Tag: pubmed

Am J Public Health. 2026 Apr 23:e1-e4. doi: 10.2105/AJPH.2026.308443. Online ahead of print.

ABSTRACT

Objectives. To estimate the mortality burden attributable to daily mean temperatures during the heat season (April through October) in Maricopa County, Arizona. Methods. We examined the effects of heat exposure on 126 854 deaths that occurred in Maricopa County during the 2019 to 2023 heat seasons. Using a quasi-Poisson regression with distributed lag nonlinear models, we estimated the cumulative relative risk (relative to 77°F) between population-weighted daily mean temperatures and all-cause mortality over a lag period of 3 days. Results. At 99°F (the 95th percentile of the population-weighted daily mean temperature), we observed an 11% (95% confidence interval [CI] = 7%, 16%) increase in daily all-cause mortality relative to 77°F. Overall, 3036 (95% empirical CI = 968, 4887) deaths were attributable to heat, which is 57% more deaths than identified through epidemiological heat surveillance. Conclusions. The mortality burden increases with increasing population-weighted daily mean temperatures, indicating that the effects of heat on mortality can be indirect and incompletely captured by routine surveillance. Public Health Implications. Statistical approaches can help estimate the mortality burden associated with heat exposure, complementing countywide surveillance efforts that provide actionable insights into enhancing heat prevention strategies. (Am J Public Health. Published online ahead of print April 23, 2026:e1-e4. https://doi.org/10.2105/AJPH.2026.308443).

PMID:42024837 | DOI:10.2105/AJPH.2026.308443

Am J Public Health. 2026 Apr 23:e1-e10. doi: 10.2105/AJPH.2026.308465. Online ahead of print.

ABSTRACT

Objectives. To examine the association of abortion bans with changes in maternal, pregnancy-related, and pregnancy-associated mortality. Methods. Using national vital statistics data (2016-2023), we used a Bayesian panel model to examine maternal, pregnancy-related, and pregnancy-associated mortality in 14 US states that implemented abortion bans by the end of 2022. Models accounted for temporal trends and state-specific factors. Results. Among the 14 states with abortion bans, there was some evidence of a potential 9.2% (95% credible interval [CI] = -1.6, 20.7) increase in the number of pregnancy-associated deaths above expectation, equivalent to 68 (95% CI = -13, 147) excess deaths; the rate was also higher than expected, with 3.3 (95% CI = -2.6, 9.0) additional deaths per 100 000 live births. Relative changes in pregnancy-related mortality were similar in magnitude but had greater uncertainty. There was no detectable increase in maternal mortality. Conclusions. Abortion bans may be associated with an increase in pregnancy-associated and pregnancy-related mortality, although data limitations and chance variation in these rare outcomes constrain the certainty of these and other findings. (Am J Public Health. Published online ahead of print April 23, 2026:e1-e10. https://doi.org/10.2105/AJPH.2026.308465).

PMID:42024836 | DOI:10.2105/AJPH.2026.308465

Am J Public Health. 2026 Apr 23:e1-e4. doi: 10.2105/AJPH.2026.308522. Online ahead of print.

ABSTRACT

Objectives. To investigate the effects of recreational cannabis laws (RCLs) on the rate of Medicare fee-for-service enrollees with cannabis-related disorders (CRDs) and claims involving CRDs. Methods. We used Medicare fee-for-service inpatient and outpatient claims from 2010 to 2022 to compare CRD outcomes in US states with and without effective RCLs and open recreational cannabis dispensaries (RCDs) using difference-in-difference models. We estimated the impact of RCLs and RCDs on the overall rate of Medicare enrollees with CRD per 10 000 enrollees and the rate of claims with CRD per 10 000 enrollees at the state‒year level (n = 663). Results. We found statistically significant increases in CRD outcomes following RCLs (19.73 patients per 10 000 enrollees [P < .001]; 20.56 claims per 10 000 enrollees [P = .005]) and RCDs (14.14 patients per 10 000 enrollees [P < .001]; 13.98 claims per 10 000 enrollees [P = .004]). Conclusions. Given that RCLs were associated with increased rates of CRD diagnoses and claims including CRD among Medicare fee-for-service enrollees, states considering implementation of RCLs should consider the negative harms of legalization, particularly for older adults. (Am J Public Health. Published online ahead of print April 23, 2026:e1-e4. https://doi.org/10.2105/AJPH.2026.308522).

