Tag: pubmed

Int J Equity Health. 2025 Feb 3;24(1):35. doi: 10.1186/s12939-025-02399-1.

ABSTRACT

BACKGROUND: Access to healthcare is critical for population health; however, geographic barriers persist especially in rural and deprived regions. This study aims to develop an overall composite potential spatial accessibility index to healthcare facilities and services in Sistan and Baluchestan Province in southeast Iran.

METHODS: This study employed the enhanced two-step floating catchment area (E2SFCA) method to create an overall composite spatial accessibility index for healthcare facilities and services in Sistan and Baluchestan Province, southeast Iran. Spatial accessibility for general practitioners, nursing, dentistry, midwifery, pharmacy, medical laboratory, nutrition, public health, radiology, psychology, environmental health, rural health workers, inpatient hospital beds, and five medical specialty services were calculated. Spatial accessibility scores were normalized from 0 to 1 (no access = 0, low = 0.01 to 0.33, moderate = 0.331 to 0.66, high = 0.661 to 1) and aggregated into overall indices of primary, secondary, and overall healthcare accessibility for each district. Inequality was assessed using the Lorenz curve and Gini coefficient analysis.

RESULTS: Low geographic accessibility was found across Sistan and Baluchestan Province, especially in rural areas. Almost 75% of the population had low/no access to overall primary care services within a 30-minute drive time. For secondary care, nearly 45% had low/no access to hospital inpatient beds within a 30-minute drive time, and around 40% had low/no access to specialists within a 60-minute drive time. Just 11.6% of the population had high overall healthcare access. The calculated Gini coefficient of 0.517 for the overall spatial accessibility index to healthcare services in Sistan and Baluchestan Province highlights a highly unequal distribution of healthcare services.

CONCLUSIONS: This study demonstrates a useful replicable methodology that combines individual service accessibility metrics into an overall spatial healthcare access index. Furthermore, this study provides evidence of major shortfalls in healthcare access across Sistan and Baluchestan Province. Targeted strategies are required to increase the availability and capacity of services in underserved communities. Improving geographic access is key for progressing towards universal coverage and better population health.

PMID:39901168 | DOI:10.1186/s12939-025-02399-1

BMC Med. 2025 Feb 4;23(1):65. doi: 10.1186/s12916-025-03910-9.

ABSTRACT

BACKGROUND: Antenatal steroid (ANS) therapy is given to women at risk of preterm delivery to accelerate fetal lung maturation. However, the benefit of ANS therapy is variable and how maternal and fetal factors contribute to this observed variability is unknown. We aimed to test the degree of concordance in preterm lung function, and correlate this with genomic, transcriptomic, and pharmacokinetic variables in preterm dizygotic twin ovine fetuses.

METHODS: Thirty-one date-mated ewes carrying twin fetuses at 123 ± 1 days’ gestation received maternal intramuscular injections of either (i) 1 × 0.25 mg/kg betamethasone phosphate and acetate (CS1, n = 11 twin pairs) or (ii) 2 × 0.25 mg/kg betamethasone phosphate and acetate, 24 h apart (CS2, n = 10 twin pairs) or (iii) 2 × saline, 24 h apart (negative control, n = 10 twin pairs). Fetuses were surgically delivered 24 h after their final treatment and ventilated for 30 min.

RESULTS: ANS-exposed female fetuses had lower arterial partial pressure of carbon dioxide (PaCO₂) values than male fetuses (76.5 ± 38.0 vs. 97.2 ± 42.5 mmHg), although the observed difference was not statistically significant (p = 0.1). Only 52% of ANS-treated twins were concordant for lung maturation responses. There was no difference in fetal lung tissue or plasma steroid concentrations within or between twin pairs. Genomic analysis identified 13 single-nucleotide polymorphisms (SNPs) statistically associated with ANS-responsiveness, including in the proto-oncogene MET and the transcription activator STAT1.

