Tag: pubmed

JAMA Health Forum. 2026 May 1;7(5):e260979. doi: 10.1001/jamahealthforum.2026.0979.

ABSTRACT

IMPORTANCE: Primary care improves population health, yet access is a challenge in the US. It is unclear how primary care use, access, and access disparities have changed since widespread adoption of telemedicine during the pandemic.

OBJECTIVE: To quantify trends in primary care use and determine the role of telemedicine in primary care access and access disparities for traditional Medicare beneficiaries.

DESIGN, SETTING, AND PARTICIPANTS: Serial cross-sectional study using 2017-2023 100% claims and administrative data for traditional Medicare beneficiaries continuously enrolled and alive for the given year. Data were analyzed from October 2024 to July 2025.

MAIN OUTCOMES AND MEASURES: Primary care visits per beneficiary, primary care access (defined as ≥1 virtual or in-person primary care visit in the year), and primary care continuity (Bice-Boxerman Index).

RESULTS: Among 258 324 127 person-years from 2017 to 2023, primary care visit rates decreased from 2.54 per person-year in 2017 to 2.27 per person-year in 2023, and access dropped from 61.9% to 59.8%. In 2023, virtual visits comprised 7% of primary care visits and 14% of beneficiaries who accessed primary care used telemedicine to do so. Disparities in access by race, geography, and income increased slightly from 2019 to 2023, and beneficiaries in historically underserved groups by race, geography, and income who accessed primary care were more likely than others to use telemedicine to do so. Primary care continuity decreased from 0.72 in 2019 to 0.65 in 2023; in 2023, continuity was slightly higher for those using telemedicine for primary care than for those who were not.

CONCLUSIONS AND RELEVANCE: This serial cross-sectional study found that across all traditional Medicare beneficiaries, primary care visit rates and access decreased, with virtual visits comprising a small share of previously in-person visits. Access disparities widened while those in underserved groups were more likely than others to use telemedicine for this access. Results suggest that telemedicine plays a small but potentially important role in primary care access.

PMID:42065879 | DOI:10.1001/jamahealthforum.2026.0979

J Phys Chem A. 2026 May 1. doi: 10.1021/acs.jpca.6c01093. Online ahead of print.

ABSTRACT

The fluorinated Criegee intermediate, FCHOO, is produced from the ozonolysis of hydrofluoroolefins (HFOs) which are next-generation refrigerants. Unimolecular decay of syn-FCHOO proceeds via a 1,3 ring closure pathway to fluorodioxirane and subsequent rearrangement and/or dissociation to many products including hydroxyl (OH) radicals that are detected experimentally. Vibrational activation of jet-cooled syn-FCHOO with two quanta of CH stretch (17.70 kcal mol^-1) leads to unimolecular decay via quantum mechanical tunneling at an energy slightly below the transition state barrier of 18.03 ± 0.25 kcal mol^-1, determined utilizing the high accuracy composite HEAT-345(Q)_Λ method. The observed unimolecular decay rate of (5.4 ± 1.6) × 10⁷ s^-1 is an order of magnitude slower than that predicted by statistical unimolecular reaction theory with quantum mechanical tunneling. The nonstatistical behavior originates from excitation of a CH stretch vibration that is orthogonal to the heavy atom motions along the reaction coordinate and slow intramolecular vibrational energy redistribution due to the sparse density of states.

PMID:42065861 | DOI:10.1021/acs.jpca.6c01093

J Epidemiol Glob Health. 2026 May 1. doi: 10.1007/s44197-026-00570-7. Online ahead of print.

ABSTRACT

BACKGROUND: The long-term effects of Percutaneous Endoscopic Gastrostomy (PEG) versus Nasogastric Tube (NG) placement on adult mortality and aspiration pneumonia are debated. This study aimed to compare these long-term risks using a large, multi-institutional retrospective database.

METHODS: This retrospective cohort study used de-identified data from the TriNetX US Collaborative Network (2005-2024). Adults undergoing PEG or NG tube placement were propensity score-matched (1:1), although swallowing study results were unavailable for matching. Primary outcomes over a 10-year follow-up were incident aspiration pneumonia and all-cause mortality. Analyses included Cox proportional hazards models, landmark analyses, and stratified analyses by NG tube placement frequency.

