Tag: pubmed

JAMA Otolaryngol Head Neck Surg. 2025 Mar 6. doi: 10.1001/jamaoto.2024.5409. Online ahead of print.

ABSTRACT

IMPORTANCE: Up to 80% of survivors of head and neck squamous cell carcinoma (HNSCC) currently or previously smoked. Thus, tobacco use is a major modifiable risk factor for HNSCC, even in the era of human papillomavirus (HPV)-associated disease. However, how smoking underlies chromosomal and epigenetic changes that are associated with HNSCC outcomes remains unclear.

OBJECTIVE: To characterize genetic and molecular differences and associated biological pathways in patients with HNSCC based on smoking history.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included patients with a confirmed diagnosis of HNSCC from the Cancer Genome Atlas via cBioPortal data independent of HPV status. Data were analyzed between April 2023 and May 2024.

MAIN OUTCOMES AND MEASURES: Smoking history was defined as individuals who smoked (currently or previously) compared with nonsmokers (never smoked). Genetic and molecular differences of interest were single nucleotide variation, copy number alteration, DNA methylation, and messenger RNA (mRNA) expression. Accounting for multiple testing, we reported the false discovery rate (FDR), with a statistically significant FDR of 0.05 or less. Potential functions and pathways were investigated using the Panther classification system, and the Fisher exact test was used for overrepresentation, using the Reactome pathway dataset as a guide. Associations between smoking-related genetic alterations and overall survival were analyzed using log-rank tests.

RESULTS: Of 511 participants, 135 (26.4%) were female, and the mean (SD) age was 60.8 (11.9) years. People who smoked (389 [76.1%]) demonstrated significantly enriched copy number alterations on 9 genes located on chromosome 11q13 compared with nonsmokers (122 [23.9%]; FDR, 0.044-0.046). Two genes, FADD and CTTN, were significantly highly methylated in nonsmokers. Also, PPFIA1, FGF19, CCND1 and LTO1 were highly expressed in mRNA in those who smoked, while FADD mRNA expression was negatively correlated with FADD DNA methylation in nonsmokers (Pearson r = -0.53; 95% CI, -0.59 to -0.49) and those who smoked (Pearson r = -0.57; 95% CI, -0.63 to -0.51). People who smoked with altered FADD had higher risk of dying than those with FADD unaltered (hazard ratio, 1.40; 95% CI, 1.004-1.96). Pathway analysis showed the significant genes were collectively associated with cellular processes and biological regulations, including olfactory signaling and the PI3K/AKT network.

CONCLUSION AND RELEVANCE: The results of this cohort study suggest that there may be patterned genetic and molecular differences in patients with HNSCC based on smoking history, especially genes located on chromosome 11q13. These genomic differences due to smoking make smoking a modifiable risk factor for HNSCC outcomes.

PMID:40048195 | DOI:10.1001/jamaoto.2024.5409

JAMA Netw Open. 2025 Mar 3;8(3):e250137. doi: 10.1001/jamanetworkopen.2025.0137.

ABSTRACT

IMPORTANCE: Screening for adverse social determinants of health (SDOH) in the emergency department (ED) may help reduce health disparities in underserved populations.

OBJECTIVE: To understand barriers and facilitators to screening, documenting, and addressing adverse SDOH in a diverse sample of US EDs.

DESIGN, SETTING, AND PARTICIPANTS: This qualitative study used in-depth interviews with leaders of a purposive sample of EDs across urban, rural, academic, and community settings who self-reported screening for adverse SDOH on a prior National Emergency Department Inventory (NEDI) USA survey. EDs that completed the 2022 NEDI-USA survey and reported adverse SDOH screening were eligible for recruitment. Eligible participants were interviewed in April to September 2023. Inductive thematic analysis was conducted from September 2023 to January 2024 to identify themes and concepts.

MAIN OUTCOMES AND MEASURES: Themes and concepts related to ED practices for adverse SDOH screening and referral.

