Tag: pubmed

JAMA Health Forum. 2025 Feb 7;6(2):e245565. doi: 10.1001/jamahealthforum.2024.5565.

ABSTRACT

IMPORTANCE: Rising out-of-pocket costs of maternal health care for people with commercial insurance may affect use of health care and outcomes. There are stark racial and ethnic disparities in outcomes, but little is known about differences in spending.

OBJECTIVE: To measure differences in out-of-pocket spending for maternity care by race and ethnicity.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional study used administrative data from Blue Cross Blue Shield of Massachusetts from January 1, 2018, through December 31, 2022, for pregnancies, deliveries, and 42-day postpartum care. Participants were continuously enrolled during pregnancy, delivery, and 42 days post partum (collectively termed maternity episode).

EXPOSURES: The primary characteristic of interest was the birthing person’s race and ethnicity.

MAIN OUTCOMES AND MEASURES: The primary outcome was total out-of-pocket spending during the maternity episode. Out-of-pocket spending was measured separately for the pregnancy period, prenatal services, and delivery, by type of cost sharing, and as a percentage of the median household income in the patient’s census tract (using American Community Survey data). Race and ethnicity were measured via self-report and imputation.

RESULTS: The analytic sample included 87 253 maternity episodes among 76 826 unique birthing persons (mean [SD] age, 32.4 [4.7] years; 99.8% female) between 2018 and 2022; among maternity episodes, 8572 birthing persons (9.8%) were Asian, 3331 (3.8%) were Black, 6872 (7.9%) were Hispanic, and 68 478 (78.5%) were White. Mean out-of-pocket spending for the maternity episode was highest among Black birthing people ($2398 [$426]), followed by Hispanic ($2300 [$572]), Asian ($2202 [$603]), and White ($2036 [$1547]) birthing people (P < .001). These differences remained statistically significant after adjusting for health and demographic characteristics. The differences were largest in the prenatal period and for coinsurance payments. Black (1003 [30.1%]) and Hispanic (2302 [33.5%]) birthing people were more likely than Asian (1569 [18.3%]) and White (12 600 [18.4%]) birthing people to be enrolled in plans with high coinsurance, but not plans with high deductibles (3317 [38.7%] for Asian, 1232 [37.0%] for Black, 2350 [34.2%] for Hispanic, and 24 515 [35.8%] for White birthing people).

CONCLUSIONS AND RELEVANCE: In this study, differences in out-of-pocket maternity spending among the commercially insured were associated with differences in coinsurance rates. These costs could lead people to forgo needed health care or other basic needs that support health (eg, food or housing). Changes to health plan benefit design could improve equity in out-of-pocket maternity spending and its consequences.

PMID:40019741 | DOI:10.1001/jamahealthforum.2024.5565

Can J Public Health. 2025 Feb 28. doi: 10.17269/s41997-024-00992-5. Online ahead of print.

ABSTRACT

OBJECTIVES: Although past studies have identified sex differences in child maltreatment experiences and poor mental and physical health‒related outcomes, more research is needed to understand child maltreatment among sexual minorities (i.e., those who identify as other than heterosexual) and how child maltreatment and sexual identity are related to depression, anxiety, and at-risk alcohol and cannabis use among emerging adults.

METHODS: Data were drawn from the longitudinal Well-Being and Experiences (WE) Study collected from 2017 (14 to 17 years) to 2022 (18 to 23 years) from Manitoba, Canada (n = 584). Descriptive statistics and logistic regression models were computed.

RESULTS: Compared to heterosexual or straight sexual identity: homosexual, gay or lesbian; bisexual; and different or other identity were associated with an increased likelihood of experiencing child maltreatment, with the most robust relationships for bisexual identity and all child maltreatment outcomes. Indicating “I don’t know” for sexual identity compared to heterosexual identity was associated with 7.45 increased odds of exposure to intimate partner violence in adjusted models. Bisexual identity compared to heterosexual identity had the most robust association, with increased odds of depression, anxiety, at-risk alcohol use, and at-risk cannabis use. Findings provide some evidence to suggest that trends may be worse for some mental health and substance use outcomes among sexual minorities who also experience child maltreatment.

CONCLUSION: Preventing child maltreatment among all children, including youth identifying as other than heterosexual, is a public health priority. Such efforts will work towards optimizing mental health and reducing substance use in early adulthood.

PMID:40019705 | DOI:10.17269/s41997-024-00992-5

3D Print Med. 2025 Feb 28;11(1):8. doi: 10.1186/s41205-025-00258-x.