RESULTS: Among 34,539 matched pairs, PEG was associated with lower observed 30-day all-cause mortality (HR 0.53, 95% CI 0.51-0.56) but higher mortality during 31-365 days (HR 1.70, 1.59-1.81) and 1-10 years (HR 1.57, 1.49-1.65). In the overall matched cohort, PEG was associated with a higher long-term aspiration pneumonia risk (HR 1.66, 1.56-1.75). When stratified by NG tube placement frequency, the between-group mortality difference attenuated from HR 1.16 (1.12-1.19) at one placement to HR 0.74 (0.65-0.86) at ≥ 5 placements. The aspiration pneumonia association attenuated but remained statistically significant across all strata.

CONCLUSION: PEG was associated with a higher overall observed risk of aspiration pneumonia; however, this association attenuated with increasing NG tube placement frequency, and the observed mortality difference was no longer statistically significant among patients with repeated NG tube placements. These observational associations may reflect differences in NG tube placement frequency and clinical context within the comparator group, and may offer a clinical reference for tube access selection in similar patients.

PMID:42065858 | DOI:10.1007/s44197-026-00570-7

Community Ment Health J. 2026 May 1. doi: 10.1007/s10597-026-01650-5. Online ahead of print.

ABSTRACT

Psychological interventions are recommended for people under Crisis Resolution Home Treatment Teams (CRHTTs). Non-registered psychology roles (Assistant Psychologists (APs) and Trainee Associate Psychological Practitioners (TAPPs)) are potentially both cost and clinically effective for delivering brief interventions in CRHTTs. This study aimed to quantitatively examine routine outcome change associated with two brief, skills-based interventions (the Crisis Toolbox (CTB) and the Emotion Coping Skills (ECS)) delivered by APs and TAPPs in one CRHTT. A retrospective service evaluation of 490 service users who accessed either the CTB or ECS between June 2020 and February 2025 was employed. The Clinical Outcomes in Routine Evaluation – 10 (Core-10) and Mental Health Confidence Scale (MHCS) measures were completed pre- and post- intervention. Paired samples t-tests were conducted and demographics (age, gender, and ethnicity) collected. There was a statistically significant effect in improving scores on both measures at the post-intervention timepoint (CORE-10: 8.636, 95% CI [7.810 to 9.461], t(297) = 20.586, p < .001; MHCS: -13.537, 95% CI [-14.827 to -12.237], t{293) = -20.568, p < .001). This significant effect remained when looking at males and females separately. Asian and Black ethnic groups were underrepresented in the sample compared to local demographics, whilst other ethnic groups showed similar representation. Findings suggest that CTB and ECS may be clinically effective in reducing distress and increasing confidence in coping with mental health challenges for service users. Additionally, this evaluation has highlighted the need for better understanding UK ethnic minority representation in CRHTTs and consideration of possible barriers to access.

PMID:42065842 | DOI:10.1007/s10597-026-01650-5

Environ Monit Assess. 2026 May 1;198(5):539. doi: 10.1007/s10661-026-15340-y.

ABSTRACT

Heavy metal contamination in lake sediments poses significant ecological and health risks, yet comprehensive national-scale assessments remain limited. This study systematically evaluates the spatial distribution, ecological risks, and human health implications of heavy metals Cu, Zn, Pb, Cr, Cd, and As in sediments from 41 representative large lakes across China. Analyses were conducted using inductively coupled plasma mass spectrometry (ICP-MS), the geoaccumulation index (I_geo), the potential ecological risk index (PERI), and health risk models. Spatial analysis via geographic information systems (GIS) revealed that heavy metal contamination was generally higher in eastern lakes (0.19-376.00 mg/kg) than in western lakes (0.17-339.00 mg/kg), with southwestern lakes (11.55-339.00 mg/kg) emerging as a notable pollution hotspot. Cd was identified as the predominant contributor to ecological risk, with 80% of lakes exceeding moderate risk thresholds (PERI > 60). Severe Cd pollution hotspots were observed notably in Chaohu (34.5 mg/kg), Dianchi (1.30 mg/kg), and Fuxian (7.90 mg/kg) lakes. Non-carcinogenic risk (hazard quotient (HQ) < 1) for Cd, Pb, Zn, and Cu were negligible, and carcinogenic risks for Cr and As (10⁻⁵-10⁻⁴) remained within acceptable limits. This multi-metric assessment underscores Cd as a priority pollutant requiring urgent mitigation. The findings provide actionable insights for policymakers to design region-specific pollution control strategies and advance sustainable lake management in China.

PMID:42065836 | DOI:10.1007/s10661-026-15340-y

Environ Monit Assess. 2026 May 1;198(5):535. doi: 10.1007/s10661-026-15382-2.

