Tag: pubmed

J Neurosurg Pediatr. 2026 Apr 10:1-8. doi: 10.3171/2025.12.PEDS25501. Online ahead of print.

ABSTRACT

OBJECTIVE: Vagus nerve stimulator (VNS) insertion has become a common treatment for drug-resistant epilepsy in children. The growing number of children undergoing VNS insertion provides a strong incentive for studies aimed at optimizing postoperative care protocols. The objective of this retrospective study was to characterize the readmission and reoperation rates associated with VNS insertion in children.

METHODS: The National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database was queried from 2012 to 2022 to find patients who underwent VNS insertion (CPT code 64568). The primary outcome measured was unplanned readmission within 7 days of VNS insertion. Propensity score matching on the criteria of baseline demographics was applied. Multivariable logistic regression analysis was conducted to determine if age, race, or anesthesia time affected same-day discharge as well as unplanned readmission and reoperation rates.

RESULTS: A total of 4267 patients who underwent VNS insertion were identified in the NSQIP-P database from 2012 to 2022. After excluding patients with missing data and readmissions > 7 postoperative days, 3070 patients were included in the final analysis. Of those patients, 63 (2.1%) experienced an unplanned readmission within 7 days of their procedure. Propensity score matching differentiating between those with a total hospital length of stay of 0 days (same-day discharge) and > 0 days (inpatient admission) on the criteria of age (p = 0.63), sex (p = 0.77), race (p = 0.99), Hispanic ethnicity (p = 0.84), and American Society of Anesthesiologists classification (p = 0.18) showed no statistically significant difference in baseline characteristics between the two cohorts. No significant difference in unplanned readmissions was found between patients with same-day discharge versus those with inpatient admission (OR 1.19, 95% CI 0.72-1.99; p = 0.5).

CONCLUSIONS: Same-day discharge of pediatric patients undergoing VNS insertion was not associated with higher readmission rates compared to patients who stayed in the hospital for more than 1 day.

PMID:41962155 | DOI:10.3171/2025.12.PEDS25501

JMIR Public Health Surveill. 2026 Apr 10;12:e88806. doi: 10.2196/88806.

ABSTRACT

BACKGROUND: While prior studies have examined structural and individual-level barriers to pre-exposure prophylaxis (PrEP) uptake, little is known about the psychological mechanisms underlying resistance to PrEP, particularly among high-risk groups. The status quo bias (SQB) theory provides a theoretical framework for understanding why individuals may resist beneficial health innovations.

OBJECTIVE: The aim of this study was to examine the associations between SQB and PrEP resistance intention among Chinese men who have sex with men (MSM) and to test whether condom-use inertia moderated these relationships.

METHODS: We conducted a cross-sectional online survey among 1022 MSM in China from November 2024 to February 2025. Theory-guided multi-item measures were constructed to capture key dimensions of SQB. Their internal consistency and construct validity were examined using confirmatory factor analysis prior to regression modeling. Multiple linear regression models assessed main effects and moderation effects, adjusting for sociodemographic and behavioral covariates.

RESULTS: A total of 1022 MSM were included in the final analysis (mean age 29.6 y); the majority identified as homosexual (767/1022, 75.1%) and were unmarried (896/1022, 87.7%). Regression analyses revealed that transition costs were positively associated with PrEP resistance intention (β=0.26, 95% CI 0.17-0.35; P<.001), while social norms were negatively associated (β=-0.19, 95% CI -0.27 to -0.12; P<.001). Condom-use inertia significantly moderated both associations, amplifying the positive relationship between transition costs and resistance (β=0.04, 95% CI 0.01-0.09; P=.03) and enhancing the negative association of social norms (β=-0.05, 95% CI -0.09 to 0.00; P=.04). Subgroup analyses showed that the amplifying effect of condom-use inertia on transition costs was particularly evident among participants with postgraduate education (β=0.13, 95% CI 0.01-0.26; P=.04). Conversely, its strengthening effect on social norms was more pronounced among MSM 30 years or younger (β=-0.11, 95% CI -0.17 to -0.04; P=.001) and those identifying as homosexual (β=-0.07, 95% CI -0.12 to -0.02; P=.01).