ABSTRACT

BACKGROUND: Patients who undergo laparoscopic right hemicolectomy often have vascular anomalies, creating challenges for surgeons. Preoperative identification of vascular anomalies and intraoperative precise navigation can enhance surgical safety and reduce the difficulty of the procedure. Accordingly, this study aimed to explore and evaluate the application of three-dimensional (3D) reconstruction and printing technology in laparoscopic right hemicolectomy and its assistance in preoperative planning and intraoperative navigation.

METHOD: 11 3D-reconstructed images and printed models of right hemicolectomy vasculature were preoperatively created to assist in developing individualized surgical plans. Intraoperatively, essential vessels (gastrocolic trunk of Henle, GTH) were identified and located with the help of the 3D printed models. Additionally, 36 cases without the assistance of 3D printing were retrospectively collected for the control group. Statistical analysis was performed to evaluate the impact of the 3D printed models on surgery-related characteristics.

RESULTS: The 3D-printed models accurately depicted anatomical structures, particularly the positions and adjacent relationships of essential vessels, including the superior mesenteric artery (SMA), superior mesenteric vein (SMV), GTH and related arterial/venous branches. The operation time was significantly lower in the 3D printing group (198.6 ± 8.8 min in 3D printing group vs. 230.7 ± 47.5 min in control group, P = 0.025).

CONCLUSIONS: In conclusion, this study represents a novel vascular 3D printed modelfor surgical planning and intraoperative navigation in laparoscopic right hemicolectomy. It underscores the potential clinical applications of 3D printing in this context. Preoperative identification of vascular anomalies and precise intraoperative navigation can feasibly reduce surgical difficulty and enhance safety.

PMID:40019697 | DOI:10.1186/s41205-025-00258-x

J Gastrointest Cancer. 2025 Feb 28;56(1):72. doi: 10.1007/s12029-025-01195-y.

ABSTRACT

BACKGROUND: Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract. However, there are limited studies on the latest survival trends and the impact of racial disparities on GIST patients’ outcomes.

METHODS: We obtained 12,808 GIST patients between 2001 and 2020 from the Surveillance, Epidemiology, and End Results (SEER) database in 17 original sites. Analysis utilizing the Kaplan-Meier method explored survival disparities and Cox regression was employed to assess the impact of prognostic factors.

RESULTS: Our study revealed an increase in the GIST incidence per 100,000 people over the past two decades, along with a rise in relative survival rate (RSR). Age, gender, social groups, tumor site, size, stage, socioeconomic status, marital status, surgery, and systemic therapy are prognostic factors. Subgroup analysis indicated higher incidence and poorer survival trends among Non-Hispanic Blacks (NHB) (Incidence, 1.88 per 100,000 people; 120 Mo RSR, 61.6%, 2001 to 2020). Colonic GIST has the worst prognosis among different locations, while rectal and anal GIST has the best. Within these groups, Non-Hispanic White (NHW) with colonic GIST have the poorest prognosis (HR, 2.032; 95% CI, 1.476-2.798), whereas NHB with rectal and anal GIST have the best prognosis.

CONCLUSION: The incidence and RSR of GIST both increased during 2001-2020. NHW with colonic GIST showed poorer survival, while NHB with rectal and anal GIST revealed better survival, highlighting the importance of targeted clinical management for GIST.

PMID:40019688 | DOI:10.1007/s12029-025-01195-y

Radiol Med. 2025 Feb 28. doi: 10.1007/s11547-025-01965-5. Online ahead of print.

ABSTRACT

PURPOSE: The distribution analysis of the morphologic characteristics and spatial relations among brain metastases (BMs) to guide screening and early diagnosis.

MATERIAL AND METHODS: This retrospective study analysed 4314 BMs across 30 brain regions from MRIs of 304 patients. This paper proposed a unified analysis model based on persistent homology (PH) and graph modelling to provide a comprehensive portrait of BMs distribution. Spatial relationships are quantified through dynamic multiple-scale graphs constructed with Rips filtration. The multi-scale centrality importance and clustering coefficients are extracted to decode BMs spatial relations. Morphologic BMs characteristics are further analysed by varying radius and volume values that are considered as clinically influential factors. Finally, two-tailed proportional hypothesis testing is used for BM statistical distribution analysis.

RESULTS: For spatial analysis, results have shown a statistical increase in the proportions of high-level centrality BMs at the left cerebellum (p<0.01). BMs rapidly form graphs with high clustering rather than those with high centrality. For demographic analysis, the cerebellum and frontal are the top high-frequency areas of BMs with 0-4 and 5-10 radii. Statistical increases in the proportions of BMs at cerebellum (p<0.01).

CONCLUSION: Results indicate that distributions of both BMs spatial relations and demographics are statistically non-random. This research offers novel insights into the BMs distribution analysis, providing physicians with the BMs demographic to guide screening and early diagnosis.