ABSTRACT

This study evaluated the presence, spatial distribution, and ecological risk of trace metal contamination in the Potomac River Test Range Complex (PRTR) middle danger zone, a heavily utilized military testing site with over a century of munitions activity. Surface water, near-bed water, and surficial sediment samples were collected from 21 sites and analyzed for trace metals (Al, As, B, Cd, Co, Cr, Cu, Fe, Mg, Mn, Ni, Pb, and Zn) using inductively coupled plasma optical emission spectroscopy. Contamination levels were interpreted using the Heavy Metal Pollution Index (HPI) for water samples and the Geoaccumulation Index (Igeo) and Potential Ecological Risk Index (PERI) for sediments. Ward’s multivariate cluster analysis with silhouette optimization was applied to assess spatial relationships between contamination patterns and historical projectile-density zones. Surface waters were generally low in contamination, whereas near-bed waters exhibited higher metal concentrations with multiple sites classified as critically polluted. Sediments showed widespread anthropogenic enrichment (Igeo Classes 1-3), with elevated ecological risks (PERI) concentrated in areas of dense historical munitions activity. Cluster analyses revealed clear spatial separation between high- and low-intensity use zones, supporting a linkage between munitions testing and localized contamination. These findings demonstrate that military activities contribute measurably to metal contamination superimposed on broader watershed inputs. This study represents one of the first field-based, multi-matrix assessments of contamination within the PRTR, advancing beyond prior evaluations that utilized modeling and screening approaches. This integrated framework provides improved resolution of contamination pathways and strengthens targeted monitoring, ecological risk assessment, and management of impacted aquatic systems.

PMID:42065826 | DOI:10.1007/s10661-026-15382-2

Ann Biomed Eng. 2026 May 1. doi: 10.1007/s10439-026-04162-1. Online ahead of print.

ABSTRACT

PURPOSE: Meniscal allograft transplantation can restore joint biomechanics and alleviate symptoms, but its clinical use is limited by the scarcity of size-matched, structurally intact grafts. Current two-dimensional sizing and subjective inspection in tissue banks fail to capture complex three-dimensional geometry and subtle surface defects, highlighting the need for an accurate, reliable, and practical solution for routine donor tissue evaluation.

METHODS: We developed an integrated system combining optical 3D scanning with curvature-based analysis for 3D geometry capture and surface defect detection in meniscus allografts. System performance was validated in terms of scanner accuracy and tissue bank workflow feasibility.

RESULTS: The system completes each scan within 2 versus ~ 60 min for micro-computed tomography (μCT). It demonstrated μCT-comparable accuracy (mean volume difference: 6.9%; surface deviation: 8.3%). Scanning through phosphate buffer saline (PBS)-immersed transparent bags yielded equivalent accuracy to scanning in air (mean volume difference: 7.2%; surface deviation: 12.5%). The workflow demonstrated high intra- and inter-operator reproducibility. Viability testing revealed PBS-preserved tissues maintained > 94% viability for 20 min, whereas air-exposed tissues dropped below 70% within 10 min. For defect assessment, curvature metrics reliably identified surface wear, longitudinal, and radial defects, with size measurements for wear and longitudinal tears showing equivalence (± 10% margin) to stereomicroscopy.

CONCLUSION: This portable system enables accurate and rapid 3D scanning under tissue banking conditions and quantitative surface defect detection. It supports improved graft shape matching and surface defect screening, offering a practical and scalable solution for tissue banks and clinical settings, potentially extendable to other fibrocartilaginous and osteochondral tissues.

PMID:42065816 | DOI:10.1007/s10439-026-04162-1

Obes Surg. 2026 May 1. doi: 10.1007/s11695-026-08712-3. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine whether a pre-lunch single bout of moderate-intensity aerobic exercise (AEX) alters time spent in hypoglycaemia (<3.0 mmol/L) during the subsequent 24 hours (24-h) and parameters of glucose homeostasis in individuals without diabetes after metabolic/bariatric surgery (MBS).

METHODS: In a randomised crossover study, 15 participants completed two conditions: 30min treadmill walking at 60% V̇O₂peak (AEX) and time-matched sitting (CON). After an overnight fast and a standardised breakfast, participants performed AEX or CON, and both conditions were followed by an identical lunch administered as a mixed-meal tolerance test (MMTT). Continuous glucose monitoring (CGM) assessed glucose levels for 24-h post-intervention, during which participants consumed standardised meals. CGM data were available for analysis in 11 participants. The primary outcome was time spent with glucose <3.0 mmol/L during the 24-h post-intervention. Secondary outcomes included other CGM-derived glucose metrics and plasma glucose and insulin responses during the 3-h MMTT.