RESULTS: From 77 eligible EDs, 27 leaders agreed to be interviewed, (18 [66.7%] female; mean [range] age, 44 [30 to 63] years; mean [range] time in current role, 3.25 [<1 to 12] years). Participants worked in a variety of leadership roles (eg, chair or medical, nursing, or operations director). Findings centered around heterogeneity in ED adverse SDOH screening and documentation practices; skepticism of utility of ED adverse SDOH screening and referral; drivers of ED adverse SDOH screening, such as regulatory mandates for the expansion of adverse SDOH screening; resource, staffing, and time constraints in adverse SDOH screening and linkage to services processes; and recommendations and suggestions for improving the implementation of ED adverse SDOH screening, such as tailoring validated tools to the ED context and ED stakeholder engagement in designing the screening process. Other suggestions included having additional dedicated screening staff, particularly social workers, and strengthening relationships with existing non-ED SDOH initiatives and community resources dedicated to addressing adverse SDOH.

CONCLUSIONS AND RELEVANCE: This qualitative study of US EDs describes an overview of practices and challenges surrounding adverse SDOH screening and identified novel solutions and areas where more research is needed for the successful implementation of adverse SDOH screening in the ED setting. At the policy level, regulatory mandates instituting adverse SDOH screening should include provisions for funding to support patient needs identified by screening. Additional research on development and implementation of ED adverse SDOH screening programs is needed.

PMID:40048167 | DOI:10.1001/jamanetworkopen.2025.0137

JAMA Netw Open. 2025 Mar 3;8(3):e250160. doi: 10.1001/jamanetworkopen.2025.0160.

ABSTRACT

IMPORTANCE: Respiratory pathogen testing has been a common deimplementation focus. The COVID-19 pandemic brought new considerations for respiratory testing; recent trends in testing rates are not well understood.

OBJECTIVE: To measure trends in respiratory testing among encounters for acute respiratory infections among children and adolescents (aged <18 years) from 2016 to 2023, assess the association of COVID-19 with these trends, and describe associated cost trends.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective serial cross-sectional study included emergency department (ED) encounters and hospitalizations in US children’s hospitals among children and adolescents with a primary acute infectious respiratory illness diagnosis. Data were ascertained from the Pediatric Health Information System database from January 1, 2016, to December 31, 2023.

EXPOSURE: Respiratory pathogen testing.

MAIN OUTCOMES AND MEASURES: The primary outcome was the percentage of encounters with respiratory testing over time. Interrupted time series models were created to assess the association of COVID-19 with testing patterns. The inflation-adjusted standardized unit cost associated with respiratory testing was also examined.

RESULTS: There were 5 090 923 eligible encounters among patients who were children or adolescents (mean [SD] age, 3.36 [4.06] years); 55.0% of the patients were male. Among these encounters, 87.5% were ED only, 77.9% involved children younger than 6 years, and 94.5% involved children without complex chronic conditions. Respiratory testing was performed in 37.2% of all encounters. The interrupted time series models demonstrated increasing prepandemic testing rates in both ED-only encounters (slope, 0.26 [95% CI, 0.21-0.30]; P < .001) and hospitalizations (slope, 0.12 [95% CI, 0.07-0.16]; P < .001). Increases in respiratory testing were seen at the onset of the COVID-19 pandemic in both ED-only encounters (level change, 33.78 [95% CI, 31.77-35.79]; P < .001) and hospitalizations (level change, 30.97 [95% CI, 29.21-32.73]; P < .001), associated initially with COVID-19-only testing. Postpandemic testing rates remained elevated relative to prepandemic levels. The percentage of encounters with respiratory testing increased from 13.6% [95% CI, 13.5%-13.7%] in 2016 to a peak of 62.2% [95% CI, 62.1%-62.3%] in 2022. While COVID-19-only testing decreased after 2020, other targeted testing and large-panel (>5 targets) testing increased. The inflation-adjusted standardized unit cost associated with respiratory testing increased from $34.2 [95% CI, $33.9-$34.6] per encounter in 2017 to $128.2 [95% CI, $127.7-$128.6] per encounter in 2022.