CONCLUSIONS: Twin fetal responses and ANS tissue levels were comparable with those from singleton fetuses in earlier studies. Twin ovine fetuses thus benefit from ANS in a similar manner to singleton fetuses, and a larger dose of betamethasone is not required. Assuming no difference in input from the placental or maternal compartments, fetal lung responses to ANS therapy in dizygotic twin preterm lambs are dependent on the fetus itself. These data suggest a potential heritable role in determining ANS responsiveness.

PMID:39901164 | DOI:10.1186/s12916-025-03910-9

Clin Neurol Neurosurg. 2025 Jan 29;249:108767. doi: 10.1016/j.clineuro.2025.108767. Online ahead of print.

ABSTRACT

BACKGROUND: Central nervous system (CNS) infections represent life-threatening conditions. Emerging evidence suggests cerebrospinal fluid (CSF) presepsin (sCD14) as a promising biomarker for these infections. However, its diagnostic accuracy remains controversial. This study aimed to systematically evaluate the reliability of CSF presepsin in diagnosing CNS infections through a comprehensive meta-analysis.

METHODS: A systematic search of PubMed, Scopus, and Web of Science databases was conducted up to November 2024. Five prospective studies involving 384 participants were included. CSF presepsin levels were compared between infected and non-infected patients. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), positive predictive value (PPV), and negative predictive value (NPV) were calculated using a random-effects model. Publication bias and clinical utility were assessed through Deek’s funnel plot and Fagan’s nomogram, respectively.

RESULTS: Infected patients exhibited significantly higher CSF presepsin levels (mean difference: 760.16 pg/mL; 95 % confidence interval (CI): 426.26-1094.05, p < 0.01). Pooled sensitivity and specificity were 87 % (95 % CI: 82-91 %) and 67 % (95 % CI: 60-74 %), respectively, with a DOR of 13.04 (95 % CI: 7.51-22.64). The pooled PPV and NPV were 79 % (95 % CI: 73-84 %) and 79 % (95 % CI: 71-85 %), respectively. The area under the curve of the summary receiver operating characteristic curve was 86 %, emphasizing high diagnostic accuracy. No statistically significant publication bias was detected (P = 0.12).

CONCLUSION: CSF presepsin demonstrated potential as a diagnostic biomarker for CNS infections, demonstrating high sensitivity and moderate specificity. Further large-scale studies are needed to refine its clinical applicability and establish standardized thresholds.

PMID:39899927 | DOI:10.1016/j.clineuro.2025.108767

Drug Alcohol Depend. 2025 Jan 29;268:112586. doi: 10.1016/j.drugalcdep.2025.112586. Online ahead of print.

ABSTRACT

PURPOSE: To assess real-world access to buprenorphine treatment in Philadelphia and measure adoption of policies and practices that facilitate buprenorphine access.

METHODS: We used an audit (“secret shopper”) design to survey all programs providing longitudinal, outpatient buprenorphine in Philadelphia from 9/2022-1/2023 (n = 130). After validating eligibility, a research coordinator posing as a case manager called eligible programs to inquire about appointment availability and treatment policies. We used descriptive statistics to analyze the data and compared practices between primary and subspecialty treatment providers.

RESULTS: We reached 107 programs with audit calls (82 % response rate). 56 (52 %) were primary care offices and 51 (48 %) were specialty addiction providers. 96 (90 %) accepted new patients for buprenorphine treatment, and 83 (78 %) accepted insurance. Median time-to-appointment was 3 business days (range 0-120), and 42 % of visits were offered with a single call. Only 42 % of programs could confirm the possibility of a buprenorphine prescription at an initial visit. 48 % of programs could not provide information about requirements for counseling or behavioral health, and few could provide information about policies for patients with ongoing substance use. Specialty models were more likely than primary care programs to provide information about medication availability at the first visit but also were more likely to require counseling and abstinence.

CONCLUSIONS: Our study provides a simulation of real-world experiences accessing buprenorphine, revealing significant variability in treatment access and persistence of practice-level barriers to treatment. These findings can inform efforts to increase engagement and retention in treatment and better align care with evidence.

PMID:39899919 | DOI:10.1016/j.drugalcdep.2025.112586

Clin Exp Optom. 2025 Feb 3:1-6. doi: 10.1080/08164622.2025.2461233. Online ahead of print.