PMID:42024835 | DOI:10.2105/AJPH.2026.308522

Health Aff (Millwood). 2026 Apr 23:101377hlthaff202501665. doi: 10.1377/hlthaff.2025.01665. Online ahead of print.

ABSTRACT

Extreme heat events have been demonstrated to increase emergency department (ED) visits, hospitalizations, and mortality, but evidence of their impacts on the associated costs and on outpatient use is more limited. We used 2016-23 health insurance claims from a large, national insurer and national temperature and humidity data to conduct a regression analysis on the relationship between extreme heat exposure and ED, inpatient, and outpatient use and cost in the commercial insurance, Medicaid, and Medicare Advantage (MA) populations. One additional day with a heat index of 100°F or hotter within a week was associated with increased ED use and cost across nearly all coverage populations and age groups. Extreme heat was associated with significant increases in inpatient use for children with commercial coverage (1.4 percent), members ages 18-64 with Medicaid coverage (0.47 percent), and MA members (0.5 percent) but was not associated with statistically significant increases in inpatient cost for any population group. It was not associated with increases in outpatient use or cost in any population group. MA members had the highest annual cost due to extreme heat. These findings provide evidence to inform population health management strategies, seasonal preparedness planning, and policy interventions to mitigate heat-related morbidity and health care costs.

PMID:42024824 | DOI:10.1377/hlthaff.2025.01665

Science. 2026 Apr 23;392(6796):395-400. doi: 10.1126/science.aeb0673. Epub 2026 Apr 23.

ABSTRACT

Translating the conductivity of individual carbon nanotubes into practical, macroscopic conductors remains a challenge. We report highly aligned fibers of double-walled carbon nanotubes intercalated with chains of tetrachloroaluminate anions (AlCl₄^–) in the intertube channels. The AlCl₄^– intercalant acts as a noncovalent dopant, accepting 0.65 electrons per anion, mostly from the outer nanotube layer. Combined with a 17% intercalant volume fraction, it produces an increase in room-temperature conductivity to values as high as 24.5 mega-Siemens per meter, which is 41% of that of copper. Specific conductivity values reach 17,345 Siemens-meter squared per kilogram, which is superior to that of metals. These fibers are five times stronger and half the weight of conventional overhead cables while remaining stable in dry conditions and retaining 80% of their conductivity protected from moisture by a cable polymer sheath.

PMID:42024735 | DOI:10.1126/science.aeb0673

J Bone Joint Surg Am. 2026 Apr 23. doi: 10.2106/JBJS.25.00667. Online ahead of print.

ABSTRACT

BACKGROUND: Understanding drivers of supply and labor cost variation in orthopaedic surgery is crucial to provide value-based care. Time-driven activity-based costing (TDABC) is a more accurate methodology for capturing costs of care than traditional methods. Anterior cruciate ligament reconstruction (ACLR) is one of the most performed outpatient procedures within orthopaedic surgery. The purpose of this study was to characterize the cost composition of ACLR and identify factors that drive cost variation.

METHODS: Cost data for supplies and time-based personnel usage were extracted from electronic health records and were used to calculate costs using TDABC. TDABC methodology was applied to calculate the cost of personnel usage by multiplying the duration and associated cost per minute. Descriptive statistics and mixed-effects modeling were used to determine cost drivers.

