Tag: pubmed

JAMA Netw Open. 2025 Jan 2;8(1):e2455258. doi: 10.1001/jamanetworkopen.2024.55258.

ABSTRACT

IMPORTANCE: Timely access to care is a key metric for health care systems and is particularly important in conditions that acutely worsen with delays in care, including surgical emergencies. However, the association between travel time to emergency care and risk for complex presentation is poorly understood.

OBJECTIVE: To evaluate the impact of travel time on disease complexity at presentation among people with emergency general surgery conditions and to evaluate whether travel time was associated with clinical outcomes and measures of increased health resource utilization.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used administrative statewide inpatient and emergency department databases with linkage across encounters, including nearly every inpatient or emergency department encounter in the states of Florida and California in 2021. Participants included adult patients who presented to an emergency department with 1 of 5 common emergency surgical conditions. Data were collected from January to December 2021 and analyzed from June to December 2023.

EXPOSURE: The primary exposure was travel time from the patient’s home to the facility where they initially received emergency care.

MAIN OUTCOMES AND MEASURES: The primary outcome of interest was surgical disease complexity at the time of presentation to emergency care. Secondary outcomes included inpatient complications, mortality, and indicators of health system resource utilization. Multivariable logistic regression models were used, and adjusted odds ratios (aOR) and 95% CIs were reported.

RESULTS: Among 190 311 adults with emergency general surgery conditions, 7138 (3.8%) lived further than 60 minutes from the facility where they sought emergency care. Longer travel times were associated with higher odds of complex disease presentation for travel time of more than 120 minutes vs 15 minutes or less (aOR, 1.28; 95% CI, 1.17-1.40). Patients with a travel time 60 minutes or more were more likely to require operative intervention (aOR, 1.17; 95% CI, 1.10-1.26), inpatient admission (aOR, 1.41; 95% CI, 1.33-1.50), interfacility transfer (aOR, 1.32; 95% CI, 1.15-1.51), and longer inpatient stay (adjusted mean difference, 0.47 days; 95% CI, 0.35-0.59), and had higher charges (adjusted mean difference, $8284; 95% CI, $5532-$11 035).

CONCLUSIONS AND RELEVANCE: In this cohort study of patients with emergency surgical conditions, travel time to emergency care was associated with markers of delayed presentation and increased facility resource utilization. As opposed to static measures, such as rurality, travel time may serve as a more useful metric to inform policy efforts aimed at preserving access to care amidst rural hospital closures and regionalization.

PMID:39836423 | DOI:10.1001/jamanetworkopen.2024.55258

JAMA Netw Open. 2025 Jan 2;8(1):e2455388. doi: 10.1001/jamanetworkopen.2024.55388.

ABSTRACT

IMPORTANCE: There is limited evidence regarding the association between age at menopause and incident type 2 diabetes (T2D).

OBJECTIVE: To investigate whether age at menopause and premature menopause are associated with T2D incidence in postmenopausal Korean women.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study was conducted among a nationally representative sample from the Korean National Health Insurance Service database of 1 125 378 postmenopausal women without T2D who enrolled in 2009. The median (IQR) follow-up was 8.4 (8.1-8.7) years. Data were analyzed in March 2024.

EXPOSURES: Age at menopause and premature menopause (menopause onset at age <40 years).

MAIN OUTCOMES AND MEASURES: The primary outcome was incident T2D. Multivariable Cox proportional hazards regression analysis was used to estimate hazard ratios (HRs) and 95% CIs for incident T2D by age at menopause, adjusting for potential confounders.

RESULTS: Of 1 125 378 participants (mean [SD] age at enrollment, 61.2 [8.4] years), 113 864 individuals (10.1%) were diagnosed with T2D at least 1 year after enrollment. Women with menopause onset at ages younger than 40 years (premature menopause; HR, 1.13; 95% CI, 1.08-1.18) and ages 40 to 44 years (HR, 1.03; 95% CI, 1.00-1.06) had increased risk of T2D compared with those with onset at age 50 years or older, with adjustment for sociodemographic, lifestyle, cardiometabolic, psychiatric, and reproductive factors; a younger age at menopause was associated with increased risk of developing T2D (P for trend <.001). Body mass index, depressive disorder, and prediabetes modified the association in subgroup analyses; for example, for individuals with premature menopause vs those with menopause at ages 50 years or older, HRs were 1.54 (95% CI, 1.14-2.06) for a BMI less than 18.5 and 1.14 (95% CI, 1.00-1.30) for a BMI of 30 or greater (P < .001), 1.28 (95% CI, 1.12-1.45) for individuals with depression and 1.11 (95% CI, 1.07-1.16) for those without depression (P = .01), and 1.25 (95% CI, 1.18-1.33) for individuals who were not prediabetic and 1.04 (95% CI, 0.99-1.11) those who were prediabetic (P < .001).

