Tag: pubmed

JAMA Psychiatry. 2025 Mar 19. doi: 10.1001/jamapsychiatry.2025.0091. Online ahead of print.

ABSTRACT

IMPORTANCE: Bariatric surgery, once the criterion standard in obesity treatment, has a small but concerning association with increased suicidality. Glucagon-like peptide 1 receptor agonists (GLP-1 RAs), originally developed to treat diabetes, now provide substantial efficacy in the treatment of obesity. However, concerns of risk of suicidality with these medicines have been raised.

OBJECTIVE: To evaluate the risk of suicidality and self-harm in randomized, placebo-controlled trials of GLP-1 RAs in adults with diabetes or obesity.

DATA SOURCES: MEDLINE, Embase, ClinicalTrials.gov, and Cochrane databases were systematically searched from inception to August 29, 2023.

STUDY SELECTION: Reports of randomized clinical trials (RCTs) lasting 6 or more months comparing GLP-1 RAs with placebo for the treatment of diabetes or obesity published in peer-reviewed journals were identified. Two independent reviewers screened all search-identified studies for inclusion. Records of outcomes were queried from primary papers, ClinicalTrials.gov entries, and corresponding authors.

DATA EXTRACTION AND SYNTHESIS: Two independent researchers abstracted data and assessed data quality and validity using PRISMA guidelines. Data were pooled using random-effects models.

MAIN OUTCOMES AND MEASURES: Pooled incidence of completed or attempted suicide, occurrences of suicidal ideation, or self-harm.

RESULTS: A total of 27 of 144 RCTs meeting inclusion criteria systematically recorded suicide and/or self-harm-related events and included 32 357 individuals receiving GLP-1 RAs and 27 046 treated with placebo, over 74 740 and 68 095 person-years of follow-up, respectively. Event incidence was very low in the GLP-1 RA (0.044 per 100 person-years) and placebo (0.040 per 100 person-years) groups, with no statistically significant difference (rate ratio [RR], 0.76; 95% CI, 0.48-1.21; P = .24). Subgroup analyses did not suggest differences in outcomes based on diabetes status or GLP-1 RA used. Five studies were considered at risk of bias due to the loss of more than 5% of participants to follow-up. Otherwise, studies were not found to be heterogeneous nor at high risk of bias.

CONCLUSIONS AND RELEVANCE: There is unlikely to be an increase in the very low incidence of suicide-related adverse events among individuals receiving GLP-1 RAs within the context of RCTs. While these findings may further ease concerns about these adverse effects, continued monitoring is warranted to identify particular patients who may be at risk as extended use of GLP-1 RAs expands.

PMID:40105856 | DOI:10.1001/jamapsychiatry.2025.0091

JAMA Netw Open. 2025 Mar 3;8(3):e251092. doi: 10.1001/jamanetworkopen.2025.1092.

ABSTRACT

IMPORTANCE: Pediatric concussion affects millions and results in heterogeneous outcomes and recovery trajectories. Given favorable outcome for most children, it is useful to understand characteristics of positive outcome to promote full recovery in all children.

OBJECTIVE: To document the timeframe of recovery to optimal functioning, defined comprehensively across motor-physical, cognitive, socioemotional, and resilience-support domains, after concussion among children ages 8 to 16 years.

DESIGN, SETTING, AND PARTICIPANTS: For this prospective cohort study, children ages 8 to 16.99 years with a concussion or orthopedic injury (OI) were recruited between September 2016 and July 2019 from 5 Pediatric Emergency Research Canada emergency departments and assessed approximately 10 days, 3 months, and 6 months after their injury. Data were analyzed from January 29, 2024, to January 11, 2025.

EXPOSURE: Concussion.

MAIN OUTCOMES AND MEASURES: Participants completed self-report and direct assessment measures of postconcussive symptoms, physical activity and function, balance, cognitive function, quality of life, resilience, and social support. The main outcome was optimal functioning, which was derived from 11 variables and criteria indicative of absence of impairment and average or above functioning in each domain (overall score, 0-11; higher score indicates better function). A longitudinal, multivariable, cumulative probability ordinal regression model was fitted to examine factors associated with optimal functioning.