RESULTS: Only one isolated hypoglycaemic event (<3.0 mmol/L) occurred, precluding statistical analysis of the primary outcome. Mean 24-h glucose (AEX: 6.4 (1.0); CON: 6.5 (0.9) mmol/L; p = 0.57) and time <3.9 mmol/L (AEX 0 (0.0, 0.5); CON 0 (0.0, 0.5) %; p = 0.68) did not differ between conditions. AEX reduced glucose coefficient of variation (p < 0.01). During the MMTT, nadir, peak, and AUC_0-180 glucose, as well as pre-MMTT insulin concentrations, were higher following AEX (all p < 0.05).

CONCLUSIONS: A pre-lunch 30-min bout of AEX did not increase the 24-h risk of hypoglycaemia post-MBS but elevated post-MMTT glucose levels.

PMID:42065808 | DOI:10.1007/s11695-026-08712-3

J Racial Ethn Health Disparities. 2026 May 1. doi: 10.1007/s40615-026-02995-z. Online ahead of print.

ABSTRACT

INTRODUCTION: The Hispanic population in the United States (U.S.) is rapidly growing. Prior research indicates that foreign-born women have lower neuraxial labor analgesia (NLA) rates than U.S.-born counterparts but influence of maternal country of origin remains unclear. This study examines the association between birthplace (foreign-born vs. US-born) and NLA during labor.

METHODS: This retrospective cross-sectional study utilized CDC WONDER’s Natality Expanded-Results Database (2016-2023) to analyze birth characteristics amongst several populous Hispanic subgroups. A Chi-Square test assessed overall differences in NLA by birthplace, Statistical significance was set at p < .05.

RESULTS: The study included 704,913 participants. Rates of NLA in U.S.-born mothers of Mexican origin were significantly higher than their foreign-born counterparts (80.30% and 74.2% respectively; absolute difference 6.1%, 95% CI: 5.9, 6.4). Rates of NLA in U.S.-born mothers of Cuban origin were significantly lower than their foreign-born counterparts (82.30% and 85/70% respectively, absolute difference-3.4, 95% CI: -4.3, -2.5). There was no difference in NLA between U.S.-born and foreign-born women of Dominican origin (81.40% and 76.70% respectively, absolute difference 4.8, CI: -6.0, 15.6). Of all the Hispanic origins, Cubans (both U.S. born and foreign-born) were most likely to use neuraxial labor analgesia (82.3% and 85.7% respectively). There is no significant difference in age of mother, birth weight, BMI, number of prenatal visits, and interval since last live birth between U.S.-born and foreign-born women of the same Hispanic origin (p>.05).

CONCLUSION: Intra-racial differences in NLA exist based on maternal birthplace and Hispanic origin, highlighting need for further research on cultural influences in obstetric pain management. These trends should be continuously monitored to formulate tailored public health interventions.

PMID:42065806 | DOI:10.1007/s40615-026-02995-z

Environ Monit Assess. 2026 May 1;198(5):536. doi: 10.1007/s10661-026-15379-x.

ABSTRACT

This study presents a long-term analysis of water quality using the National Sanitation Foundation Water Quality Index (NSFWQI) based on the monitoring data from 1966 to 2023 for the Sumida River in Tokyo. Although the NSFWQI has been widely used, it is not often applied to large, long-term datasets. This study illustrates how the NSFWQI can be effectively used for multidecadal analysis, allowing researchers to identify temporal dynamics and progressive changes in water quality. In this study, NSFWQI was developed from 27 sampling points using four to eight key parameters: transparency, temperature, pH, dissolved oxygen (DO), biochemical oxygen demand (BOD), nitrate, phosphate, and fecal coliform of the monthly dataset from 1966 to 2023. The results show that the overall water quality improved from poor in 1966 to good by 2012, driven mainly by reduced BOD and enhanced DO. Moreover, the analysis identified eight significant change points, indicating gradual improvements in water quality that correspond to major policy and infrastructure advancements. However, among eight water quality parameters, fecal coliform levels remained persistently high, indicating continuing microbial risks linked to diffuse sources and aging sewer infrastructure. The findings highlight how sustained governance and infrastructure investment can reverse urban river degradation, while emphasizing that chemical recovery alone is insufficient without microbial management. Incorporating WQI-based assessments into Japan’s monitoring frameworks could enhance adaptive water governance and public communication of river health.

PMID:42065793 | DOI:10.1007/s10661-026-15379-x