CONCLUSIONS AND RELEVANCE: The findings of this cross-sectional study suggest that respiratory testing rates have increased over time, with large increases at the onset of the COVID-19 pandemic that have persisted. Respiratory testing rates and related costs increased significantly, supporting a need for future deimplementation efforts.

PMID:40048166 | DOI:10.1001/jamanetworkopen.2025.0160

JAMA Netw Open. 2025 Mar 3;8(3):e250201. doi: 10.1001/jamanetworkopen.2025.0201.

ABSTRACT

IMPORTANCE: Understanding how wealth influences the end-of-life experience is crucial for improving patient care and policy, particularly with regard to symptom burden.

OBJECTIVE: To examine the prevalence of 12 end-of-life symptoms by wealth categories; the association between wealth and a composite measure of high symptom burden; and whether this association is mediated by multimorbidity, functional impairment, or dementia.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from the Health and Retirement Study (HRS), a nationally representative survey of older adults in the US, on decedents who died between January 1, 2000, and February 28, 2021, from proxy-reported exit interviews through February 28, 2021. Decedents were HRS participants aged 65 years or older who had completed a core interview within 24 months before death and had a proxy-reported exit interview. The data analysis was performed from October 6, 2023, through November 26, 2024.

EXPOSURES: Wealth (assets opposed to income) was categorized into low (bottom quartile, <$6000), medium (middle 2 quartiles, $6000-$120 000), and high (top quartile, >$120 000).

MAIN OUTCOMES AND MEASURES: The presence of 12 individual end-of-life symptoms and a composite measure of high symptom burden (≥7 symptoms) were analyzed using modified Poisson regression. Mediators included multimorbidity, functional impairment, and dementia. Models were adjusted for age, sex, marital status, race and ethnicity, education, childhood socioeconomic status, HRS proxy respondent relationship, location of death, survey timing, year of death, and private insurance.

RESULTS: Of 8976 decedents (mean [SD] age, 81.3 [8.6] years; 4927 women [55.1%] women) in the cohort, 2197 (22.5%) were included in the low wealth category, 4534 (50.5%) in the medium wealth category, and 2245 (27.1%) in the high wealth category. Decedents with lower wealth had a higher prevalence of end-of-life symptoms. High symptom burden was most common in the low wealth group (800 decedents [37.0%]) vs the medium (1301 decedents [28.0%]) and high wealth (512 decedents [23.2%]) groups. Low wealth was associated with a significantly increased risk of high symptom burden vs medium wealth (adjusted risk ratio, 0.79; 95% CI, 0.73-0.87) and high wealth (adjusted risk ratio, 0.71; 95% CI, 0.63-0.79). Multimorbidity, functional impairment, and dementia were more common in the low wealth group and mediated this association, with functional impairment being the strongest mediator.

CONCLUSIONS AND RELEVANCE: This cohort study found that lower wealth was associated with a higher symptom burden at the end of life, mediated in part by higher rates of multimorbidity, functional impairment, and dementia. These findings highlight the need for policies and programs to support patients with lower financial resources to improve end-of-life experiences and mitigate wealth disparities.

PMID:40048165 | DOI:10.1001/jamanetworkopen.2025.0201

JAMA Netw Open. 2025 Mar 3;8(3):e250214. doi: 10.1001/jamanetworkopen.2025.0214.

ABSTRACT

IMPORTANCE: Offering pregnant women financial rewards to stop smoking is associated with a more than 2-fold increase in smoking cessation and is cost-effective; however, it is possible that the association is the result of gaming of the outcome measure (eg, not smoking for 24 hours before outcome measurement using a carbon monoxide breath test). Birth weight is an outcome measure that is independent of the rewards process.

OBJECTIVE: To examine birth weight change associated with offering financial rewards for smoking cessation to pregnant women, and to estimate the average expected birth weight change for neonates born to those who quit smoking because of the rewards.