RESULTS: A total of 967 children (median [IQR] age, 12.3 [10.5-14.3] years; 562 [58.1%] male) were enrolled, including 633 children with a concussion and 334 children with an OI. The median (IQR) optimal functioning scores for the OI group were 6.0 (4.0-8.0) at 10 days, 7.0 (5.0-9.0) at 3 months, and 7 (5.0-9.0) at 6 months, compared with 4.0 (2.0-6.0) at 10 days, 6.0 (4.0-9.0) at 3 months, and 7.0 (4.0-9.0) at 6 months in the concussion group. The 3 main variables (time, sex, and group) were significantly associated with optimal functioning, as were all 2-way interactions. Time was the strongest factor associated with optimal functioning (Wald χ258 = 485.11; P < .001), followed by group (Wald χ26 = 95.10; P < .001), and sex (Wald χ26 = 23.19; P < .001). At the 10-day follow-up, concussion was associated with lower optimal functioning than OI among females (odds ratio [OR], 0.24 [95% CI, 0.16-0.36]) and males (OR, 0.37 [95% CI, 0.26-0.53]). This difference persisted for females at 3 months (OR, 0.57 [95% CI, 0.35-0.93]) but not for males. Optimal functioning was comparable at 6 months.

CONCLUSIONS AND RELEVANCE: In this prospective cohort study of children with concussion, achieving optimal functioning levels across physical, cognitive, socioemotional, and resilience domains took 3 months or more, especially for girls with concussion. Multiple domains of outcome need to be taken into account when considering full recovery and optimal function after pediatric concussion.

PMID:40105842 | DOI:10.1001/jamanetworkopen.2025.1092

JAMA Netw Open. 2025 Mar 3;8(3):e251100. doi: 10.1001/jamanetworkopen.2025.1100.

ABSTRACT

IMPORTANCE: The Centers for Medicare & Medicaid Services Severe Sepsis and Septic Shock Management Bundle (SEP-1) is supported by observational studies that report SEP-1 compliance is associated with lower mortality. Most studies, however, adjusted for limited confounders and provided little insight into why bundle-compliant care was not provided.

OBJECTIVES: To identify the clinical factors that complicate the diagnosis and management of sepsis and assess their association with SEP-1 compliance and mortality.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study was conducted among 590 adults with sepsis in the emergency department of 4 academic hospitals from January 1, 2019, to December 31, 2022. Patients’ medical records were reviewed between September 2022 and December 2023.

MAIN OUTCOMES AND MEASURES: Study outcomes were (1) characteristics of patients who received SEP-1-compliant care vs characteristics of patients who received noncompliant care and (2) association between SEP-1 compliance and hospital mortality using multivariable models to adjust for successively more potential confounders (first demographics and comorbidities, then infection source, then severity of illness, and then clinical markers of complexity).

RESULTS: Of 590 patients with sepsis (median age, 65 years [IQR, 53-77 years]; 329 men [55.8%]), 335 (56.8%) received SEP-1-compliant care, and 225 (43.2%) received noncompliant care. Compared with patients in the compliant group, patients in the noncompliant group were more likely to be 65 years or older (142 [55.7%] vs 158 [47.2%]; odds ratio [OR], 1.41 [95% CI, 1.01-1.95]), to have multiple comorbidities (Elixhauser score >20: 99 [38.8%] vs 99 [29.6%]; OR, 1.51 [95% CI, 1.07-2.13]), and to have a higher incidence of septic shock (107 [42.0%] vs 107 [31.9%]; OR, 1.54 [95% CI, 1.10-2.16]), kidney dysfunction (87 [34.1%] vs 80 [23.9%]; OR, 1.65 [95% CI, 1.15-2.37]), and thrombocytopenia (43 [16.9%] vs 37 [11.0%]; OR, 1.16 [95% CI, 1.02-2.62]) on presentation. Compared with patients in the compliant group, those in the noncompliant group also had more nonfebrile presentations (136 [53.3%] vs 121 [36.1%]; OR, 2.02 [95% CI, 1.45-2.82]), impaired mental status (92 [36.1%] vs 94 [28.1%]; OR, 1.45 [95% CI, 1.02-2.05]), need for bedside procedures (57 [22.4%] vs 41 [12.2%]; OR, 2.06 [95% CI, 1.33-3.21]), acute concurrent noninfectious illnesses (140 [54.9%] vs 151 [45.1%]; OR, 1.48 [95% CI, 1.07-2.06]), and noninfectious illness as the primary factor associated with their presentation (84 [32.9%] vs 71 [21.2%]; OR, 1.82 [95% CI, 1.08-3.08]). SEP-1 compliance was associated with lower crude mortality rates compared with noncompliance (40 [11.9%] vs 41 [16.1%]; unadjusted OR, 0.60 [95% CI, 0.37-0.98]), but there was no statistically significant difference between groups after successively adjusting for demographics and comorbidities (adjusted OR [AOR], 0.71 [95% CI, 0.42-1.18]), infection source (AOR, 0.71 [95% CI, 0.43-1.20]), severity of illness (AOR, 0.86 [95% CI, 0.50-1.49]), and clinical markers of complexity (AOR, 1.08 [95% CI, 0.61-1.91]).

