Tag: pubmed

Ann Work Expo Health. 2025 Feb 3:wxaf002. doi: 10.1093/annweh/wxaf002. Online ahead of print.

ABSTRACT

OBJECTIVES: With continued global warming, the effects of elevated temperatures on the health of agricultural workers are a particular concern. This study characterized the levels of heat stress in Thai sugarcane workers and investigated whether season and harvesting method were associated with it.

METHODS: Three hundred sugarcane workers in Nakhon Sawan Province, Thailand, were recruited, and information on demographics, working conditions, and clothing characteristics was collected from participants during the cooler months (n = 152 participants, mid-January to mid-February) and hotter month (n = 148, March). Heat stress was measured using the Wet Bulb Globe Temperature (WBGT) index, and the WBGT instruments were operated for a full work shift in the sugarcane fields where the participants worked. One-hour time weighted average (TWA) effective WBGT (WBGTeff-1hrTWA) estimates were determined for different times of the day based on the measured WBGT and clothing adjustment factor.

RESULTS: The average WBGTeff-1hrTWA in the cooler months ranged from 22.5 °C during the early morning to 31.3 °C during the hottest time of the day, and for the hotter month, it ranged from 25.4 °C to 33.9 °C, respectively. The measured WBGT, natural wet-bulb temperature (Tnwb), dry-bulb temperature (Tdb), globe temperature (Tg), air velocity (Av), and absolute water vapor pressure (ea) were all statistically significantly higher in the hotter month than in the cooler months. Harvesting during the hotter month and harvesting burnt sugarcane were significantly associated with increased effective WBGT. The harvesters’ heat stress in both seasons exceeded the American Conference of Governmental Industrial Hygienists – Threshold limit value for 72.7% of the working time in the cooler months and 90.9% in the hotter month.

CONCLUSIONS: The heat stress in Thai sugarcane workers was high in both seasons, particularly in the hotter month and when harvesting burnt sugarcane. This results in a very high risk of developing heat-related health effects, and measures are needed to reduce heat stress. Heat stress in agricultural and other outdoor work in tropical climates is an immediate and growing problem.

PMID:39899707 | DOI:10.1093/annweh/wxaf002

J Addict Med. 2025 Jan-Feb 01;19(1):102-104. doi: 10.1097/ADM.0000000000001355.

ABSTRACT

OBJECTIVES: Nearly 70% of people who use tobacco want to quit. Combination nicotine replacement therapy (cNRT), a long-acting controller plus short-acting reliever, is the most effective way to prescribe nicotine but is infrequently prescribed by primary care physicians (PCPs). We tested the feasibility and effectiveness of a brief, educational intervention to increase cNRT prescribing by PCPs in a large integrated health system.

METHODS: We conducted a pre-post study from 2022-2023 at a large integrated health system in California where specific NRT products are covered with a prescription. PCPs were offered a 30-minute virtual training about cNRT during a required monthly meeting (n = 267; 202 attended). The training was interactive, included simple “asks” and a 6-week follow-up communication. Chi-square analysis was used to test for changes in cNRT prescribing behaviors in the 6 months before and after training.

RESULTS: Among physicians who completed a posttraining questionnaire (180/202), 93% reported increased confidence, 91% reported favorable attitudes, and 88% reported intention to prescribe cNRT. According to data obtained from the integrated pharmacy database, the total number of patients who received a cNRT prescription increased from the 6-month pre- to 6-month postintervention from 135 (9%) to 380 (23%), P < 0.001. The total number of physicians who prescribed cNRT increased pre- to posttraining from 78 (23%) to 124 (37%), P < 0.001.

CONCLUSION: cNRT is an underutilized form of tobacco cessation therapy by PCPs. This may reflect a gap in prescriber knowledge. A brief, virtual training delivered to PCPs was associated with increased cNRT prescribing.

PMID:39899675 | DOI:10.1097/ADM.0000000000001355

Clin Implant Dent Relat Res. 2025 Feb;27(1):e13441. doi: 10.1111/cid.13441.

ABSTRACT

INTRODUCTION: This retrospective study aimed to evaluate peri-implant marginal bone loss (MBL) and prosthetic complications between two types of locator attachments in two implant-supported mandibular overdentures.

