONS AND RELEVANCE: In this cohort study with relatively low ambient O3 exposure, early-life O3 was associated with asthma and wheeze outcomes at age 4 to 6 years and in mixture with other air pollutants but not at age 8 to 9 years. Regulating and reducing exposure to ambient O3 may help reduce the significant public health burden of asthma among US children.

PMID:40172886 | DOI:10.1001/jamanetworkopen.2025.4121

JAMA Netw Open. 2025 Apr 1;8(4):e255235. doi: 10.1001/jamanetworkopen.2025.5235.

ABSTRACT

IMPORTANCE: Uterine fibroids are benign tumors that can cause severe symptoms. Fibroid burden among Asian or Pacific Islander individuals, particularly in specific subgroups, remains largely unexamined.

OBJECTIVE: To describe fibroid diagnosis rates by race and ethnicity.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study (January 2009 to December 2022) used data from electronic health records of the Kaiser Permanente Northern California (KPNC) integrated health care system. Eligible participants included female (sex assigned at birth) KPNC members aged 18 to 54 years with at least 12 months of continuous membership, no prior fibroid diagnosis, and no history of hysterectomy. Data were analyzed January to September 2024.

EXPOSURE: Race and ethnicity was categorized into 9 groups: Black (African American, other Black [ie, any Black race or ethnicity not otherwise specified], and unknown Black race or ethnicity), East Asian (Chinese, Japanese, and Korean), Hispanic (Hispanic or Latino), South Asian (Asian Indian, Bangladeshi, East Indian, Nepali, Sri Lankan, and any South Asian ethnicity not otherwise specified), Southeast Asian (Filipino, Vietnamese, and other Southeast Asian [ie, any Southeast Asian ethnicity not otherwise specified]), White (White or White Middle Eastern), other Asian or Pacific Islander (Native Hawaiian or Pacific Islander, multiethnic Asian, and other or unspecified Asian ethnicity [ie, any Asian ethnicity not otherwise specified]), other races and ethnicities (American Indian or Alaska Native and multiracial), and unknown race or ethnicity.

MAIN OUTCOMES AND MEASURES: Incident fibroid diagnosis was identified using diagnostic codes. Poisson regression models were used to calculate incidence rates of fibroid diagnosis by racial and ethnic group, standardized to the 2022 US female population. Incidence rate ratios (IRRs) and 95% CIs compared incidence within each racial and ethnic group with White participants.

RESULTS: A total of 1 917 794 patients were included (median [IQR] percentage, 7% [6%-7%] Black; 5% [5%-6%] East Asian; 22% [21%-23%] Hispanic; 3% [2%-3%] South Asian; 7% [7%-8%] Southeast Asian; 42% [39%-45%] White; 8% [6%-10%] other Asian or Pacific Islander; 2% [2%-2%] of other races and ethnicities; 4% [4%-5%] unknown or missing race and ethnicity), and 84 206 patients (4.4%) received a first fibroid diagnosis during the study period. Compared with White patients, there was a higher rate of fibroid diagnosis among Southeast Asian (IRR, 1.29; 95% CI, 1.26-1.33), East Asian (IRR, 1.47; 95% CI, 1.43-1.51), and South Asian patients (IRR, 1.71; 95% CI, 1.65-1.78). Black (IRR, 3.11; 95% CI, 3.05-3.17) and Hispanic patients (IRR, 1.37; 95% CI, 1.34-1.39) also had elevated rates of fibroid diagnosis. All Asian patients were less likely than other groups to have ICD-9 or ICD-10 coded symptoms before diagnosis.

CONCLUSIONS AND RELEVANCE: In this cohort study of nearly 2 million KPNC patients, South Asian, East Asian, Southeast Asian, Hispanic, and Black patients had higher fibroid diagnosis rates than White patients. If diagnosis rates reflect true variation in disease prevalence, future research should identify sources of these disparities and strategies to reduce them.

PMID:40172885 | DOI:10.1001/jamanetworkopen.2025.5235

JAMA Cardiol. 2025 Apr 2. doi: 10.1001/jamacardio.2025.0328. Online ahead of print.

ABSTRACT

IMPORTANCE: The impact of hypertensive disorders of pregnancy on developing dilated cardiomyopathy is unknown.

OBJECTIVE: To determine whether hypertensive disorders of pregnancy are associated with long-term risk of dilated cardiomyopathy.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study performed in England used the following linked electronic health records databases: Clinical Practice Research Datalink (CPRD) Pregnancy Register, CPRD Aurum (primary care), Hospital Episode Statistics Admitted Patient Care, and Office for National Statistics mortality data. Participants included an exposed cohort of 14 083 patients in their first pregnancy with hypertensive disorders of pregnancy (index date observed: January 1997 to December 2018; followed up until July 2023) and unexposed cohort of 70 415 with normotensive pregnancies randomly sampled from the Pregnancy Register (5:1 ratio).