CONCLUSIONS AND RELEVANCE: In this study, premature and early menopause were associated with a higher risk of T2D, highlighting the need for targeted public health strategies aimed at preventing or delaying T2D among postmenopausal women.

PMID:39836420 | DOI:10.1001/jamanetworkopen.2024.55388

Antivir Ther. 2025 Feb;30(1):13596535241313244. doi: 10.1177/13596535241313244.

ABSTRACT

BACKGROUND: Molnupiravir (MOV) is an orally bioavailable ribonucleoside with antiviral activity against all tested SARS-CoV-2 variants. We describe the demographic, clinical, and treatment characteristics of non-hospitalized Danish patients treated with MOV and their clinical outcomes following MOV initiation.

METHOD: Among all adults (>18 years) who received MOV between 16 December 2021 and 30 April 2022 in an outpatient setting in Denmark, we summarized their demographic and clinical characteristics at baseline and post-MOV outcomes using descriptive statistics. Outcomes were emergent hospitalization and all-cause mortality during the 28 days after MOV initiation. We estimated the odds ratios (OR) of outcomes by time from positive test to treatment using logistic regression.

RESULTS: We identified 3691 MOV-treated patients, of whom 45.8% were male and mean age was 70.1 years. Most patients (76.2%) initiated MOV within 0-2 days after a positive SARS-CoV-2 test and 16.8% within 3-5 days. Over a 28-day period, rates for all-cause, respiratory- or COVID-19-related, and COVID-19-related hospitalization were 4.8%, 2.6% and 1.5%, respectively. All-cause mortality was 1.6%. Initiation of MOV 3-5 days after a positive SARS-CoV-2 test compared to 1-2 days was associated with an increased risk of all-cause (OR 1.85, 95% CI 1.29-2.67) and respiratory or COVID-19-related (OR 1.78, 95% CI 1.07-2.94) hospitalization, and all-cause mortality (OR 2.90, 95% CI 1.64-5.15).

CONCLUSION: MOV was primarily prescribed to vaccinated elderly persons with multiple comorbidities. The all-cause hospitalization and mortality rates in this population were low. Early initiation of MOV reduced the risk of hospitalization and death compared with late initiation.

PMID:39836400 | DOI:10.1177/13596535241313244

Am J Sports Med. 2025 Jan 21:3635465241309307. doi: 10.1177/03635465241309307. Online ahead of print.

ABSTRACT

BACKGROUND: Anterior glenoid bone defects significantly influence surgical outcomes in shoulder instability cases. Various measurement methods based on 3-dimensional computed tomography (3D-CT) have been developed. Recently, the simple linear formula method, which establishes a correlation between glenoid height and width, has emerged as a promising technique.

PURPOSE: This study aimed to assess the differences in glenoid morphology between patients with anterior shoulder instability and healthy controls within a specific East Asian population (Han Chinese). The objectives included establishing linear formulas specific to both groups and comparing the efficacy of the simple linear formula method with traditional methods for measuring glenoid defects using 3D-CT.

STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 3.

METHODS: 3D-CT images of both the affected and unaffected shoulders of patients with anterior shoulder instability, as well as one shoulder of healthy controls, were analyzed. Glenoid height and width were measured, and linear formulas were established for this specific Han Chinese population. P values were determined using linear regression analysis to assess the statistical significance of the relationship between glenoid height (H) and width (W). A P value <.05 indicated a statistically significant relationship. R² values were calculated to determine the strength of the relationship, with higher values (closer to 1) indicating a stronger correlation. The glenoid defect ratio was calculated using the simple linear formula method and compared with traditional methods: the Griffith, linear-based best-fit circle, and area-based best-fit circle methods. Interrater agreement was assessed using intraclass correlation coefficients (ICCs).