MATERIAL AND METHOD: From the archived records, information about patients who had two implants inserted utilizing two different types of locator attachments into the interforaminal region between November 2019 and December 2023 was obtained. Overall, 60 patients (Total = 120 implants) from the archive records of the Prosthodontics Department, Faculty of Dentistry, Mansoura University, with ages ranging from 40 to 60 (mean age 50), were included in the study. Group I (control): Overall, 30 patients who would be delivered mandibular implant overdenture using conventional locator attachments. Group II (study): Overall, 30 patients who would be delivered mandibular implant overdenture using RTx locator attachments. After the placement of the mandibular overdenture (T0), 6 months (T6), 12 months (T12), and 3 years (T3) later, the marginal bone loss (MBL) was assessed. Prosthetic complications were evaluated for both groups 3 years after prosthetic delivery.

RESULT: A statistically significant increase (p = 0.000) was found in MBL scores at all observation times between both groups. Group II showed a statistical increase in MBL than Group I. For prosthetic complications, no significant difference was found between both groups. Group II showed more matrix wear than Group I however, it was not statistically significant (p = 0.60).

CONCLUSION: Within the limitation of this study, we can conclude the following: Both types of locator attachment (conventional and RTx locator) can be used clinically with no preference concerning the frequency of prosthetic complications. From the MBL perspective, conventional locators are more favorable than RTx locators.

PMID:39899315 | DOI:10.1111/cid.13441

J Gerontol Nurs. 2025 Feb;51(2):13-22. doi: 10.3928/00989134-20250102-01. Epub 2025 Jan 10.

ABSTRACT

PURPOSE: To evaluate the factor structure of the Brief Pain Inventory-Short Form (BPI-SF) and measurement invariance across two age groups for African American (AA) older adults with osteoarthritis (OA).

METHOD: Participants were AA older adults aged 50 to 94 years with self-reported OA and chronic pain (N = 110). Cross-sectional data from the BPI-SF were obtained from all participants, and confirmatory factor analysis (CFA) was used to evaluate the factor structure. Measurement invariance across young-old (aged 50 to 69 years) and old-old (aged 70 to 94 years) participants was examined at configural, full metric, and full scalar levels.

RESULTS: CFA revealed that a three-factor model (i.e., pain intensity, activity interference, and affective interference) demonstrated the best fit (χ²/df = 1.595, comparative fit index [CFI] = 0.949, root-mean-square error of approximation = 0.074). The change of CFI between configural and metric invariance was below the cutoff point of 0.01, supporting full metric (i.e., factor loadings) invariance across the two age groups. However, full scalar (i.e., item intercepts) invariance was not demonstrated.

CONCLUSION: Results support a three-factor structure of the BPI-SF, which is consistent across two age groups for AA older adults with OA. This study provides evidence that the BPI-SF can reliably measure pain intensity and two distinct dimensions of pain interference in this population. [Journal of Gerontological Nursing, 51(2), 13-22.].

PMID:39899313 | DOI:10.3928/00989134-20250102-01

JAMA Neurol. 2025 Feb 3. doi: 10.1001/jamaneurol.2024.4974. Online ahead of print.

ABSTRACT

IMPORTANCE: Although past research suggests an association between migraine and attempted suicide, there is limited research regarding risk of attempted and completed suicide across headache disorders.

OBJECTIVE: To examine the risk of attempted and completed suicide associated with diagnosis of migraine, tension-type headache, posttraumatic headache, and trigeminal autonomic cephalalgia (TAC).

DESIGN, SETTING, AND PARTICIPANTS: This was a population-based cohort study of Danish citizens from 1995 to 2020. The setting was in Denmark, with a population of 5.6 million people. Persons 15 years and older who were diagnosed with headache were matched by sex and birth year to persons without headache diagnosis with a ratio of 5:1. Data analysis was conducted from May 2023 to May 2024.

EXPOSURES: First-time headache diagnoses identified from inpatient hospitalizations, emergency department visits, and outpatient specialty clinic visits using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes.

MAIN OUTCOMES AND MEASURES: Diagnostic codes from the ICD-10 were used to identify attempted suicide from the Danish National Patient Registry and the Danish Psychiatric Central Research Register and completed suicides from the Danish Register of Causes of Death. Absolute risks (ARs) and risk differences (RDs) for attempted and completed suicide were calculated using the cumulative incidence function. Hazard ratios (HRs) for attempted and completed suicide associated with headache diagnosis were computed adjusting for age, sex, year, education, income, baseline comorbidities, and accounting for competing risk of death.