CONCLUSIONS AND RELEVANCE: In this cohort study of adults with sepsis, complex clinical presentations were more common among patients whose treatment was noncompliant with SEP-1. These nuances are poorly captured in most observational studies but confound the association between SEP-1 compliance and mortality.

PMID:40105841 | DOI:10.1001/jamanetworkopen.2025.1100

JAMA Netw Open. 2025 Mar 3;8(3):e251122. doi: 10.1001/jamanetworkopen.2025.1122.

ABSTRACT

IMPORTANCE: Children with growth faltering are more susceptible to infections and may experience cognitive, physical, and metabolic developmental impairments.

OBJECTIVE: To assess whether prenatal and preconception meteorological and environmental factors are associated with village-level rates of childhood growth outcomes in Uganda.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data collected between June 20, 2015, and December 16, 2016, from the 2016 Ugandan Demographic and Health Survey for individuals aged 0 to 59 months with available anthropometric measures (weight and length or height). Data analysis was conducted from October 2020 to April 2024.

EXPOSURES: Factors assessed included meteorological information, such as drought index (Standardized Precipitation-Evapotranspiration Index [SPEI]), Aridity Index, rainfall, temperature, and vegetation indices; demographic and economic development factors (nighttime light emissions, driving time to the nearest city); and land topography (slope angle, elevation above sea level).

MAIN OUTCOMES AND MEASURES: The main outcomes were height-for-age z score (HAZ), weight-for-age z score (WAZ), and weight-for-height z score (WHZ). Spatial resolution estimates, at 1 km × 1 km of childhood growth faltering indicators, were created.

RESULTS: Of the 5219 individuals aged 0 to 59 months included in the analysis, 2633 (50%) were female; mean (SD) age was 29 (17) months. Of these individuals, 30.22% (95% CI, 29.36%-30.98%) had stunting, 12.23% (95% CI, 11.55%-12.91%) had underweight, and 3.63% (95% CI, 3.46%-3.80%) had wasting. Large disparities in the burden of childhood growth faltering existed within Uganda at smaller and larger spatial scales; villages in the northeastern and southwestern areas of the country had the highest prevalence of all forms of growth faltering (stunting, >40%; underweight, >16%; and wasting, >6%). Higher SPEI at 3 months before birth was positively associated with all childhood growth outcomes: HAZ (β, 0.06; 95% CI, 0.02-0.10), WAZ (β, 0.04; 95% CI, 0.01-0.07), and WHZ (β, 0.03; 95% CI, 0.001-0.06). Higher location mean rainfall 11 months before birth was also positively associated with HAZ (β, 0.06; 95% CI, 0.01-0.10). Aridity Index associations with WAZ (β, 0.09; 95% CI, 0.04-0.13) and WHZ (β, 0.09; 95% CI, 0.02-0.16) were consistent with findings for SPEI.

CONCLUSIONS AND RELEVANCE: In this study of 5219 individuals 0 to 59 months of age in Uganda, rainfall and long-term availability of water at preconception and during gestation were positively associated with nutritional child growth outcomes. Understanding the relative contributions of meteorological environment factors on the spatial distribution of undernutrition at various spatial scales within Uganda (from the village to the district level) may help in the design of more cost-effective delivery of precision public health programs.

PMID:40105840 | DOI:10.1001/jamanetworkopen.2025.1122

JAMA Netw Open. 2025 Mar 3;8(3):e251152. doi: 10.1001/jamanetworkopen.2025.1152.

ABSTRACT

IMPORTANCE: Indefinite suppressive antibiotic therapy (SAT) is sometimes prescribed after initial antibiotic treatment for prosthetic joint infection (PJI). Limited evidence on outcomes after SAT exists, and using SAT for patients at low risk who may not need it could be associated with antibiotic resistance and adverse events.

OBJECTIVES: To characterize clinical decision-making about SAT after PJI and identify stewardship intervention opportunities to stop or reduce SAT for patients who may not benefit.