RESULTS: There were 206 patients in the patient group and 206 participants in the healthy control group. In the patient group, the mean glenoid height and width of the unaffected shoulders were 35.21 ± 3.39 and 24.26 ± 2.74 mm, respectively (formula: W = 0.75H – 2.12; R² = 0.86; P < .001). In the male patient subgroup, they were 37.57 ± 1.35 and 26.23 ± 0.91 mm, respectively (formula: W = 0.47H + 8.60; R² = 0.79; P < .001). In the female patient subgroup, they were 31.63 ± 2.21 and 21.26 ± 1.65 mm, respectively (formula: W = 0.52H + 4.78; R² = 0.74; P < .001). In the healthy control group, the mean glenoid height and width were 33.48 ± 3.32 and 24.18 ± 3.02 mm, respectively (formula: W = 0.86H – 4.58; R² = 0.89; P < .001). In the male healthy control subgroup, they were 36.43 ± 1.35 and 26.89 ± 1.17 mm, respectively (formula: W = 0.67H + 2.63; R² = 0.58; P < .001). In the female healthy control subgroup, they were 30.54 ± 1.70 and 21.47 ± 1.49 mm, respectively (formula: W = 0.61H + 2.90; R² = 0.69; P < .001). The actual glenoid defect in the entire patient cohort averaged 12.3% ± 5.9%. The simple linear formula method demonstrated an ICC of 0.82, with a glenoid defect ratio averaging 15.7% ± 6.9%. The Griffith method had an ICC of 0.85, yielding a glenoid defect ratio of 16.5% ± 5.8%. The linear-based and area-based best-fit circle methods had ICCs of 0.73 and 0.77, respectively, with glenoid defect ratios of 16.9% ± 6.0% and 13.1% ± 6.2%, respectively.

CONCLUSION: Glenoid morphology in patients with anterior shoulder instability, particularly among male patients, was characterized by elongation and narrowing compared with healthy participants. The simple linear formula method demonstrated excellent reliability and accuracy, comparable with traditional methods, offering an efficient approach to measuring glenoid defects. Further validation across diverse populations is warranted.

PMID:39836389 | DOI:10.1177/03635465241309307

Arch Environ Occup Health. 2025 Jan 21:1-8. doi: 10.1080/19338244.2025.2451910. Online ahead of print.

ABSTRACT

During the COVID-19 pandemic, the need for computer-users to work-from-home (WFH) has increased world-wide. This study aims to explore how the COVID-19 lockdown has affected pain in the lower-back of adult computer professionals. Individuals aged 20-55, both male and female, meeting inclusion criteria (computer/laptop WFH, worked more than an hour on a computer/laptop) were invited to participate voluntarily after providing informed consent. A Google Forms survey was distributed, including self-reported demographic questions, work hours on a computer/laptop during-lockdown, and Oswestry-Low-Back-Disability-Questionnaire (OLBDQ) to assess low-back-pain (LBP) pre- and during-lockdown. The mean OLBDQ score, pre-lockdown 3.681 with 95% confidence interval (CI) [2.621, 4.741] and during-lockdown 4.893 with 95% CI [3.317, 6.470]. A relevant difference was identified among the working hours’ scores from the pre-lockdown and during-lockdown of the OLBDQ for low back pain. The obtained p-value in this context is 0.005, signifying that the observed negative difference is statistically significant for the study. WFH increases LBP of working females and males during the COVID-19 lockdown, poor ergonomics at home is one possible source. Therefore, it is essential to enhance awareness among employed individuals regarding proper ergonomic practices when using a computer both at home and in the workplace.

PMID:39836374 | DOI:10.1080/19338244.2025.2451910

Am J Sports Med. 2025 Jan 21:3635465241302797. doi: 10.1177/03635465241302797. Online ahead of print.

ABSTRACT

BACKGROUND: Views surrounding acromioplasty at the time of arthroscopic rotator cuff repair (RCR) have shifted dramatically over time. In recent years, various studies have argued against acromioplasty, citing equivocal functional outcomes after arthroscopic RCR with or without acromioplasty.

PURPOSE: To assess the statistical fragility of functional outcomes after arthroscopic RCR with and without acromioplasty using the reverse continuous fragility index (RCFI).

STUDY DESIGN: Systematic review and meta-analysis; Level of evidence, 3.

METHODS: A systematic review and meta-analysis was performed including all randomized controlled trials through February 5, 2024 investigating arthroscopic RCR with and without acromioplasty. The RCFI, defined as the number of qualifying data points required to be moved from the lower mean group to the higher mean group to alter the significance, was calculated for the Welch t test, Student t test, and Wilcoxon rank-sum test under various data assumptions. The reverse continuous fragility quotient (RCFQ) was determined by dividing the RCFI by the sample size.