RESULTS: In total, 119 486 persons (83 046 female [69.5%]) diagnosed with headache were identified and matched with 597 430 persons (415 230 female [69.5%]) drawn from the general population. Participants’ median (IQR) age was 40.1 (29.1-51.6) years. The 15-year AR of attempted suicide among persons diagnosed with headache was 0.78% (95% CI, 0.72%-0.85%) vs 0.33% (95% CI, 0.31%-0.35%) in the comparison cohort (RD, 0.45%; 95% CI, 0.39%-0.53%). The 15-year AR of completed suicide among persons diagnosed with headache was 0.21% (95% CI, 0.17%-0.24%) vs 0.15% (95% CI, 0.13%-0.16%) in the comparison cohort (RD, 0.06%; 95% CI, 0.02%-0.10%). The hazards of attempted suicide (HR, 2.04; 95% CI, 1.84-2.27) and completed suicide (HR, 1.40; 95% CI, 1.17-1.68) were elevated among persons with headache vs comparison cohort members. Findings were consistent across headache types, with stronger associations for TACs and posttraumatic headache.

CONCLUSIONS AND RELEVANCE: Results of this cohort study revealing the robust and persistent association of headache diagnoses with attempted and completed suicide suggest that behavioral health evaluation and treatment may be important for these patients.

PMID:39899309 | DOI:10.1001/jamaneurol.2024.4974

JAMA Netw Open. 2025 Feb 3;8(2):e2453993. doi: 10.1001/jamanetworkopen.2024.53993.

ABSTRACT

IMPORTANCE: Health care-associated infections (HAIs) are a major cause of morbidity and mortality, but little is known about whether structural factors impacting race and rurality are associated with HAI and subsequent outcomes.

OBJECTIVE: To evaluate the association of race and rurality, which are proxies for structural disadvantage, with HAI and subsequent outcomes.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study was conducted at 3 US urban and suburban hospitals. Participants were adults aged 18 years or older admitted for 48 hours or longer from January 1, 2017, to August 31, 2020. Statistical analysis was performed from November 2022 to April 2024.

EXPOSURE: Patient race and rurality status were defined as the combination of race (Black or White) and residence (urban or rural per patient zip code).

MAIN OUTCOMES AND MEASURES: HAI was defined as a positive culture from a urine, blood, or respiratory specimen obtained 48 hours or longer after admission. To determine the association of race and rurality with HAIs, multivariable generalized estimating equations models were used to account for clustering of admissions by patient. Among patients with HAI admissions, similar models examined post-HAI intensive care unit admission and in-hospital death.

RESULTS: Among 214 955 patients admitted to the hospital (median [IQR] age, 63 [51-73] years; 108 679 female patients [50.6%]; 72 490 Black patients [33.7%]; 142 465 White patients [66.3%]), recognized HAIs occurred during 6699 (3.1%). Compared with White urban patients, Black urban patients had a decreased risk of HAI (adjusted relative risk [aRR], 0.81; 95% CI, 0.75-0.87), White rural patients had an increased risk of HAI (aRR, 1.12; 95% CI, 1.05-1.20), and Black rural patients (aRR, 1.08; 95% CI, 0.81-1.44) had a similar risk of HAI. Among patients with HAI admissions, Black rural patients had an increased risk of intensive care unit admission (aRR, 1.92; 95% CI, 1.16-3.17) and in-hospital death (aRR, 1.78; 95% CI, 1.26-2.50). White rural and Black urban patients had outcomes similar to those of White urban patients.

CONCLUSIONS AND RELEVANCE: This cohort study of hospitalized adults identified inequities related to race and rurality in HAIs and adverse outcomes from HAIs. These findings suggest that factors such as structural racism and disinvestment in rural communities may be associated with individual HAI risk and post-HAI outcomes. Future work to further understand the reasons underpinning these disparities and methods to address structural factors through policy and process changes are critical to eliminate health inequities.

PMID:39899297 | DOI:10.1001/jamanetworkopen.2024.53993

JAMA Netw Open. 2025 Feb 3;8(2):e2457770. doi: 10.1001/jamanetworkopen.2024.57770.

ABSTRACT

IMPORTANCE: Hypertension is the predominant pathology underlying nonlobar intracerebral hemorrhage (ICH), and antihypertensive agents have distinct biological implications for cerebral microvasculature. It is unknown if the class of antihypertensive medications initiated after ICH affects functional outcome beyond blood pressure (BP) control.