DESIGN, SETTING, AND PARTICIPANTS: In this qualitative study, interviews were conducted with 41 clinicians involved in decision-making about SAT after PJI at 8 US Veterans Affairs hospitals between November 1, 2019, and July 31, 2021. Analysis was conducted from June 9, 2020, to August 31, 2022.

MAIN OUTCOMES AND MEASURES: Systematic thematic analysis of transcripts of semistructured interviews was conducted to assess the decision-making process for SAT after PJI, including identifying decision-makers, risks and benefits of SAT, and significant time points that occur before or after the SAT prescribing decision.

RESULTS: A total of 41 clinicians were interviewed. Interviewees reported a complex, usually patient-specific, sometimes collaborative decision-making process. Decisions were emotionally charged because of serious possible repercussions for patients and limited evidence about benefits and risks associated with SAT. Surgeons and infectious diseases physicians were the primary SAT prescribers. Their initial risk-benefit calculation for SAT usually included whether revision surgery could be performed and what type, the organism, patient factors, and clinical signs of infection, as well as their perception of the existing evidence base for SAT after PJI. Interviewees identified significant time points that occured before or after the SAT prescribing decision, including PJI treatment decisions and follow-up appointments. Other potential decision-makers over time included patients, primary care physicians, and pharmacists. Interviewees identified opportunities to discuss SAT-associated benefits and risks with patients as well as other clinicians. Interviewees wanted more evidence about patient outcomes to inform prescribing decisions and emphasized the importance of clinician autonomy and buy-in for practice change.

CONCLUSIONS AND RELEVANCE: This qualitative study found that surgeons and infectious diseases physicians often made initial decisions about SAT and identified other potential decision-makers (patients, primary care physicians, pharmacists) and significant time points that occur before or after the SAT prescribing decision, including PJI treatment decisions and follow-up appointments. Stewardship interventions should take into account decision points for patients with PJI across time and the range of decision-makers, including patients, across time.

PMID:40105839 | DOI:10.1001/jamanetworkopen.2025.1152

JAMA Netw Open. 2025 Mar 3;8(3):e251158. doi: 10.1001/jamanetworkopen.2025.1158.

ABSTRACT

IMPORTANCE: Opioid-involved overdose mortality has been on the rise for 2 decades in the US, exacerbated by an unregulated drug supply that is unpredictable and has increasingly contained highly potent fentanyl analogs starting a decade ago.

OBJECTIVE: To determine whether there is a geospatial association between law enforcement drug seizures and opioid-involved overdose mortality in San Francisco.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used location- and time-stamped overdose mortality data from the Office of the Chief Medical Examiner and publicly available crime data from the San Francisco Police Department between 2020 and 2023 to assess whether location and time of law enforcement drug seizures were associated with subsequent opioid-involved overdose mortality. Data were analyzed from January 2020 to September 2023.

EXPOSURES: Time-stamped locations of law enforcement drug seizures involving a drug distribution charge.

MAIN OUTCOMES AND MEASURES: The primary outcomes were the time and location of (1) overdose mortality involving any opioid and (2) overdose mortality involving fentanyl or any fentanyl analog. The relative risk (RR) and 95% CIs for endemic and epidemic factors were calculated.

RESULTS: There were 2653 drug seizure crime events that involved any drug distribution charge and 1833 overdose deaths that tested positive for any opioid or synthetic opioid, including heroin and fentanyl analogs. Within the surrounding 100 meters, law enforcement drug seizures were associated with increase risk of fatal opioid-involved overdoses the day following the drug seizure event (RR, 1.74; 95% CI, 1.06-2.83; P = .03) and elevated risk persisted for 7 days (2 days: RR, 1.55; 95% CI, 1.09-2.21; P = .02; 3 days: RR, 1.45; 95% CI, 1.08-1.93; P = .01; 7 days: RR, 1.27; 95% CI, 1.11-1.46; P = .001). Similar statistically significant spatiotemporal patterns were observed in the 250- and 500-meter spatial bandwidths. Within each space-time kernel, the strength of the association, all of which were statistically significant, dissipated the further away in time and distance from the law enforcement drug seizure event.

CONCLUSIONS AND RELEVANCE: The findings of this cross-sectional study suggest that the enforcement of drug distribution laws to increase public safety for residents in San Francisco may be having an unintended negative consequence of increasing opioid overdose mortality. To reduce overdose mortality, it may be better to focus on evidence-based health policies and interventions.

PMID:40105838 | DOI:10.1001/jamanetworkopen.2025.1158

JAMA Surg. 2025 Mar 19. doi: 10.1001/jamasurg.2025.0172. Online ahead of print.