ABSTRACT

CLINICAL RELEVANCE: Since inflammation plays an important role in the pathogenesis of diabetic retinopathy, serum biomarkers and retinal imaging aimed at evaluating the presence of inflammation have emerged as useful tools to monitor the appearance and progression of diabetic retinopathy.

BACKGROUND: This study aims to investigate the value of YKL-40 levels in patients with diabetes mellitus with different stages of diabetic retinopathy and without diabetic retinopathy, and to compare those findings with results from healthy individuals without diabetes mellitus.

METHODS: This prospective cross-sectional study included 67 diabetic patients with or without diabetic retinopathy who underwent cataract surgery and 23 patients (control group) having no ocular and systemic disease other than senile cataract. Participants with diabetes mellitus were separated into three subgroups: the first group consisted of 26 patients without diabetic retinopathy, the second group included 21 patients with non-proliferative diabetic retinopathy and the third group included 20 patients with proliferative diabetic retinopathy. Serum and aqueous humour YKL-40 levels were analysed and compared between the groups.

RESULTS: The mean serum (p < 0.001) and aqueous humour (p < 0.001) YKL-40 levels were statistically significantly lower in control subjects compared to patients with diabetes mellitus. The aqueous humour YKL-40 levels showed statistically significant elevations with the progression of diabetic retinopathy. Duration of diabetes mellitus was significantly correlated with aqueous humour YKL-40 levels (p = 0.001, r = 0.384).

CONCLUSION: Both serum and aqueous humour YKL-40 levels are higher in patients with diabetes mellitus compared to healthy subjects. Levels of YKL-40 in aqueous humour increase with the progression of diabetic retinopathy.

PMID:39899896 | DOI:10.1080/08164622.2025.2461233

Int J Med Educ. 2025 Jan 30;16:11-20. doi: 10.5116/ijme.676f.ce30.

ABSTRACT

OBJECTIVES: This study was aimed at improving clarity regarding the goals underlying motivation for attendance at international meetings to accommodate evolving needs.

METHODS: We performed a case study of a large international medical conference by undertaking (a) semi-structured interviews with 13 multi-disciplinary stakeholders, which underwent thematic analysis, and (b) surveys of 1229 conference attendees, which underwent descriptive statistical analysis and directed content analysis.

RESULTS: Interviews suggested scientific updates and networking are priorities for in-person formats whereas flexibility and reduced travel are priorities for virtual formats. Surveys suggested motivations for attending both in-person and virtual conferences included: scientific updates (81.3% and 85.4%, respectively) and advancements in patient care (76.6%, 78.2%). Social interaction (e.g., to meet experts 80.6% and make/deepen professional connections 69.3%) was highly rated for in-person meetings, but not virtual meetings (51.0% and 30.8%, respectively). 58.9% of attendees prefer future meetings to be hybrid, including both in-person and virtual formats.

CONCLUSIONS: We found a disconnect between attendees’ preferences and recommendations currently put forward as socially responsible in terms of climate, equity and diversity. Meeting organisers may need to educate others about the value and costs involved in hybrid formats. When hybrid formats are possible, our data provide guidance on what to prioritize during in-person components and how to combine those with the benefits of global accessibility and flexibility enabled by virtual technology.

PMID:39899888 | DOI:10.5116/ijme.676f.ce30

J Med Internet Res. 2025 Feb 3;27:e53306. doi: 10.2196/53306.

ABSTRACT

BACKGROUND: The COVID-19 pandemic has shifted health care toward virtual and online models, impacting both users and providers. Numerous user concerns and perceived risks related to telemedicine are continually evolving and adjusting in response to the pandemic. In many countries, there has been a substantial increase in the use of virtual health care visits, which offers a unique opportunity for researchers to explore these user concerns.

OBJECTIVE: This study aimed to first reconstruct the risk dimensions associated with telemedicine, then identify the risk factors affecting users’ adoption, and finally propose effective solutions to mitigate these concerns. By integrating the newly constructed perceived risk with the technology acceptance model (TAM), we scrutinized various dimensions of perceived risk and their influence on users’ perceptions of ease of use, perceived usefulness, and use intention (UI).