OBJECTIVE: To ascertain the association between the class of antihypertensive agents initiated during hospitalization and 90-day functional outcome in nonlobar ICH.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study uses data from the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study, a case-control cohort study investigating ICH risk factors among Hispanic, non-Hispanic Black (hereafter Black), and non-Hispanic White (hereafter White) populations at 42 US hospitals from 2010 to 2015. Data for this analysis were examined from May to September 2024. ERICH study participants were selected for the present analysis if they survived hospitalization and had available covariate and outcome data. Individuals with complications that would limit antihypertensive choice were excluded.

EXPOSURES: Initiation of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB), calcium channel blocker, β-blocker, thiazide diuretic, and other antihypertensive medications during index hospitalization.

MAIN OUTCOMES AND MEASURES: Primary outcome was a favorable functional outcome, defined as a 90-day (follow-up) modified Rankin Score score of 0 to 2 (score range: 0 [indicating no disability] to 6 [indicating death]). Mixed-effects logistic regression adjusted for demographic characteristics, medical history, ICH characteristics, BP measurement, total number of antihypertensive medications, and hospitalization site was used to calculate the odds of favorable functional outcome.

RESULTS: Of the 1561 ERICH study participants in the analytic cohort, 1079 had nonlobar and 482 had lobar ICH. Among the 1079 participants in the nonlobar ICH group (mean [SD] age, 58.5 [12.9] years; 676 males [62.6%]; 429 Hispanic [39.8%], 388 Black [36.0%], and 262 White [24.4%] individuals), a total of 407 (37.7%) ACEIs or ARBs, 419 (38.8%) β-blockers, 503 (46.6%) calcium channel blockers, 180 (16.7%) thiazide diuretics, and 277 (25.7%) other antihypertensive classes were initiated during hospitalization (median [IQR], 3 [2-3] agents at discharge). At follow-up, 481 participants (44.6%) had a favorable functional outcome. Initiation of ACEI or ARB was associated with higher odds of favorable functional outcome (adjusted OR [AOR], 1.49; 95% CI, 1.08-2.05; P = .01). No other antihypertensive class was associated with functional outcome. Findings were consistent across several sensitivity analyses. The interaction with ACEI or ARB was mediated by the presence of radiographic features of cerebral small vessel disease (AOR, 3.04; 95% CI, 1.01-9.19; P = .049). No association with class of antihypertensive agent was observed in lobar ICH.

CONCLUSIONS AND RELEVANCE: This large cohort study found that initiation of ACEI or ARB was associated with favorable 90-day functional outcomes after nonlobar ICH. This finding supports a medication class-specific benefit in hypertensive arteriopathy.

PMID:39899295 | DOI:10.1001/jamanetworkopen.2024.57770

JAMA Netw Open. 2025 Feb 3;8(2):e2458170. doi: 10.1001/jamanetworkopen.2024.58170.

ABSTRACT

IMPORTANCE: In 2023, the Massachusetts Medicaid and Children’s Health Insurance Program (MassHealth) required accountable care organizations (ACOs) to increase payments to primary care practices and shift to monthly payments, currently calibrated to historical revenues and enhanced practice capabilities, such as being staffed to address behavioral health needs. To prevent rewarding practices for avoiding difficult patients, future payments to primary care practices should reflect their patients’ apparent need.

OBJECTIVE: To describe MassHealth’s initiative and a complexity-adjusted payment model.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study of payment model development and performance was conducted between February 2022 and November 2024. Participants included all 2019 Massachusetts Medicaid managed-care eligible members who were enrolled for 183 days or longer.

EXPOSURES: Medical and social complexity.

MAIN OUTCOMES AND MEASURES: For each member, the primary care activity level (PCAL) outcome proxies the resources that primary care clinicians need to provide comprehensive, coordinated care. Models were evaluated via R2 and through ratios of observed-to-expected (ie, estimated by the model) outcomes for selected subgroups, which will be approximately 1.0 when payments and expected costs are well matched. The implications of paying practices using PCAL (vs a model based only on age and sex) were explored by examining financial and practice-level characteristics in high and low deciles of practice-level estimated mean.