RESULTS: This study included 861 patients who underwent ACLR at 8 hospitals. The mean patient age (and standard deviation) was 31.1 ± 11.6 years. Of the 861 patients, 350 were male and 511 were female; 85.6% of patients were White, 8.1% were Asian, and 3.4% were Black. There was 3.2-fold variation in supply costs ($2,950) and 1.6-fold variation in labor costs ($940) between the 10th and 90th percentiles. Overall, supply costs accounted for 58.2% of total costs, whereas labor costs comprised the remaining 41.8%. The intraoperative phase was the greatest generator of total cost (89.7%). After adjusting for surgeon and hospital variability, variation in total cost was most effectively explained by graft type, primary surgery status, and meniscal repair (conditional R2 = 0.84; marginal R2 = 0.27). On subanalysis, patients undergoing allograft ACLR had significantly higher total costs, implant costs, and age compared with those undergoing ACLR with any autograft type (all p < 0.01).

CONCLUSIONS: The most notable drivers of labor and supply cost variation were graft type, surgeon, surgery center, primary surgery status, and concomitant meniscal repair. Understanding modifiable cost drivers may aid health systems in designing value-based pathways, implant formularies, and surgeon education programs. Future studies may integrate cost with outcome measures for a more holistic view of value.

LEVEL OF EVIDENCE: Economic and Decision Analysis Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:42024715 | DOI:10.2106/JBJS.25.00667

Int Health. 2026 Apr 23:ihag039. doi: 10.1093/inthealth/ihag039. Online ahead of print.

ABSTRACT

BACKGROUND: Despite increased facility-based childbirth in Nepal, stagnant neonatal and high maternal mortality highlight a critical ‘know-do’ gap in care quality. To address this, a modular, competency-based learning resource package (LRP) was developed for maternal and newborn health providers.

METHODS: A mixed-methods exploratory pilot study involved curriculum alignment with international standards, multidisciplinary co-design and a single-group pre-post evaluation among 24 nursing professionals in Gandaki Province. Feasibility and acceptability were evaluated utilizing objective structured clinical examinations (OSCEs) and qualitative interviews.

RESULTS: Non-parametric analyses revealed significant educational gains. Median knowledge scores increased from 64.0 to 88.0. Statistically significant median improvements (p<0.001) were documented across all OSCE clinical domains: antenatal care (30.0 to 92.1), postnatal care (53.8 to 90.4), infection prevention (31.8 to 90.0) and respectful maternity care (30.0 to 92.9). Qualitative data indicated high acceptability; however, heavy clinical workloads and linguistic diversity constrained programmatic sustainability.

CONCLUSIONS: The LRP is a feasible intervention to bridge clinical competency gaps. Definitive national scale-up requires larger controlled trials assessing patient-level outcomes along with essential systemic investments in supply chains, healthcare infrastructure and continuous post-training mentorship.

PMID:42023467 | DOI:10.1093/inthealth/ihag039

Actas Esp Psiquiatr. 2026 Apr 15;54(2):287-300. doi: 10.62641/aep.v54i2.2043.

ABSTRACT

BACKGROUND: Non-suicidal self-injury (NSSI) in adolescents and young adults is a serious public health concern. The COVID-19 pandemic significantly impacted mental health worldwide. This longitudinal study aimed to investigate the differential impacts of COVID-19 on psychological health, social support, and academic performance among young adults with and without previous history of NSSI.

METHODS: From an initial sample of 603 college students, 241 (40%) completed this 2.5-year follow-up study. The first assessment was in January-February/2020 (pre-pandemic) and the second in June-July/2022 (post-pandemic). Participants were grouped based on the pres-ence or absence of NSSI at baseline. Variables assessed included sociodemographic data, academic performance, COVID-19-related experiences, clinical characteristics, and perceived social support.

RESULTS: A significant reduction in the prevalence of NSSI behaviors was observed over the follow-up period, decreasing from 35% to 8.7%. The NSSI group endorsed worse academic performance post-pandemic. While they maintained stable clinical severity with no observed worsening, during pandemic period they experienced an improvement in perceived social support. In contrast, the Non-NSSI group experienced a decline in perceived social support during the same period.