METHODS: Our target population consists of adults aged ≥18 years who have used or may use telemedicine services, recruited through an anonymous, voluntary, open, web-based survey. We collected responses and used part of them to reconstruct risk dimensions using exploratory factor analysis. Subsequently, we analyzed the intricate relationship between perceived risk, the TAM, and the acceptance of telemedicine using structural equation modeling with another part of the responses.

RESULTS: A total of 1600 valid responses were collected. Eight distinct risk dimensions were reconstructed, revealing a substantial negative impact of performance risk on UI. The psychological and social risk was the strongest barrier to the ease of using telemedicine. Time risk, provider risk, and privacy risk were not statistically significant to the TAM. The resulting model elucidates a remarkable 66% variance in UI for telemedicine services.

CONCLUSIONS: This study substantially advances the field of telemedicine research by reconstructing and redefining 8 risk dimensions and confirming the statistical significance of 5 perceived risks on the adoption of telemedicine services. These insights are poised to facilitate the promotion and enhancement of telemedicine services in the health care sector.

PMID:39899842 | DOI:10.2196/53306

J Med Internet Res. 2025 Feb 3;27:e63864. doi: 10.2196/63864.

ABSTRACT

BACKGROUND: Racial inequity in health outcomes, particularly in colorectal cancer (CRC), remains one of the most pressing issues in cancer communication and public health. Social media platforms like Twitter (now X) provide opportunities to disseminate health equity information widely, yet little is known about the availability, content, and reach of racial health equity information related to CRC on these platforms. Addressing this gap is essential to leveraging social media for equitable health communication.

OBJECTIVE: This study aims to analyze the volume, content, and exposure of CRC racial health equity tweets from identified CRC equity disseminator accounts on Twitter. These accounts were defined as those actively sharing information related to racial equity in CRC outcomes. By examining the behavior and impact of these disseminators, this study provides insights into how health equity content is shared and received on social media.

METHODS: We identified accounts that posted CRC-related content on Twitter between 2019 and 2021. Accounts were classified as CRC equity disseminators (n=798) if they followed at least 2 CRC racial equity organization accounts. We analyzed the volume and content of racial equity-related CRC tweets (n=1134) from these accounts and categorized them by account type (experts vs nonexperts). Additionally, we evaluated exposure by analyzing follower reach (n=6,266,269) and the role of broker accounts-accounts serving as unique sources of CRC racial equity information to their followers.

RESULTS: Among 19,559 tweets posted by 798 CRC equity disseminators, only 5.8% (n=1134) mentioned racially and ethnically minoritized groups. Most of these tweets (641/1134, 57%) addressed disparities in outcomes, while fewer emphasized actionable content, such as symptoms (11/1134, 1%) or screening procedures (159/1134, 14%). Expert accounts (n=479; 716 tweets) were more likely to post CRC equity tweets compared with nonexpert accounts (n=319; 418 tweets). Broker accounts (n=500), or those with a substantial portion of followers relying on them for equity-related information, demonstrated the highest capacity for exposing followers to CRC equity content, thereby extending the reach of these critical messages to underserved communities.

CONCLUSIONS: This study emphasizes the critical roles played by expert and broker accounts in disseminating CRC racial equity information on social media. Despite the limited volume of equity-focused content, broker accounts were crucial in reaching otherwise unexposed audiences. Public health practitioners should focus on encouraging equity disseminators to share more actionable information, such as symptoms and screening benefits, and implement measures to amplify the reach of such content on social media. Strengthening these efforts could help bridge disparities in cancer outcomes among racially minoritized groups.

PMID:39899839 | DOI:10.2196/63864

JMIR Form Res. 2025 Feb 3;9:e54147. doi: 10.2196/54147.