CONCLUSIONS: This study suggests that SQB is an important psychological barrier to PrEP adoption among Chinese MSM. The moderating role of condom-use inertia highlights the relevance of habitual condom-use routines in shaping PrEP resistance. Behaviorally informed strategies that reduce transition costs and leverage social norms may help mitigate resistance and improve PrEP uptake.

PMID:41962129 | DOI:10.2196/88806

Swiss Med Wkly. 2026 Jan 6;156:4490. doi: 10.57187/s.4490.

ABSTRACT

BACKGROUND: Guidelines for diagnostic work-up in first-episode psychosis (FEP) vary worldwide. The German DGPPN S3 guidelines recommend a comprehensive work-up, including neuroimaging. However, real-world adherence to these recommendations remains unclear. This study examined guideline adherence in a Swiss tertiary psychiatric hospital.

METHODS: We conducted a retrospective cross-sectional study analysing electronic healthcare records of first-episode psychosis patients hospitalised with an ICD-10 chapter F2 diagnosis for the first time between October 2022 and September 2023. We assessed adherence to recommended mandatory DGPPN S3 assessments – neurological examinations, blood analyses, drug screening, MRI – and evaluated completion of optional assessments such as EEG and lumbar puncture.

RESULTS: A total of 68 first-episode psychosis patients were included from 364 patients screened: 44 (64.7%) were men; their median age was 29 (IQR: 23-33) years; 35 (51.5%) were involuntary admissions. Nearly all patients (n = 66 or 97.1%) received thorough neurological examinations and blood analyses, while 56 (82.4%) underwent drug screening (with 35 [44.6%] testing positive for cannabis). MRI was conducted in 38 (55.9%) cases. Non-completion of MRI was mainly due to patient refusal (n = 10 or 14.7%) or early discharge (n = 16 or 23.5%). Optional EEG and lumbar puncture were less frequently performed: in 26 (38.2%) and 4 (5.9%) patients, respectively.

CONCLUSIONS: Overall, guideline adherence was high, particularly for essential diagnostic procedures. However, only around half of the sample underwent MRI imaging, largely because of patient refusal or patient-requested discharge prior to completion of the suggested assessment. These findings highlight the need for optimised diagnostic workflows and enhanced patient education strategies to improve guideline adherence in FEP assessment.

PMID:41962128 | DOI:10.57187/s.4490

Neurology. 2026 May 12;106(9):e214860. doi: 10.1212/WNL.0000000000214860. Epub 2026 Apr 10.

ABSTRACT

BACKGROUND AND OBJECTIVES: Intensive blood pressure (BP) reduction may reduce the risk of poor functional outcomes in patients with acute intracerebral hemorrhage (ICH). Whether these potential benefits apply similarly to lobar and deep ICH, 2 biologically and clinically distinct subtypes, remains uncertain. We tested the hypothesis that intensive BP reduction has differential effects on functional outcomes based on ICH location.

METHODS: We performed a stepwise meta-analysis, stratified by ICH location, of 3 landmark randomized clinical trials of intensive BP reduction: Acute Cerebral Hemorrhage (ATACH-2), Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial 2 (INTERACT2), and INTERACT3. Step 1 pooled ATACH-2 and INTERACT2 (3-month outcomes; intensive BP lowering only). Step 2 added INTERACT3 (6-month outcomes; care bundle protocol with intensive BP lowering plus glucose management, antipyresis, and anticoagulant reversal). For ATACH-2, we used pooled results from individual patient data (adjusted for age, Glasgow Coma Scale score, and presence of intraventricular hemorrhage), whereas for INTERACT2 and INTERACT3, we used their pooled, publicly available results. Our exposure of interest contrasted intensive systolic BP targets <140 mm Hg vs standard care 140-180 mm Hg. Our outcome of interest was poor functional outcome, defined as a modified Rankin Scale score of 4-6 in ATACH-2 and INTERACT3 and of 3-6 in INTERACT2.