EXPOSURE: Hypertensive disorder of pregnancy (preeclampsia, gestational hypertension).

MAIN OUTCOMES AND MEASURES: Cox proportional hazards models were fitted to estimate hazard ratios (HRs) of developing dilated cardiomyopathy.

RESULTS: The cohort included 14 083 individuals with a hypertensive disease of pregnancy during their first pregnancy and 70 415 individuals with normotensive first pregnancies. A first-time pregnancy complicated by a hypertensive disorder of pregnancy, compared with a normotensive first-time pregnancy, was associated with a 93% higher risk of developing dilated cardiomyopathy (adjusted HR, 1.93 [95% CI, 1.33-2.81]; P = .001; adjusted for maternal age). Dilated cardiomyopathy developed a median (IQR) of 5.1 (0.7-10.6) years post partum in those with HDP and 10.6 (4.2-15.8) years post partum in those with normotensive first pregnancies. The association remained significant after adjusting for maternal age, birth year, gestational diabetes, postpregnancy diabetes, postpregnancy hypertension, total parity, ethnicity, and socioeconomic status (adjusted HR, 1.55 [95% CI, 1.04-2.31]; P = .03). There was a dose response; there was a higher risk of DCM in those with preeclampsia (adjusted HR, 1.85 [95% CI, 1.24-2.76]; P = .002) and severe preeclampsia (adjusted HR, 4.29 [95% CI, 2.32-7.96]; P < .001). Maternal age (adjusted HR per year of age, 1.06 [95% CI, 1.03-1.08]; P < .001) and postpartum incident hypertension (adjusted HR, 1.68 [95% CI, 1.16-2.42]; P = .006) were independently associated with the development of DCM.

CONCLUSIONS: Patients with hypertensive disorders of pregnancy had a greater risk of developing dilated cardiomyopathy. Older maternal age and postpartum hypertension were associated with higher risk of dilated cardiomyopathy after a hypertensive disorder of pregnancy. These findings support long-term clinical vigilance of patients with a history of hypertensive disorders of pregnancy.

PMID:40172877 | DOI:10.1001/jamacardio.2025.0328

JAMA Psychiatry. 2025 Apr 2. doi: 10.1001/jamapsychiatry.2025.0206. Online ahead of print.

NO ABSTRACT

PMID:40172869 | DOI:10.1001/jamapsychiatry.2025.0206

J Adv Nurs. 2025 Apr 2. doi: 10.1111/jan.16931. Online ahead of print.

ABSTRACT

AIMS: To determine the prevalence of burnout and back pain in homecare workers in Switzerland and assess their associations with psychosocial work environment factors.

DESIGN: National multicentre cross-sectional study.

METHODS: Using paper-pencil questionnaires, data were collected from January 2021 to September 2021 from employees of 88 homecare agencies across Switzerland. Respondents who identified themselves as administrators, apprentices, or trainees, who were in leadership positions, or who were not involved in the provision of care or housekeeping were excluded from this analysis. Burnout was assessed with the Copenhagen Burnout Inventory Scale (possible score range 0-100) and back pain with a single item from the Federal Statistical Office’s Swiss Health Survey. Multilevel regression analyses were used to assess burnout and back pain’s associations with psychosocial work environment factors.

RESULTS: We included 2514 homecare workers. More than two-thirds (68.6%) reported back pain in the past 4 weeks. The overall mean burnout score was 36.0 (SD 18.3). Poorer work-life balance, higher perceived workload and verbal aggression from clients were positively associated with both outcomes. Better leadership and social support from colleagues were negatively associated with burnout. Higher role conflict levels correlated with higher burnout levels.

CONCLUSION: Our findings indicate that the psychosocial work environment should be considered when designing interventions to reduce the prevalence of burnout and back pain among homecare workers.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: The high reported burnout and back pain prevalences among homecare workers highlight an urgent need to design and implement psychosocial work environment-improving interventions. In addition to contributing to homecare employees’ long-term attraction and retention, protecting and promoting their health and well-being will likely not only benefit them, but also contribute to patient safety, quality of care and homecare sustainability.

IMPACT: The study reports the prevalence of burnout and back pain among homecare workers and their associations with psychosocial work environment factors. The results indicate that six psychosocial work environment factors-work-life balance, perceived workload, leadership quality, levels of social support from colleagues, role conflict levels, and verbal aggression from clients-all correlate with burnout and/or back pain in homecare workers. For policy makers, researchers, healthcare managers, and homecare agencies, this study’s findings will inform the development of interventions to enhance homecare work environments, leading to improvements both in workers’ health and in the quality of their care.

REPORTING METHOD: We have adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting checklist for cross-sectional studies.

PATIENT OR PUBLIC CONTRIBUTION: Our stakeholder group included patient representatives, policy makers, researchers, clinicians and representatives of professional associations. Throughout the study, all provided support and input on topics including questionnaire development, result interpretation and the design of strategies to improve response rates.

