Tag: pubmed

Clin Orthop Relat Res. 2025 Feb 25. doi: 10.1097/CORR.0000000000003421. Online ahead of print.

ABSTRACT

BACKGROUND: Fractures of the thoracic and lumbar spine are uncommon injuries in children and adolescents, but they carry substantial morbidity and a real risk of death. Compared with the adult spine, the pediatric spine has unique anatomic and biomechanical properties that yield different fracture patterns than the adult population. The mechanisms of injury and degree of skeletal maturity constitute important predictors of the outcomes of pediatric thoracic and lumbar fractures; however, there remains a paucity of meaningful epidemiologic data with specific attention to the pediatric spine.

QUESTIONS/PURPOSES: (1) What are the overall incidence and trends of all-cause pediatric thoracic and lumbar fractures in the past 20 years, and how do these differ by age and sex? (2) What are the primary mechanisms of injury responsible for all-cause pediatric thoracic and lumbar fractures, and how do these differ by age and sex? (3) What are the sex-specific incidence risks of all-cause pediatric thoracic and lumbar fractures in the past 20 years? (4) What are the age-specific incidence risks of all-cause pediatric thoracic and lumbar fractures in the past 20 years?

METHODS: The National Electronic Injury Surveillance System (NEISS) is a publicly available database from a nationally representative sample of emergency departments that offers key details on mechanisms of injury and a statistically valid calculation method of national injury estimates. The NEISS was retrospectively queried for patients ages 0 to 18 years who presented with all-cause thoracic and lumbar fractures between 2004 and 2023. Thoracic and lumbar fractures were identified from upper trunk and lower trunk fracture NEISS diagnosis codes, filtering out nonpertinent diagnoses such as rib, hip, or pelvis fractures (72% [5853 of 8131]). From relevant thoracic and lumbar fractures, only acute fractures were included after narrative review; chronic or incidental fractures or spondylolysis (0.2% [5 of 2278]) and acute fractures that did not specify an affected thoracic or lumbar region (6% [136 of 2278]) were subsequently excluded. Collected variables included age, sex, hospitalization, primary mechanism of injury, fracture level(s), and fracture type. Each NEISS case record is assigned a statistical weight, representing an estimate of such injury occurring nationally. The aggregate of these weights in patients presenting with a thoracic or lumbar fracture provides a total national estimate of these injuries. Age was subsequently classified into children (younger than 14 years) and adolescents (ages 14 to 18 years). There were 1064 case records of thoracic fractures, 988 case records of lumbar fractures, and 85 case records of thoracic and lumbar fractures between 2004 and 2023, corresponding to a national estimate of 26,732 thoracic fractures, 29,274 lumbar fractures, and 2083 thoracic and lumbar fractures after computing the aggregate statistical weights of the associated case records. Fractures affecting both the thoracic and lumbar spine were included in the separate cohorts of thoracic and lumbar fractures, totaling a final national estimate of 28,814 thoracic fractures and 31,357 lumbar fractures. Of patients with thoracic fractures, 43% (12,264 of 28,814) and 57% (16,550 of 28,814) were children and adolescents, respectively, and 64% (18,328 of 28,814) and 36% (10,486 of 28,814) were male and female, respectively. Of patients with lumbar fractures, 29% (9109 of 31,357) and 71% (22,248 of 31,357) were children and adolescents, respectively, and 61% (19,084 of 31,357) and 39% (12,273 of 31,357) were male and female, respectively. Incidence rates were calculated using provided national estimates and as incidence per population at-risk using US census data. Simple linear regression analysis characterized overall and demographic-specific trends over the 20-year period, with the beta coefficient (β) representing change in fracture national estimates per year. Incidence rate ratios were calculated to compare demographic groups with regard to overall fracture incidence, recreation-related mechanism of injury, multilevel injury, and hospitalizations.