DATA SOURCES: Medline, American Psychological Association PsycInfo, Embase, Cochrane (the Cochrane Central Register of Controlled Trials, the Cochrane Tobacco Addiction Group Specialized Register, and the Cochrane Database of Systematic Reviews), and PubMed were searched from their inception until December 5, 2023, for published reports of trials of incentives for abstinence from substance use among pregnant women.

STUDY SELECTION: Only trials using an experimental design allowing treatment effects to be attributed to the reward intervention were included. For this review update, potentially relevant studies retrieved were screened by a reviewer.

DATA EXTRACTION AND SYNTHESIS: Data were pooled using both fixed-effects and random-effects models. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed.

MAIN OUTCOMES AND MEASURES: The primary outcomes were mean (SD) birth weight, birth weight for gestational age z score, and numbers of newborns with low birth weight (<2.5 kg) and who were small for gestational age (<10th percentile).

RESULTS: Fixed-effects intention-to-treat analysis including 8 trials (2351 participants)-2 trials from the UK (1475 participants), 1 trial from France (407 participants), and 5 trials from the US (469 participants)-estimated a statistically significant mean 46.30 g (95% CI, 0.05 to 92.60 g) birth weight increase associated with adding financial rewards for smoking cessation. Complier average causal effects analysis (2239 participants) estimated a mean 206.00 g (95% CI, -69.12 to 481.14 g) increase for neonates born to smokers who quit because of rewards, but the increase was not statistically significant. There was no association with low birth weight or birth weight adjusted for gestational age, although fewer neonates were born small for gestational age, particularly if cessation was associated with rewards (complier average causal effects risk difference -17.70%; 95% CI, -34.90% to -0.42%).

CONCLUSIONS AND RELEVANCE: In this meta-analysis, neonates were significantly heavier when pregnant women were offered the addition of financial rewards contingent on smoking cessation, supporting the effectiveness and, therefore, cost-effectiveness of financial rewards in this health care setting.

PMID:40048164 | DOI:10.1001/jamanetworkopen.2025.0214

JAMA. 2025 Mar 6. doi: 10.1001/jama.2024.18781. Online ahead of print.

NO ABSTRACT

PMID:40048160 | DOI:10.1001/jama.2024.18781

JAMA Otolaryngol Head Neck Surg. 2025 Mar 6. doi: 10.1001/jamaoto.2024.3738. Online ahead of print.

ABSTRACT

IMPORTANCE: Patients with head and neck squamous cell cancer (HNSCC) are at a greater risk of developing pulmonary metastases and/or second primary lung cancer. However, it remains uncertain whether lung screening in these patients, when the initial staging studies are negative, confers any survival benefit.

OBJECTIVE: To evaluate long-term cancer survival outcomes in patients with HNSCC undergoing chest radiography vs low-dose computed tomography screening for pulmonary metastasis and/or second primary lung cancer.

DESIGN, SETTING, AND PARTICIPANTS: This randomized parallel trial was conducted at a large academic hospital in Canada enrolling treatment-naive patients with de novo HNSCC from September 2015 to December 2022. Eligible patients did not meet the criteria for lung screening established by the US National Comprehensive Cancer Network guidelines. Participants were randomized to chest radiography or low-dose computed tomography screening groups. Data were analyzed from March to August 2024.

INTERVENTION OR EXPOSURE: Comparison of chest radiography vs low-dose computed tomography screening methods.

MAIN OUTCOMES AND MEASURES: Primary outcomes were the lung cancer detection rate measured by comparing the sensitivity and specificity of low-dose computed tomography with chest radiography. Secondary outcomes were overall survival and disease-free survival.

RESULTS: A total of 137 patients (mean [SD] age, 65.1 [14.1] years; 34 [24.8%] females and 103 [75.2%] males) were included and randomized, 68 (49.6%) to chest radiography and 69 (50.4%) to low-dose computed tomography. Nine of 137 patients (6.5%) developed a second primary lung cancer (6 patients) or lung metastases (3 patients). There were no clinically meaningful differences in survival outcomes between the 2 groups (hazard ratio, 1.2; 95% CI, 0.4-3.9). Chest radiography exhibited a relatively low sensitivity of 66.7% but a specificity of 100%. Low-dose computed tomography demonstrated both high sensitivity (100%) and specificity (100%), for an overall accuracy of 100%.