RESULTS: A total of 6 clinical trials consisting of 609 patients with functional outcome scores were analyzed. Using the Welch t test, the median RCFI across all study outcomes was 20 (interquartile range [IQR], 17-24). For the Student t test, the median RCFI across all study outcomes was 14 (IQR, 13-19), with a median RCFQ of 0.18 (IQR, 0.15-0.20). For the Wilcoxon rank-sum test, the median RCFI was 14 (IQR, 13-17), with a median RCFQ of 0.17 (IQR, 0.13-0.19). While using the Welch t test, 64% of study outcomes had an RCFI greater than the loss to follow-up (LTFU). When using the other tests, 32% of study outcomes had an RCFI greater than the LTFU.

CONCLUSION: The fragility of these studies was largely dependent on the statistical test used to analyze the results. The Wilcoxon rank-sum test and Student t test appeared to be most appropriate to find differences in treatment arms. When using these tests, we found the results to be fragile. This, in combination with a small number of studies and the LTFU close to or exceeding 20%, indicates an overall lack of strong evidence to support previously accepted conclusions.

PMID:39836369 | DOI:10.1177/03635465241302797

Minerva Anestesiol. 2024 Dec;90(12):1098-1107. doi: 10.23736/S0375-9393.24.18245-4.

ABSTRACT

BACKGROUND: Frail elderly patients have a higher risk of postoperative morbidity and mortality. Prehabilitation is a potential intervention for optimizing postoperative outcomes in frail patients. We studied the impact of a prehabilitation program on length of stay (LOS) in frail elderly patients undergoing elective surgery.

METHODS: An RCT study was conducted. Frail patients scheduled for elective surgery were randomized to receive either pre-surgical conditioning protocol (PCP) or standard preoperative care. PCP included nursing, anesthetic, and geriatric assessment, nutritional intervention, and physical training for 4-weeks preoperatively. A nurse followed both groups until discharge criteria were met. The primary outcome was postoperative LOS. Secondary outcomes were nutritional status, preoperative frailty status (frailty phenotype-FP) after PCP, and postoperative complications up to three months categorized according to the Clavien-Dindo Classification. Means and medians between the control and intervention groups were compared, with statistical significance set at α=5%.

RESULTS: Thirty-four patients were to intervention and Thirty-seven to the control group. In the intervention group, adherence to prehabilitation was 90%. The median LOS after surgery was three days in both groups, without finding statistically significant differences between groups (P=0.754), although there was a trend towards lower LOS in the urologic surgery subgroup. We found a significant reduction in frailty status after PCP (FP<inf>pre</inf>=2.4±0.5 and FP<inf>post</inf>=1.7±0.5, P<0.001). Nutritional status significantly improved in frail patients after prehabilitation (MNA<inf>basal</inf>=9.0±2.5 and MNA<inf>post</inf>=10.6±2.6), P=0.028. The intervention group had less severe postoperative complications, which were not statistically significant.

CONCLUSIONS: The PCP conducted both in-person and online, for older frail patients undergoing elective colorectal and urological surgery was not associated with shorter LOS. However, frailty status significantly improved after completing PCP.

PMID:39836361 | DOI:10.23736/S0375-9393.24.18245-4

Minerva Anestesiol. 2024 Dec;90(12):1065-1073. doi: 10.23736/S0375-9393.24.18416-7.

ABSTRACT

BACKGROUND: Surgical fear is present in many patients awaiting surgery. However, a validated Italian version of the Surgical Fear Questionnaire (SFQ) was not available yet. Therefore, the aim of this study was to translate the SFQ into Italian and to test its reliability and validity.

METHODS: Design: prospective cohort study on Italian-speaking Swiss patients scheduled for a minimally invasive spinal procedure or spinal surgery. After forward and back translation and a pilot test, reliability and validity of the 8-item SFQ was assessed using the intraclass correlation coefficient, (ICC), Cronbach’s alpha, confirmatory factor analysis (CFA), and Spearman’s correlation coefficient.

RESULTS: Results on 63 patients revealed median SFQ-total scores of 22 (minimum-maximum: 0-68) at inclusion and 22.5 (0-70) one week before surgery. Test-retest reliability between first and second SFQ-total score was high, ICC=0.947 (95% CI: 0.912-0.968). Internal consistency of the SFQ-total score at both assessment times were high, Cronbach’s alphas 0.916 and 0.931 respectively. This was also the case for the subscale short-term fear, item 1-4 and long-term fear, item 5-8 (range 0.853-0.909). CFA-results for a one-factor and a two-factor model favored the two-factor model. Correlations with pain catastrophizing, other anxiety measures, and health status were weak and only state anxiety assessed by PROMIS reached statistical significance.