NO ABSTRACT

PMID:40105828 | DOI:10.1001/jamasurg.2025.0172

Pain. 2025 Mar 18. doi: 10.1097/j.pain.0000000000003573. Online ahead of print.

ABSTRACT

This study investigates whether data from people with endometriosis (n = 58) and fibromyalgia (n = 58) exhibit what is called “ergodicity,” meaning that results from analyses of aggregated group data can be used to support conclusions about the individuals within the groups. The variables studied here are commonly investigated in chronic pain: pain intensity, pain interference, depressive symptoms, psychological flexibility, and pain catastrophizing. Data were collected twice daily for 42 days from each participant and analyzed in 2 ways: as separate cross-sectional group studies using the timepoints as the separate data sets (between-person) and as individual longitudinal studies using each person’s time series data (within person). To confirm ergodicity, the results from the 2 analyses should agree. However, this is not what was observed in several respects. The between-person data showed substantially less variability compared with within-person data. This was evident in both the summary statistics involving single variables and in the correlational analyses. Overall, between-person correlations were relatively restricted in range, while within-person correlations varied widely. These findings have potentially profound implications for the field of chronic pain research. Because ergodicity was not found, this raises doubts around the assumption that aggregated data collected from groups can accurately represent the range of individual experiences in chronic pain. These results advocate for a shift toward inclusion of more individual person-focused approaches as an addition to group-based approaches. This shift could lead to more personalized and effective treatments by better capturing and then clarifying the heterogeneous nature of chronic pain, including the processes that underlie it.

PMID:40105802 | DOI:10.1097/j.pain.0000000000003573

Eur J Prosthodont Restor Dent. 2025 Mar 12. doi: 10.1922/EJPRD_2790Fehrenbach07. Online ahead of print.

ABSTRACT

INTRODUCTION: Thin all-ceramic restorations enhance esthetics but are less predictable, especially with dark substrates, where opaque resin luting agents may be needed, though not always available. This study aimed to evaluate the influence of a resin luting agent on the final color of lithium disilicate crowns and masking of two prosthetic substrates (esthetic and metallic).

METHODS: Eighty prostheses with ceramic crowns were simulated from bovine roots. The specimens were randomized, according to the intraradicular retainer used, and divided into 2 groups (n=40): metallic (cast post and core) and esthetic (glass fiber post with composite resin core). The crowns were attached to their cores and the first CIELAB scale was measured with a spectrophotometer. The second color measurement was performed after cementation with a dual resin luting agent. The results were submitted to color variation calculation and statistical analysis.

RESULTS: Coordinate * L and * b values increased significantly (p⟨0.05) after cementation for both groups and there was no statistical difference between the groups for the ΔE00 value (p=0.242).

CONCLUSIONS: Resin luting agent positively impacted the final crown color and aided in masking both substrates. The effect of the substrate was attenuated on the final color of ceramic crowns.

PMID:40105749 | DOI:10.1922/EJPRD_2790Fehrenbach07

Clin J Pain. 2025 Mar 19. doi: 10.1097/AJP.0000000000001284. Online ahead of print.

ABSTRACT

OBJECTIVES: To identify health professional’s perception of barriers, facilitators and training needs when working with children experiencing chronic pain.

METHODS: Cross-sectional online survey of health professionals working with children experiencing chronic pain. Survey questions were a range of exploratory open and closed-ended questions, which included yes/no responses, choosing from a list, ranking options and open responses. Quantitative data were analysed using descriptive statistics and percentages; qualitative data were analysed using content analysis.

RESULTS: 180 health professionals took part, of which 44% were physiotherapists. Tertiary hospitals and private practices were most common workplaces. The most frequently reported categories of both barriers and facilitators were workforce and system factors, child factors and parent factors. The most frequently reported confidence areas and development areas were health professional factors, approaches to care and team structure. 75% of participants reported they were moderately to extremely interested in further training in paediatric chronic pain management and indicated a preference for interactive training rather than “passive” learning formats.

DISCUSSION: Health professionals report a diverse range of perspectives when working with children experiencing chronic pain, including perceived barriers and facilitators to care. Most health professionals were interested in future training in paediatric chronic pain management. Future research exploring the parent and child perspective and how these factors present clinically is needed to inform future training opportunities for health professionals working with children experiencing chronic pain.

PMID:40105747 | DOI:10.1097/AJP.0000000000001284