ABSTRACT

BACKGROUND: Future Health Today (FHT) is a program integrated with electronic medical record (EMR) systems in general practice and comprises (1) a practice dashboard to identify people at risk of, or with, chronic disease who may benefit from intervention; (2) active clinical decision support (CDS) at the point of care; and (3) quality improvement activities. One module within FHT aims to facilitate cardiovascular disease (CVD) risk reduction in people with chronic kidney disease (CKD) through the recommendation of angiotensin-converting enzyme inhibitor inhibitors (ACEI), angiotensin receptor blockers (ARB), or statins according to Australian guidelines (defined as appropriate pharmacological therapy).

OBJECTIVE: This study aimed to determine if the FHT program increases the proportion of general practice patients with CKD receiving appropriate pharmacological therapy (statins alone, ACEI or ARB alone, or both) to reduce CVD risk at 12 months postrandomization compared with active control (primary outcome).

METHODS: General practices recruited through practice-based research networks in Victoria and Tasmania were randomly allocated 1:1 to the FHT CKD module or active control. The intervention was delivered to practices between October 4, 2021, and September 30, 2022. Data extracted from EMRs for eligible patients identified at baseline were used to evaluate the trial outcomes at the completion of the intervention period. The primary analysis used an intention-to-treat approach. The intervention effect for the primary outcome was estimated with a marginal logistic model using generalized estimating equations with robust SE.

RESULTS: Overall, of the 734 eligible patients from 19 intervention practices and 715 from 21 control practices, 82 (11.2%) and 70 (9.8%), respectively, had received appropriate pharmacological therapy (statins alone, ACEI or ARB alone, or both) at 12 months postintervention to reduce CVD risk, with an estimated between-trial group difference (Diff) of 2.0% (95% CI -1.6% to 5.7%) and odds ratio of 1.24 (95% CI 0.85 to 1.81; P=.26). Of the 470 intervention patients and 425 control patients that received a recommendation for statins, 61 (13%) and 38 (9%) were prescribed statins at follow-up (Diff 4.3%, 95% CI 0 to 8.6%; odds ratio 1.55, 95% CI 1.02 to 2.35; P=.04). There was no statistical evidence to support between-group differences in other secondary outcomes and general practice health care use.

CONCLUSIONS: FHT harnesses the data stored within EMRs to translate guidelines into practice through quality improvement activities and active clinical decision support. In this instance, it did not result in a difference in prescribing or clinical outcomes except for small changes in statin prescribing. This may relate to COVID-19-related disruptions, technical implementation challenges, and recruiting higher performing practices to the trial. A separate process evaluation will further explore factors impacting implementation and engagement with FHT.

TRIAL REGISTRATION: ACTRN12620000993998; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380119.

PMID:39899838 | DOI:10.2196/54147

J Craniofac Surg. 2025 Feb 3. doi: 10.1097/SCS.0000000000011132. Online ahead of print.

ABSTRACT

Lower-third facial feminization procedures have been associated with the development of postoperative jowling, yet quantitative evaluations of this outcome remain limited. This study evaluated the relationship between patient risk factors and bony volume reduction with postoperative jowling. Chin and gonial angle bony measurements were obtained from preoperative and postoperative computed tomography imaging, whereas changes in jowling were assessed using a validated photonumeric jowling scale on preoperative and postoperative patient images. Associations between skeletal changes, demographic variables, and soft tissue outcomes were statistically analyzed. The study included 35 patients with a mean age of 36 ± 12 years. The average time between surgery and postoperative photographs was 10.0 ± 7.5 months. Gonial angle volume decreased by 9.48% (P < 0.001), whereas chin volume decreased by 3.06% (P = 0.051). Average jowling grade increased significantly from 2.3 to 2.6 postoperatively (P = 0.03), with higher age correlating to a greater increase in jowling (r = 0.35, P = 0.037). Postoperatively, only body mass index was significantly correlated with absolute jowling score (r = 0.51, P = 0.0018). However, no significant associations were found between changes in bony measurements and changes in jowling scores. These findings underscore the importance of further investigating the interplay between patient risk factors and bony and soft tissue changes in facial feminization surgery. Future studies will focus on expanded cohorts and more sensitive assessment tools to better define risk factors and optimize surgical strategies for minimizing jowling.

PMID:39899802 | DOI:10.1097/SCS.0000000000011132