CONCLUSIONS AND RELEVANCE: The findings of this randomized parallel trial indicate that low-dose computed tomography exhibits statistically significant superior sensitivity compared with chest radiography for diagnosing lung metastases and second primary lung cancer. However, there were no important differences in survival rates. These results hold practical significance, offering valuable insights to clinicians who are guiding decisions regarding lung screening protocols.

TRIAL REGISTRATION: ISRCTN10954990.

PMID:40048159 | DOI:10.1001/jamaoto.2024.3738

JMIR Mhealth Uhealth. 2025 Mar 6;13:e63805. doi: 10.2196/63805.

ABSTRACT

BACKGROUND: Chronic heart failure (CHF) has become a serious threat to the health of the global population. Self-management is the key to treating CHF, and the emergence of mobile health (mHealth) has provided new ideas for the self-management of CHF. Despite the many potential benefits of mHealth, public utilization of mHealth apps is low, and poor health literacy (HL) is a key barrier to mHealth use. However, the mechanism of the influence is unclear.

OBJECTIVE: The aim of this study is to explore the dyadic associations between HL and mHealth usage intentions in dyads of patients with CHF and their caregivers, and the mediating role of mHealth perceived usefulness and perceived ease of use in these associations.

METHODS: This study had a cross-sectional research design, with a sample of 312 dyads of patients with CHF who had been hospitalized in the cardiology departments of 2 tertiary care hospitals in China from March to October 2023 and their caregivers. A general information questionnaire, the Chinese version of the Heart Failure-Specific Health Literacy Scale, and the mHealth Intention to Use Scale were used to conduct the survey; the data were analyzed using the actor-partner interdependence mediation model.

RESULTS: The results of the actor-partner interdependent mediation analysis of HL, perceived usefulness of mHealth, and mHealth use intention among patients with CHF and their caregivers showed that all of the model’s actor effects were valid (β=.26-0.45; P<.001), the partner effects were partially valid (β=.08-0.20; P<.05), and the mediation effects were valid (β=.002-0.242, 95% CI 0.003-0.321; P<.05). Actor-partner interdependent mediation analyses of HL, perceived ease of use of mHealth, and mHealth use intention among patients with CHF and caregivers showed that the model’s actor effect partially held (β=.17-0.71; P<.01), the partner effect partially held (β=.15; P<.01), and the mediation effect partially held (β=.355-0.584, 95% CI 0.234-0.764; P<.001).

CONCLUSIONS: Our study proposes that the HL of patients with CHF and their caregivers positively contributes to their own intention to use mHealth, suggesting that the use of mHealth by patients with CHF can be promoted by improving the HL of patients and caregivers. Our findings also suggest that the perceived usefulness of patients with CHF and caregivers affects patients’ mHealth use intention, and therefore patients with CHF and their caregivers should be involved throughout the mHealth development process to improve the usability of mHealth for both patients and caregivers. This study emphasizes the key role of patients’ perception that mHealth is easy to use in facilitating their use of mHealth. Therefore, it is recommended that the development of mHealth should focus on simplifying operational procedures and providing relevant operational training according to the needs of the patients when necessary.

PMID:40048155 | DOI:10.2196/63805

JMIR Pediatr Parent. 2025 Mar 6;8:e59215. doi: 10.2196/59215.

ABSTRACT

BACKGROUND: Over the past 3 decades, digital and screen media have evolved from broadcast, stationary platforms to a complex environment of interactive, omnipresent, mobile media. Thus, clinical guidance centered around unidimensional concepts such as “screen time” must be modernized to help families navigate the intricate digital ecosystems of readily available entertainment and information.