PMID:40019681 | DOI:10.1007/s11547-025-01965-5

Discov Oncol. 2025 Feb 28;16(1):252. doi: 10.1007/s12672-025-01989-3.

ABSTRACT

PURPOSE: Colorectal cancer (CRC) is the third most common cancer globally, necessitating novel biomarkers for early diagnosis and treatment. This study proposes an efficient pipeline leveraging an integrated bioinformatics and machine learning framework to enhance the identification of diagnostic and prognostic biomarkers for CRC.

METHODS: A selection of methylated differentially expressed genes (MeDEGs) and features (genes) was made using both statistical and Machine learning (ML) approaches from publically available datasets. These genes were subjected to STRING network construction and hub genes estimation, separately. Also, essential miRNAs (micro-RNAs) and TFs (Transcription factors) as regulatory elements were revealed and findings were validated through scRNA-seq analysis, promoter methylation, gene expression levels correlated with pathological stage, and interaction with tumor-infiltrating immune cells.

RESULTS: Through an integrated analysis pipeline, we identified 27 hub genes, among which CTNNB1, GSK3B, IL-1β, MYC, PXDN, TP53, EGFR, SRC, COL1A1, and TGBF1 showed better diagnostic behaviour. Machine learning approach includes the development of K-Nearest Neighbors (KNN), Artificial Neural Networks (ANN), and Random Forest (RF) models using TCGA datasets, achieving an accuracy range between 99 and 100%. The Area Under the Curve (AUC) value for each model is 1.00, signifying good classification performance. The high expression of some diagnostic genes was associated with poor prognosis, concluding IL-1β as both a prognostic and diagnostic biomarker. Additionally, the NF-κB and microRNAs (miR-548d-3p, miR-548-ac) and TFs (NFκB and STAT5A) play a major role in the comprehensive regulatory network for CRC. Furthermore, hub genes such as IL-1β, TGFB1, and COL1A1 were significantly correlated with immune infiltrates, suggesting their potential role in CRC progression.

CONCLUSION: Overall, the elevated expression of IL-1β coupled with abnormal DNA methylation, and its consequent effect on the PI3K/Akt signaling pathway are relevant prognostic and therapeutic marker in CRC. Additional molecular candidates reveal insights into the epigenetic regulatory targets of CRC and their association with immune cell infiltration.

PMID:40019680 | DOI:10.1007/s12672-025-01989-3

Qual Life Res. 2025 Feb 28. doi: 10.1007/s11136-025-03931-0. Online ahead of print.

ABSTRACT

PURPOSE: To test the feasibility of a co-designed PROMs collection system for hospitalised older adults.

METHODS: A mixed-methods feasibility study was conducted sequentially across one acute and one sub-acute ward, over a 12-week period. Patients aged ≥ 60 years who discharged from hospital were eligible. The EQ-5D-5L with added items on fatigue and cognition was administered on discharge and at 3-6 months post-discharge. Administration was by either a research assistant or volunteer using a variety of modes (tablet computer, phone, SMS). Feasibility was evaluated using a feasibility framework to capture demand, implementation, practicality, and acceptability. Descriptive statistics were applied. Interviews were conducted with volunteers and analysed using deductive content analysis.

RESULTS: Completion rates indicated high demand (discharge = 84%, n = 110/131; follow-up = 81%, n = 90/110). At discharge, most completed PROMs on the tablet (57%) and 9% were administered by a volunteer. Most required assistance using the tablet (67%) and the average time to administer PROMs was longest for the tablet (17.9 min, SD = 3.3), followed by phone (8.8 min, SD = 4.4) and SMS (1.3 min, SD = 0.5). Fewer participants reported acceptability with using the tablet (61%) compared to SMS (100%). At follow-up, most completed PROMs on the phone (82%) and the average time to administer PROMs was less than discharge (4.9 vs. 13.4 min). Volunteers reported administering PROMs to unwell patients was challenging.

CONCLUSION: A co-designed PROMs collection system demonstrated feasibility in hospitalised older adults with phone and SMS having greatest acceptability. Administration of PROMs by volunteers was not feasible.

TRIAL REGISTRATION: ACTRN12623000576628. Registered 25 May 2023.

PMID:40019679 | DOI:10.1007/s11136-025-03931-0

Breast Cancer Res Treat. 2025 Feb 28. doi: 10.1007/s10549-025-07648-z. Online ahead of print.

ABSTRACT

PURPOSE: Evidence on the associations between categorical mammographic density and breast cancer risk by tumor invasiveness remains limited in Asian women. This large, population-based cohort study investigated the distribution of mammographic density by age and menopausal status, as well as its association with the risks of invasive breast cancer and ductal carcinoma in situ (DCIS) in South Korean women.