PMID:40172860 | DOI:10.1111/jan.16931

J Adv Nurs. 2025 Apr 2. doi: 10.1111/jan.16945. Online ahead of print.

ABSTRACT

AIMS: This study engaged key stakeholders-older adults, family caregivers, home care support workers, nurses, and home healthcare leaders-to explore perspectives on essential components and integration into home care models, and to explore the role of their technology readiness for health smart homes adoption.

DESIGN: A qualitative methodology with a quantitative component, early-phase exploratory design.

METHODS: Semi-structured interviews underwent qualitative thematic analysis, with cross-case analysis comparing stakeholder perspectives to identify convergences and divergences. Descriptive statistics were used to analyse Technology Readiness Index (TRI 2.0) survey data to provide background and context to the qualitative findings.

RESULTS: Among 18 participants-older adults (n = 6), family caregivers (n = 2), nurses (n = 7), and support workers/healthcare leaders (n = 3)-findings reflected optimism for health smart home adoption and its potential to support ageing in place. Nurses and care workers saw health smart home as a tool for improving care coordination and quality of life. Key adoption considerations included education, data visualisation, privacy, and security. Technology readiness scores were moderate, with nurses scoring highest (3.52), followed by caregivers (3.41), support workers (3.13), and older adults (3.10).

CONCLUSION: While stakeholders were open to integrating health smart home into home care, concerns around usability, security, and training must be addressed to facilitate adoption.

IMPLICATIONS FOR THE PROFESSION: Findings suggest that while health smart home technology holds promise for enhancing ageing in place, varying levels of technology readiness across stakeholders highlight the need for tailored education and support strategies to ensure successful implementation.

PROBLEM ADDRESSED: Despite a strong preference for ageing in place among older adults, integrating health smart home technologies into home care remains challenging. Key issues include ensuring intuitive functionality, protecting privacy, and clarifying the roles of caregivers and healthcare professionals in a technology-enhanced care model. This study addresses the critical gap in understanding how health smart home solutions can be effectively tailored to support the diverse needs of older adults, family caregivers, and home care nurses and support workers.

MAIN FINDINGS: Stakeholders were generally optimistic about health smart home technologies supporting ageing in place and improving quality of life. Nurses and support workers highlighted the need for tailored data visualisations, alert parameters, and clear role guidelines. A novel finding was that older adults and family caregivers viewed health smart home as a way to reduce intrusive monitoring, promote independence, and maintain a familiar living environment. Family caregivers valued the ability to stay involved remotely through activity data, offering reassurance and peace of mind. Across all groups, privacy safeguards were seen as essential, with strong concerns about data security, transparent usage policies, and user control over data sharing.

IMPACT: Findings have implications for community-dwelling older adults, family caregivers, home care professionals, researchers, and technology developers. Insights from this study can inform the design of user-friendly health smart home technologies, shape future research, and guide tailored implementation strategies in home care settings.

PATIENT OR PUBLIC CONTRIBUTION: An advisory group of community-dwelling older adults in Western Australia provided input on study design and methodology. Their recommendations led to the use of one-on-one interviews to ensure accessibility and relevance for older adults when exploring technology readiness and smart home integration. While the advisory group did not contribute to the data itself or its analysis, their feedback shaped the method of engagement to ensure its relevance and accessibility to potential participants.

PMID:40172858 | DOI:10.1111/jan.16945

Work. 2025 Feb;80(2):539-547. doi: 10.3233/WOR-230595. Epub 2025 Apr 2.

ABSTRACT

BACKGROUND: The bibliometric and visualization of a journal informs the editorial team about its current situation. As an interesting and popular journal in the field of Occupational Health and Safety (OHS), WORK is a good target for bibliometric analysis and visualization.

OBJECTIVE: To conduct an overview of WORK from a bibliometric perspective.

METHODS: Using the Scopus database, the present bibliometric study was carried out to evaluate WORK from its whole life (1990-2022). Data extraction was performed on May 8, 2023. Using Microsoft Excel and VOSviewer software, bibliometric analysis and visualization approaches were conducted. Related findings such as various indices trends, co-authorship as well as most cited and most productive authors, highly cited papers, and most productive countries were introduced and discussed.

RESULTS: Overall, positive trends were observed in published documents and received citations by WORK. The top-cited paper in WORK had 478 citations. Straker, Innes, and Jacobs were the most cited authors with nearly 500 citations. American and European countries had more contributions to WORK. The same findings were obtained regarding international cooperation. The co-occurrence of keywords showed that WORK covers all aspects of OHS with more emphasis on the Ergonomics issues.

CONCLUSIONS: The positive trends in published papers as well as its impacts proved the fact that WORK is progressing year by year. The findings of the present study can be useful both for audiences and the editorial team of WORK.

PMID:40172850 | DOI:10.3233/WOR-230595