RESULTS: The mean ± SD annual incidence rate over the 20-year study span was 19 ± 6 pediatric thoracic fractures and 20 ± 5 pediatric lumbar fractures per 1 million person-years. There were overall increasing trends in pediatric thoracic fractures by 58 fractures per year (β = 58 [95% confidence interval (CI) 30 to 86]; p < 0.001). Increases in thoracic fractures were noted among males, females, children, and adolescents, with the largest increases in males by 41 fractures per year (β = 41 [95% CI 19 to 63]; p < 0.001) and adolescents by 41 fractures per year (β = 41 [95% CI 19 to 64]; p = 0.001). There were overall increasing trends in pediatric lumbar fractures by 38 fractures per year (β = 38 [95% CI 9 to 67]; p = 0.01), most prominently in males by 30 fractures per year (β = 30 [95% CI 9 to 51]; p = 0.007). These slight yearly increases resulted in substantial total increases in thoracic and lumbar fractures over the 20-year period. Falls from height and motorsports were the most common mechanisms of injury for overall pediatric thoracic and lumbar fractures. Males primarily sustained thoracic and lumbar fractures from motorsports, football, and falls from height, whereas females primarily sustained thoracic and lumbar fractures from falls from height, horseback riding, winter sports, and playground accidents. Children primarily sustained thoracic and lumbar fractures from falls from height and playground accidents, whereas adolescents primarily sustained thoracic and lumbar fractures from motorsports, falls from height, and winter sports. Age- and sex-based differences in motorsports were especially large, with motorsports accounting for nearly fourfold as many fractures in males than in females and more than twofold as many fractures in adolescents than in children. The overall rate of thoracic and lumbar fractures was 1.82 (95% CI 1.77 to 1.86; p < 0.001) and 1.63 (95% CI 1.60 to 1.67; p < 0.001) times higher in males compared with females. The overall rate of thoracic and lumbar fractures was 3.67 (95% CI 3.58 to 3.75; p < 0.001) and 6.69 (95% CI 6.52 to 6.85; p < 0.001) times higher in adolescents compared with children.

CONCLUSION: Our findings suggest that increased public policy attention be directed toward recreational activities such as motorsports and football, which disproportionately affect adolescent males. Formal safety training, strict age requirements, and regulations on the speed and horsepower of all-terrain vehicles and dirt bikes should be considered for motorsports. Similar age limits and introduction of modified tackling and football skills development should be considered prior to full-contact football. It is the responsibility of orthopaedic surgeons to increase public attention on the fracture risk of horseback riding, which has been traditionally perceived to be low risk. Increased barrier protection on bunk beds, windows, staircases, and playground equipment may lower the rate of accidental falls for all demographics.

LEVEL OF EVIDENCE: Level III, prognostic study.

PMID:40036050 | DOI:10.1097/CORR.0000000000003421

JAMA Netw Open. 2025 Mar 3;8(3):e2462263. doi: 10.1001/jamanetworkopen.2024.62263.

ABSTRACT

IMPORTANCE: Although children across low- and middle-income countries (LMICs) are increasingly surviving, many are not fully thriving. Both stunting and off-track early child development (ECD) hinder children’s potential to thrive.

OBJECTIVES: To estimate the global prevalence of the co-occurrence of stunting and off-track ECD and explore its association with nurturing care and sociodemographic factors.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study pooled data from the most recent Demographic and Health Surveys and Multiple Indicator Cluster Surveys (2010-2020) on 173 416 children aged 36-59 months in 41 LMICs. Statistical analysis was conducted from February to December 2024.

EXPOSURE: Risk factors pertaining to inadequate nurturing care, low socioeconomic status, and other sociodemographic characteristics.

MAIN OUTCOMES AND MEASURES: Children were classified into 4 groups with respect to thriving: children who were stunted only (height-for-age z score <-2 SD), off-track ECD only (measured using the Early Childhood Development Index), both stunted and off-track ECD (co-occurrence), or neither.

RESULTS: In the pooled sample of 173 416 children, the mean (SD) child age was 47.1 (6.8) months, and 88 242 (50.9%) were boys. Approximately 1 in 6 children (17.0% [95% CI, 16.8%-17.2%]) were both stunted and had off-track ECD, 17.1% (95% CI, 16.9%-17.3%) were stunted only, 27.8% (95% CI, 27.6%-28.0%) had off-track ECD only, and 38.1% (95% CI, 37.9%-38.4%) were neither stunted nor had off-track ECD. Socioeconomic gradients were observed, with more co-occurrence in lower-income countries (18.2% [95% CI, 17.9%-18.6%]), poorer households (22.1% [95% CI, 21.7%-22.5%] for poorest wealth quintile), mothers with lower educational levels (20.8% [95% CI, 20.6%-21.0%] for primary education or less), and rural settings (19.3% [95% CI, 19.1%-19.6%]). Various indicators of inadequate nurturing care along with low socioeconomic status were associated with co-occurrence. The top 5 factors associated with co-occurrence were poorest wealth quintile (adjusted odds ratio [AOR], 2.75; 95% CI, 2.53-2.99), no early childhood education (AOR, 2.22; 95% CI, 2.10-2.34), low maternal educational level (AOR, 1.44; 95% CI, 1.37-1.51), no toys at home (AOR, 1.43; 95% CI, 1.35-1.51), and diarrhea (AOR, 1.38; 95% CI, 1.31-1.45). The associations of poor household wealth, no birth registration, and no early childhood education with co-occurrence were significantly larger than their associations with stunting only or off-track ECD only.