CONCLUSIONS: Contrary to previous studies, our findings indicate that young adults with NSSI significantly reduced self-harm behaviors after the COVID-19 pandemic. Although their academic performance was negatively affected, their clinical severity and social support did not worsen compared to those without NSSI. Findings indicate that the COVID-19 outbreak did not increase NSSI behaviors or exacerbate psychopathology in individuals with NSSI.

PMID:42023465 | DOI:10.62641/aep.v54i2.2043

Actas Esp Psiquiatr. 2026 Apr 15;54(2):335-347. doi: 10.62641/aep.v54i2.2066.

ABSTRACT

BACKGROUND: The Scale of Externalizing Problem Behaviors in Adults (SEPBA) was developed as a hybrid psychometric instrument designed to assess both dimensional traits and categorical diagnoses associated with externalizing psychopathology. Based on an integrative operational framework drawing on Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the Hierarchical Taxonomy of Psychopathology (HiTOP) model, the SEPBA assesses 15 traits/facets and 6 disorders within the domains of antagonism and disinhibition.

METHODS: The present study analyzed the psychometric properties of the SEPBA in a combined community and prisoner sample (n = 922). The final version of the SEPBA included 144 items rated on a 4-point Likert scale. Reliability (α, ω), item discrimination, convergent/discriminant validity, confirmatory factor analyses, and gender measurement invariance were examined.

RESULTS: The results indicated adequate item discrimination and internal consistency across all scales. Confirmatory factor analyses supported the unidimensionality of the individual scales and the hypothesized hierarchical organization of traits and facets. Gender invariance of the measure was demonstrated. In addition, evidence of convergent and discriminant validity was provided through correlations with external measures.

CONCLUSION: The findings support the SEPBA as a suitable assessment instrument. Its hybrid structure offers an integrative approach to transdiagnostic assessment, enhancing both the clinical utility of categorical diagnoses and the empirical applicability of dimensional profiles for assessing externalizing behaviors in adults.

PMID:42023463 | DOI:10.62641/aep.v54i2.2066

Actas Esp Psiquiatr. 2026 Apr 15;54(2):545-555. doi: 10.62641/aep.v54i2.2089.

ABSTRACT

BACKGROUND: Suicide is a leading cause of death among adolescents worldwide. Suicide is a complex multifactorial issue and, in 2025, became the third-leading cause of death among individuals aged 15-29. We sought to evaluate the effectiveness of technology-assisted interventions (TIs) in reducing both suicidal behaviour and non-suicidal self-injury among adolescents.

METHODS: For this meta-analysis, we searched the EBSCO (APA PsycArticles, APA PsycInfo, MEDLINE, APA PsycTherapy, Psychology and Behavioral Sciences Collection), PubMed and Cochrane databases from inception until May 2025, seeking out articles featuring data (quantitative outcomes related to suicidal ideation or behaviour) on evaluated suicide or self-harm interventions among children and adolescents (aged 13-18) that incorporated digital technologies in some manner. We used random effects meta-analysis to estimate the effect size for suicidal ideation reduction. We assessed heterogeneity using the I² statistic, and, due to the small number of considered studies, publication bias was assessed using an adaptation of Cochrane’s guidelines for the assessment of bias risk. The review was registered with INPLASY, with the code INPLASY202570073.

RESULTS: After applying the eligibility criteria, six studies were selected for the analysis. Although the initial conceptual aim pertained to suicidal risk and self-harm more broadly, suicidal ideation was the only outcome consistently reported across the eligible studies; therefore, it served as the primary meta-analytic outcome.

CONCLUSIONS: The results highlight that technology-assisted interventions yield an overall statistically significant moderate reduction in suicidal ideation, providing valuable support for the implementation of such interventions during adolescence, although further rigorous research is needed to strengthen the evidence base.

PMID:42023461 | DOI:10.62641/aep.v54i2.2089