METHODS: Mammographic screening was performed on 6,365,522 women between 2009 and 2014 through the Korean National Cancer Screening Program. Mammographic parenchymal composition was classified using the fourth edition of Breast Imaging Reporting and Data System. We computed multivariable-adjusted hazard ratios and 95% confidence intervals (CIs) using Cox proportional hazards regression models for the association between mammographic parenchymal composition and the risk of invasive cancer and DCIS.

RESULTS: Overall, 40.6% of women had dense breasts, with the proportion decreasing with increasing age. A total of 44,468 incident breast cancer cases (0.7%) were documented. Compared with almost entirely fatty breasts, increasing mammographic density was associated with a higher risk of breast cancer (HR, 1.55; 95% CI 1.51-1.60 for scattered fibroglandular densities; HR, 2.14; 95% CI 2.08-2.21 for heterogeneously dense breasts; and HR, 2.59; 95% CI 2.50-2.69 for extremely dense breasts). Associations between mammographic density and breast cancer risk were similar for invasive cancer and DCIS, and did not vary significantly by menopausal status.

CONCLUSIONS: Mammographic density may be a significant risk factor for both invasive cancer and DCIS, regardless of menopausal status. It should be incorporated into breast cancer risk stratification and screening strategies.

PMID:40019668 | DOI:10.1007/s10549-025-07648-z

Diabet Med. 2025 Feb 28:e70018. doi: 10.1111/dme.70018. Online ahead of print.

ABSTRACT

AIMS: Effective diabetes management requires adherence to medication regimens and nutritional guidelines, underscoring the importance of health literacy. Our study aimed to develop and validate diabetes and nutrition knowledge questionnaires and correlate diabetes-specific health literacy with glucose metrics in people with type 1 and type 2 diabetes.

METHODS: In a cross-sectional study at a Swiss tertiary centre, questionnaires were developed to assess diabetes and nutrition knowledge in 289 participants with type 1 diabetes on insulin pumps or basal-bolus insulin and 222 participants with type 2 diabetes with or without insulin. Questionnaire validation involved content and construct validity established by a multidisciplinary team, and measurement properties were evaluated using the Rasch model. Multiple linear regression was performed to analyse the relationship between scores and glucose metrics.

RESULTS: The questionnaire demonstrated strong content and construct validity, with minor item misfits identified. In type 1 diabetes participants, higher nutrition knowledge scores (≥9/10) were significantly associated with reduced HbA1c levels (-5 mmol/mol or -0.47%, p < 0.05) and increased TIR (+9.2%, p < 0.05). No significant associations were observed in type 2 diabetes after adjusting for confounders, such as gender, BMI and diabetes duration.

CONCLUSIONS: We developed and validated a questionnaire encompassing diabetes and nutrition knowledge, tailored to diabetes type and treatment strategy. Psychometric analysis demonstrated robust measurement properties for assessing health literacy across diverse diabetes populations. Better nutrition knowledge was significantly linked to improved glycaemic control in type 1 diabetes, reflected by lower HbA1c and increased TIR.

PMID:40019655 | DOI:10.1111/dme.70018

Orthod Craniofac Res. 2025 Feb 28. doi: 10.1111/ocr.12912. Online ahead of print.

ABSTRACT

BACKGROUND: Orofacial myofunctional therapy (OMT) has emerged as an alternative and adjunct for the treatment of sleep-disordered breathing (SDB) in adults and children. While OMT efficacy has been demonstrated, the morphofunctional mechanisms triggered by each exercise remain poorly elucidated. This study aimed to characterise morphofunctional upper airway (UA) changes associated with established oropharyngeal exercises utilised to treat SDB by nasofibrolaryngoscopy (NFL).

METHODS: Thirteen OMT exercises were selected and analysed based on the relevant literature. Respecting inclusion and exclusion criteria, 15 healthy adult subjects of both sexes performed all the exercises, resulting in 390 video recordings of changes in UA dynamics through NFL, from the nasopharyngeal and oropharyngeal view. The video analyses were performed by three blinded ENT doctors using a specific instrument that included structural verification, movement type and intensity classification. Statistical analyses included the Fleiss Kappa Agreement Coefficient and the Friedman Test for comparison between exercises.

RESULTS: This original study used a methodology that allowed for the description and identification of which exercises produce greater mobility, stiffness and modification in the regions of the soft palate, pharyngeal/hypopharyngeal wall, retrolingual region and epiglottis. The 13 exercises analysed provided insights into their action mechanisms in the UA. The exercises that induce the most significant changes, for each pharyngeal region, were identified.

CONCLUSION: The analyses of the morphofunctional changes described in this study contribute to the understanding of how exercises used in OMT act, aiding in the selection of the most effective clinical approaches.

PMID:40018879 | DOI:10.1111/ocr.12912