CONCLUSIONS AND RELEVANCE: This cross-sectional study of young children in LMICs suggests that a significant proportion were both stunted and had off-track ECD. These findings underscore the need for multisectoral interventions that holistically target nutrition, health, and ECD risks to ensure that all children globally can thrive, especially those facing the double burden of stunting and off-track ECD.

PMID:40036037 | DOI:10.1001/jamanetworkopen.2024.62263

Harv Rev Psychiatry. 2025 Mar-Apr 01;33(2):90-101. doi: 10.1097/HRP.0000000000000424.

ABSTRACT

LEARNING OBJECTIVE: After participating in this CME activity, the psychiatrist should be better able to:• Discuss the effects of structural racism on pregnancy and obstetric care and their contributions to maternal mental health challenges and inequitable outcomes.• Outline the current understanding of interventions initiated during pregnancy or childbirth that use reproductive justice principles to improve Black maternal perinatal and intergenerational mental health outcomes.

BACKGROUND: There are significant racial disparities in maternal outcomes for Black compared to White birthing people in the United States (US). Maternal mental health problems negatively affect mothers and their infants. Effects of structural racism during pregnancy and obstetric care may contribute to inequitable maternal mental health challenges and negative offspring outcomes. A reproductive justice framework provides a path for addressing these inequities. This systematic review examines whether pregnancy care interventions driven by reproductive justice principles have successfully improved Black maternal perinatal and intergenerational mental health outcomes.

METHODS: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for studies identified in November 2024 in PubMed, PsycInfo, and CINAHL. The studies included randomized clinical trials of Black birthing parents in the US and their offspring. Interventions incorporating reproductive justice principles were defined as those explicitly designed to increase autonomy, community input, racial equity, and/or cultural relevance.

RESULTS: The search revealed 619 unique records. After screening and full-text review, 12 studies were included. Of these, 7 studies reported statistically significant effects on mental health outcomes. The interventions included interpersonal therapy, culturally tailored cognitive behavioral therapy, group prenatal care, community health worker home visits, and an educational online platform. Six studies reported positive effects on maternal mental health outcomes (e.g., depressive symptoms or anxiety). One study reported positive infant mental health or developmental effects.

CONCLUSIONS: The effects of reproductive justice-driven interventions on Black maternal and offspring mental health outcomes are promising, but studies are limited. Future studies should further identify active intervention components and assess mental health-related outcomes in both generations to improve the mental health of Black mothers and prevent negative intergenerational effects.

PMID:40036027 | DOI:10.1097/HRP.0000000000000424

Prev Sci. 2025 Mar 4. doi: 10.1007/s11121-025-01791-1. Online ahead of print.

ABSTRACT

Recently, Baseline Target Moderated Mediation (BTMM) has received a lot of attention in the field of prevention science. Prevention scientists are interested in BTMM because the model goes beyond whether an intervention achieves effects but also details how and for whom the intervention is most effective. In BTMM, baseline measures are used to investigate potential baseline-by-treatment interactions. However, BTMM has some important challenges including how to incorporate multiple moderator variables when identifying subgroups that benefit the most from the intervention and how to interpret subgroup effects in the presence of multiple moderator variables. Further, with the emergence of causal mediation analysis, it is important to investigate potential treatment-by-mediator interactions which allow the posttest mediator-outcome relation to vary in magnitude across intervention groups. Few methodological developments have addressed the challenges of assessing BTMM in the presence of multiple baseline-by-treatment interactions and the treatment-by-posttest mediator interaction. If the goal is to identify subgroups of individuals who respond better/worse to the intervention, it is important to use a method that can handle the many possible interactions while capturing the heterogeneity within the subgroups of interest. There are three aims of this paper. First, we describe the methodological challenges and substantive interpretation of mediation effects in the presence of multiple moderating variables. Second, we describe two statistical methods to estimate conditional mediation effects in the presence of multiple moderating variables. Third, the methods are applied to an empirical example from the ATLAS study. Implications for BTMM are discussed.

PMID:40035988 | DOI:10.1007/s11121-025-01791-1

J Racial Ethn Health Disparities. 2025 Mar 4. doi: 10.1007/s40615-025-02348-2. Online ahead of print.