RESULTS: Among 1 092 742 MassHealth members enrolled in 3602 primary care practices (1 014 252 person-years; mean [SD] age, 25.9 [18.4] years; 538 065 [53.1%] female), the PCAL model achieved R2 = 69.6% and estimates within 10% of observed PCAL spending for high-risk populations (mental health disorders, substance use disorders, complex chronic conditions, and disabilities) and across racial and ethnic groups. Age-adjusted and sex-adjusted payments would overpay practices in the lowest-need decile by 10% and underpay those in the highest-need decile by 34%, while the PCAL model would match payment to estimated need almost exactly in the lowest decile and underpay by just 6% in the highest decile.

CONCLUSIONS AND RELEVANCE: MassHealth’s 2023 reform invests in primary care. This cross-sectional study developed a risk model that can adjust primary care payments to patient needs. Neither age and sex adjustments nor inflated historical payments would provide adequate resources to primary care practices caring for the most complex patients.

PMID:39899293 | DOI:10.1001/jamanetworkopen.2024.58170

Int J Radiat Biol. 2025 Feb 3:1-11. doi: 10.1080/09553002.2025.2453995. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study was to evaluate the thickness and biomechanical parameters of the sternocleidomastoid muscle (SCM) before, during, and after radiotherapy using ultrasound elastography to predict radiotherapy-induced muscle fibrosis.

MATERIALS AND METHODS: The mean daily absorbed doses of 20 SCMs were determined. To find out the Young and shear modulus, shear wave elastography (SWE) and the B-mode sequential images processing method were implemented. In the B-mode sequential images processing method, by administering dynamic stress, the Young and shear modulus were estimated utilizing the maximum gradient and the block-matching algorithms, respectively. The imaging was done before, during the third and sixth weeks of treatment, and 3 months after radiotherapy.

RESULTS: There was a statistically significant increase in the maximum thickness during the sixth week compared to before radiotherapy (p = .043). However, this parameter did not change significantly 3 months later (p = .095). The Young modulus (p = .611) derived from SWE did not differ significantly throughout any of the weeks of radiotherapy. But Young and shear modulus increased significantly in the B-mode sequential images processing method before and during the third and sixth weeks of treatment (p = .001). The outcomes observed 3 months after radiotherapy revealed a statistically significant increase in both Young modulus (p = .029) and shear modulus (p = .004) compared to pre-radiotherapy.

CONCLUSION: The Young modulus and shear modulus are introduced as biological markers used to detect the onset of the fibrosis process during the initial radiotherapy fractions.

PMID:39899279 | DOI:10.1080/09553002.2025.2453995

Cardiovasc Interv Ther. 2025 Feb 3. doi: 10.1007/s12928-025-01092-y. Online ahead of print.

ABSTRACT

Limited data are available for sex-related long-term outcomes of patients treated for coronary drug-eluting stent (DES) restenosis. The aim of this observational, retrospective analysis was to close this lack of evidence. Between January 2007 and February 2021, a total of 3511 patients with 5497 in-stent restenosis (ISR) lesions were treated at two large-volume centers in Munich, Germany, of which 763 (21.7%) were female. Endpoints of interest were all-cause mortality and rates of repeat revascularization. Outcomes are presented as Kaplan-Meier event rates. Univariate and multivariate analyses were performed. Female patients were older (72.1 ± 10.4 versus 68.4 ± 10.4 years, p < 0.001) and suffered more often from diabetes (38.8% versus 34.4%, p = 0.029). There was no statistical difference regarding the clinical presentation and interventional treatment strategy. After 10 years, the risk of all-cause mortality was higher in female patients [hazard ratio (HR) 1.18 (1.02-1.35); p = 0.022]; however, after adjustment for age, the risk did not differ significantly between both sexes [adjusted HR 0.96 (0.83-1.11); p = 0.6]. Regarding target vessel revascularization (TVR) and non-target vessel revascularization (NTVR), the risk was lower in female patients [HR 0.73 (0.61-0.87); p < 0.001 and HR 0.74 (0.64-0.86); p < 0.001] even after age adjustment. No statistical differences were found regarding the risk of target lesion revascularization, target vessel myocardial infarction and stent thrombosis. In the long term, all-cause mortality after percutaneous coronary intervention of DES-ISR did not differ between both sexes after age adjustment. The risk of TVR and NTVR was lower in female patients even after age adjustment.

PMID:39899260 | DOI:10.1007/s12928-025-01092-y