OBJECTIVE: This study aimed to identify and examine distinct latent profiles of media use in families with young children. We hypothesized that latent profile analysis (LPA) would identify different media use profiles characterized by more heavy, reactive, individual, and permissive media use and more intentional, regulated, or shared uses of media.

METHODS: We analyzed data from 398 preschool-aged children. English-speaking parents were recruited through community settings. Participants completed surveys regarding several aspects of family media use, such as child device use or activities, parent concerns and attitudes, limit setting and mediation, parent media use, and technology interference, examined in an LPA. The number of latent media profiles was determined using Bayesian Information Criteria. Parents also completed validated scales of parenting stress, depression symptoms, parenting style, child behavior, child sleep, and household disorganization. Multivariable logistic regression was used to examine parent, child, and household predictors of group membership.

RESULTS: The LPA yielded 2 distinct groups that differed in the duration of media used by parents and children, to calm children or help them fall asleep. Statistically significant differences between groups included: families in group 1 (n=236, which we termed social-emotional drivers) had parents who preferred interactions via text or email to in-person (P=.01) and were more likely to use media to calm their children (P=.03); in contrast, families in group 2 (n=162, intentional media) used more task-oriented media, like audio and nongame apps (P=.01), had more concerns about effects of media on child language development (P=.04), and used more media restrictions (P=.01). In regression models, female sex of the parent respondent, greater number of siblings, and later child sleep midpoint independently predicted group 1 membership.

CONCLUSIONS: Findings suggest divergent family media use patterns that can be categorized into 2 main media user groups: those using media to buffer social situations or regulate emotions and those planning mobile device use around functional purposes and concerns around media exposure. Profiles were associated with household size and child sleep. More research is needed to examine the impact of social and emotional uses of media on child outcomes.

PMID:40048153 | DOI:10.2196/59215

Musculoskelet Surg. 2025 Mar 6. doi: 10.1007/s12306-025-00888-8. Online ahead of print.

ABSTRACT

BACKGROUND: Given the increased life expectancy, an increasing number of proximal femur fractures (PFFs) will occur in centenarian patients. In these patients, PFF has a serious impact on quality of life with high morbidity and mortality and an increase in total cost of care. Therefore, it is important to understand the surgical outcome for this group of patients defining preoperative risk factors.

MATERIAL AND METHOD: From January 1, 2010, to December 31, 2020, 33 centenarian patients with PFF were treated with locked nail or hemiarthroplasty. Mortality risk factors were assessed. Several survival-related factors were evaluated using the log-rank test and univariate Cox regression statistical analysis for categorical and quantitative variables, respectively. Significative variables at the univariate analysis were included in the Cox multivariate model, using Backward Elimination technique. A P value of < 0.05 was considered statistically significant for all tests. Software STATA 17.0 was used for statistical analysis.

RESULTS: Centenarians with femoral neck and pertrochanteric fracture were treated with hemiarthroplasty and locked nail, respectively. At the time of admission, only 21% had normal hemoglobin value. Postoperatively, a moderate anemia was observed in 45% of patients and a severe dementia was observed in 18%. In 85% of patients, Charlson Index was less than 3. At the time of admission, 30% of them were considered independent in walking and activity of daily living (ADL), but at discharge ambulation was worsened and none of them were independent in ADL at one month. Postoperative delirium was observed in 30% of patients preventing a complete rehabilitation program. One month after discharge 27% of patients were readmitted in hospital for complications. Mortality was 16%, 59%, and 66% at 1-6-12 months, respectively. At a multivariate evaluation, male, severe anemia and Functional Ambulation Categories (FAC) score < 3 at admission were the only variables statistically related to high risk of mortality.

CONCLUSION: The anemia value was found to be related to mortality, and a quick restoration of these values is necessary. Geriatric and functional status scores, especially FAC score, are related to survival, providing an accurate prognosis. In our study, a high percentage of patients are unable to return to their pre-fracture level of independence. This suggests that the prognosis for centenarian patients with PFF may be as poor as previously thought.

PMID:40048138 | DOI:10.1007/s12306-025-00888-8