CONCLUSIONS: We conclude that the Italian version of the SFQ is suitable for use in practice and has a high reliability. Validity and sensitivity need additional testing on a larger population.

PMID:39836360 | DOI:10.23736/S0375-9393.24.18416-7

Rheumatol Ther. 2025 Jan 21. doi: 10.1007/s40744-025-00744-y. Online ahead of print.

ABSTRACT

INTRODUCTION: Prescribable digital health applications (DiGAs) present scalable solutions to improve patient self-management in rheumatology, however real-world evidence is scarce. Therefore, we aimed to assess the effectiveness, usage, and usability of DiGAs prescribed by rheumatologists, as well as patient satisfaction.

METHODS: The DiGAReal registry includes adult patients with rheumatic conditions who received a DiGA prescription. Data at baseline (T0) and the 3-month follow-up (T1) were collected through electronic questionnaires. Study outcomes included DiGA-specific outcome assessments as well as generic outcome assessments, including the Patient Global Impression of Change (PGIC), Patient Activation Measure (PAM®), and the German Telehealth Usability and Utility Short Questionnaire (TUUSQ). Changes between T0 and T1 were analyzed using descriptive statistics and paired tests.

RESULTS: A total of 191 patients were included between June 2022 and April 2023. Of these, 127 completed the 3-month follow-up, and 114 reported using the prescribed DiGA, with 66% reporting weekly use and 15% completing the full DiGA program. The most commonly prescribed DiGAs targeted pain management (53%). Symptom improvement was reported by 51% of patients using a DiGA, with significant reductions in exhaustion levels (p = 0.03). Significant DiGA-specific improvements were observed for DiGAs addressing back pain (p = 0.05) and insomnia (p = 0.006). However, no overall significant changes were detected in patient activation, health literacy, pain, overall health, or disease activity. Back pain and weight management DiGAs were the most effective, frequently used, and best-rated DiGAs, with symptom improvements reported by 50% to 82% of patients.

CONCLUSION: The findings suggest that DiGAs can improve symptom management in rheumatic patients, especially for conditions like back pain and weight control. Further real-world evidence is needed and may support value-based digital health efforts and reimbursement frameworks.

PMID:39836353 | DOI:10.1007/s40744-025-00744-y

Clin Rheumatol. 2025 Jan 21. doi: 10.1007/s10067-025-07316-z. Online ahead of print.

ABSTRACT

OBJECTIVES: To investigate the long-term course of aortic regurgitation (AR) and the width of the proximal ascending aorta (PAA) in patients with ankylosing spondylitis (AS).

METHOD: This is a follow-up cohort study of patients with AS examined with echocardiography at inclusion (2009 to 2011). Out of the initial 187, a subgroup of 52 patients (54% men, mean age 62 years) was selected for follow-up based on presence/absence of AR at baseline; 26 with AR (18 mild, 7 moderate, 1 severe) and 26 age/sex-matched without AR. These patients were re-examined with echocardiography in 2014 by an independent observer. Severity of AR and PAA diameter were assessed. Related samples Wilcoxon signed rank and Mann-Whitney U tests were used to analyze the change (Δ) in PAA diameter.

RESULTS: Regarding the 26 patients with AR at baseline, two had an aggravated grade, 16 an unchanged grade, and eight a less severe AR versus baseline. Two of the 26 patients with no AR at baseline had a mild grade of AR at follow-up. The mean (SD) ΔPAA diameter was 0 (3) mm, and no statistically significant ΔPAA diameter was found overall or in analyses stratified by sex and baseline presence of AR.

CONCLUSIONS: Most patients with AS had an unchanged grade of AR and PAA diameter at follow-up 3 to 5 years after the initial echocardiography. These findings suggest that the average progress of AR in patients with AS is slow and that progression of PAA dilatation seems rare. Key points • Aortic regurgitation (AR) is not uncommon in patients with ankylosing spondylitis (AS) and caused by aortic root dilatation and/or cusp fibrosis/retraction, but little is known about its course. • According to this repeated echocardiography study in median 4.3 years after the baseline evaluation, the majority of patients had no progress of AR or increase in the proximal ascending aorta diameter. • AR in AS is rarely rapidly progressive.

PMID:39836332 | DOI:10.1007/s10067-025-07316-z