NO ABSTRACT

PMID:40035951 | DOI:10.1007/s40615-025-02348-2

J Assist Reprod Genet. 2025 Mar 4. doi: 10.1007/s10815-025-03436-2. Online ahead of print.

ABSTRACT

OBJECTIVE: Recurrent implantation failure (RIF) is a significant challenge in assisted reproductive technology (ART), affecting many women undergoing in vitro fertilization (IVF). This study aims to compare the efficacy of various intrauterine infusion treatments, including granulocyte colony-stimulating factor (G-CSF), platelet-rich plasma (PRP), human chorionic gonadotropin (HCG), and peripheral blood mononuclear cells (PBMCs), in improving clinical pregnancy rate (CPR), live birth rate (LBR), and miscarriage rate (MR) in women with RIF.

METHODS: A comprehensive search was conducted in multiple databases, including Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Web of Science, and China National Knowledge Internet (CNKI), to identify randomized controlled trials (RCTs) evaluating the efficacy of intrauterine infusion treatments for RIF. Data extraction and quality assessment were performed independently by two reviewers. Network meta-analysis was conducted using a random-effects model to compare the outcomes of different treatments.

RESULTS: A total of 25 RCTs involving 3035 patients were included in the network meta-analysis. The treatments involved G-CSF, PRP, HCG, PBMCs, placebo, and blank control. The results of the network meta-analysis for CPR and LBR were statistically significant among treatments, but there was no statistical significance in MR. The surface under cumulative ranking curve (SUCRA) ranking of CPR and LBR showed that intrauterine infusion treatments of G-CSF, PRP, HCG, and PBMCs were much better than placebo and blank. The SUCRA values of CPR were ranked probabilistically from high to low as follows: PRP (84.5%) > PBMCs (76.5%) > G-CSF (65.7%) > HCG (52.5%) > placebo (20.8%) > blank (0.1%). The SUCRA values of LBR were ranked probabilistically from high to low as follows: PRP (81.4%) > PBMCs (64.6%) > G-CSF (58.0%) > HCG (48.7%) > placebo (42.4%) > blank (4.9%).

CONCLUSION: All these findings confirmed that intrauterine infusions of PRP and PBMCs significantly improve pregnancy outcomes in women with RIF. PRP emerged as the most effective treatment. However, to establish the most effective approach for managing patients with RIF, future research should prioritize direct and robust comparisons between PRP and other therapeutic strategies, ensuring a comprehensive evaluation of their relative efficacy.

PMID:40035946 | DOI:10.1007/s10815-025-03436-2

Eur Phys J E Soft Matter. 2025 Mar 4;48(3):12. doi: 10.1140/epje/s10189-024-00466-z.

ABSTRACT

In the past years, the amount of research on active matter has grown extremely rapidly, a fact that is reflected in particular by the existence of more than 1000 reviews on this topic. Moreover, the field has become very diverse, ranging from theoretical studies of the statistical mechanics of active particles to applied work on medical applications of microrobots and from biological systems to artificial swimmers. This makes it very difficult to get an overview over the field as a whole. Here, we provide such an overview in the form of a metareview article that surveys the existing review articles and books on active matter. Thereby, this article provides a useful starting point for finding literature about a specific topic.

PMID:40035927 | DOI:10.1140/epje/s10189-024-00466-z

Updates Surg. 2025 Mar 4. doi: 10.1007/s13304-025-02143-y. Online ahead of print.

ABSTRACT

To analyze the risk factors associated with the occurrence of cervical lymph node metastasis (LNM) and distant metastasis (DM) in patients with primary squamous cell carcinoma of the thyroid (PSCCT). Clinical data of 96 patients with PSCCT from SEER database were obtained and analyzed by logistic regression for clinicopathological characteristics, including age, marital status, race, gender, tumor size (mm), extrathyroidal extension (ETE), multifocality, T stage, M stage and other indicators. Differences were considered statistically significant when P < 0.05. (1) Analysis of risk factors for the occurrence of cervical lymph node metastasis in patients with PSCCT: The results of univariate analysis showed that compared with patients without lymph node metastasis, patients with metastasis had a higher percentage of patients with the age ≥ 70 years old, tumor sizes greater than 40 mm, extrathyroidal extension, multifocal tumors, T4 stage and distant metastasis, the difference was statistically significant (P < 0.05). The results of multivariate analysis showed that multifocality and M stage were independent risk factors for the occurrence of LNM in PSCCT patients (P < 0.05). (2) Analysis of risk factors for the occurrence of distant metastasis in PSCCT patients: The results of univariate analysis showed that the percentage of patients who developed distant metastasis with age ≥ 70 years old, tumor size > 40 mm, T4 stage, and lymph node metastasis was higher than that of those who did not develop distant metastasis, and the difference was statistically significant (P < 0.05). The results of multivariate logistic regression analysis showed that cervical lymph node metastasis was an independent risk factor for the occurrence of distant metastasis in PSCCT patients (P < 0.05). (3) Relevant clinicopathologic features have not been found to be statistically significant with lung and bone metastasis, with P values greater than 0.05. Multifocality and M stage are independent risk factors for LNM in PSCCT patients, and cervical lymph node metastasis is an independent risk factor for distant metastasis in PSCCT patients. The findings of this study may provide guidance for individualized treatment plans for PSCCT patients.

PMID:40035921 | DOI:10.1007/s13304-025-02143-y

Environ Geochem Health. 2025 Mar 4;47(4):97. doi: 10.1007/s10653-025-02387-y.

ABSTRACT

The Kåfjord area in northern Norway hosts numerous Cu deposits that were subjected to mining activities back in the nineteenth century. Relicts of the historical mining activity are still visible at several abandoned mines and associated mine waste disposal sites that may represent an environmental threat. The area was subjected to mining activities during the nineteenth century and abandoned mines and associated mine waste disposal sites still may represent a significant environmental threat. The Cu mineralization, found within the Paleoproterozoic Alta-Kvænangen Tectonic Window, primarily occurs as epigenetic sulfide-quartz-carbonate hydrothermal veins that crosscut the Kvenvik volcano-sedimentary complex and the overlying Storviknes sedimentary sequence. This study aims to determine the geochemical composition of stream sediments associated with the sediment-hosted Cu deposits and examine the role of host lithologies in the dispersion of elements associated with the deposits. Sediments from two streams and a river in the Kåfjord area were analyzed using phase and element analyses (aqua regia chemistry), complemented by a seven-step sequential extraction procedure. Results from Annaselva stream, draining Cu occurrences in the carbonate sediments of the Storviknes sequence, showed a significant positive correlation of Cu with mobile chalcophile elements (Pb, Zn, Ni, Tl, Hg, Ag, Sb, Bi) and lithophile elements (Sr, Ca, Ba, Al, K). In contrast, Brakkelva stream, draining the mafic volcanics of the Kvenvik complex, exhibited no statistically significant correlations between Cu and any of the analyzed elements. Møllneselva River, draining both lithologies, showed a strong Cu-Sc correlation, with principal component analysis indicating limited distinction between lithology-derived elements. These results did not completely align with statistical analysis outcomes highlighting the challenges of statistical data interpretation using a limited number of samples.

PMID:40035910 | DOI:10.1007/s10653-025-02387-y

Ann Surg Oncol. 2025 Mar 4. doi: 10.1245/s10434-025-17113-2. Online ahead of print.

ABSTRACT

BACKGROUND: Many patients with foregut cancer do not receive guideline-concordant treatment (GCT). Although social determinants of health (SDOH) have been associated with differences in receipt of GCT, the underlying mechanisms that perpetuate these disparities remain unknown. This mixed-methods study explored barriers to receipt of care among patients with foregut cancer.

METHODS: Patients with foregut cancers treated at a safety-net hospital in the Deep South were purposively selected. The patients completed semi-structured interviews, which were recorded, transcribed, and analyzed. Grounded theory methodology was used to generate themes through open coding, develop a thematic coding structure, and create a codebook. Intercoder agreement was above 90%. Patient sociodemographic and treatment-related variables were abstracted from the patients’ medical records to produce simple descriptive statistics.

RESULTS: The majority of the 30 participating patients were male (n = 23, 77%), black (n = 18, 60%), and with a median age of 63 years (interquartile range, 55-67 years). Using the socioecologic model, barriers were categorized into individual, interpersonal, organizational, and policy levels. Within the individual level, the barriers were access to primary care providers, personal barriers, competing responsibilities, multifaceted financial barriers, and transportation barriers. The interpersonal barriers involved communication challenges, physician mistrust, and absence of social support. The organizational level barriers were health system mistrust, inadequate health care infrastructure, and lack of insurance coverage consequences. The policy level barriers were health care access policies and insurance policies.

CONCLUSIONS: The patients reported multiple barriers related to accessing and adhering to their treatments. Understanding these barriers is critical to forming the basis for developing and implementing programs to increase the delivery of GCT.

PMID:40035908 | DOI:10.1245/s10434-025-17113-2