RESULTS: Step 1 included a total of 2,983 patients with deep and 537 patients with lobar ICH (mean age 63 y/o, 37% female). Intensive BP reduction was not associated with a significant difference in poor functional outcome for either deep (odds ratio [OR] 0.89; 95% CI 0.40-1.98; I² = 0%) or lobar (OR 0.92; 95% CI 0.73-1.17; I² = 0%) ICH. Step 2 included a total of 7,917 patients with deep and 1,105 patients with lobar ICH (mean age 63 y/o, 37% female). Similarly, intensive BP reduction was not associated with a significant difference in poor outcome in both deep (OR 0.82; 95% CI 0.57-1.18; I² = 60%) and lobar (OR 0.97; 95% CI 0.76-1.24; I² = 0%) ICH.

DISCUSSION: In this stepwise meta-analysis of 3 landmark ICH trials, intensive BP reduction did not demonstrate a significant benefit in either deep or lobar ICH. Although our estimates did not reach statistical significance, the direction of effect in deep ICH and the substantial heterogeneity across trials, particularly with the inclusion of INTERACT3, limit firm conclusions. Given these uncertainties and the biological distinctions between deep and lobar ICH, future well-powered studies specifically designed to test whether intensive BP reduction has differential effects by hematoma location are warranted.

PMID:41962119 | DOI:10.1212/WNL.0000000000214860

Wiad Lek. 2026;79(3):508-517. doi: 10.36740/WLek/218271.

ABSTRACT

OBJECTIVE: Aim: This study aimed to assess adult perceptions and awareness of factors influencing longevity and healthy ageing in the UAE.

PATIENTS AND METHODS: Materials and Methods: A cross-sectional study was conducted among 446 adults in the UAE using a self-administered, structured online questionnaire comprised of different domains. Data was analyzed using SPSS version 29. Descriptive statistics summarized perception levels, and Chi-square tests assessed associations between sociodemographic, cultural, lifestyle, and healthcare-related factors and perceptions of longevity. A p-value <0.05 was considered statistically significant.

RESULTS: Results: Most participants demonstrated good overall longevity perception (87.9%). Lifestyle-related factors, including healthy diet (84.5%), regular physical activity (83.6%), stress management (84.8%), non-smoking (79.8%), and limited alcohol consumption (82.7%), were widely recognized as important contributors to longevity. Access to quality healthcare (83.6%) and financial security (79.4%) were also strongly endorsed. Significant associations were observed between longevity perception and nationality (p=0.011), education level (p=0.007), occupation (p=0.002), marital status (p=0.025), and age group (p<0.001). Preventive health beliefs, particularly stress management, healthy diet, and regular medical check-ups (p<0.001), showed strong associations with positive longevity perception.

CONCLUSION: Conclusions: Adults exhibit high awareness of modifiable lifestyle and healthcare determinants of longevity. Perceptions are shaped primarily by preventive health beliefs rather than cultural or caregiving exposure alone. Strengthening public health education and preventive healthcare initiatives is essential to support national healthy-ageing strategies.

PMID:41962090 | DOI:10.36740/WLek/218271

Wiad Lek. 2026;79(3):500-507. doi: 10.36740/WLek/218266.

ABSTRACT

OBJECTIVE: Aim: The primary aim of this study was to identify and analyze the socio-demographic determinants of constipation among elderly individuals (≥60 years) attending a tertiary care hospital in Ajman, United Arab Emirates, in order to address an important gap in regional geriatric gastrointestinal research.

PATIENTS AND METHODS: Materials and Methods: A record-based case-control study was conducted among patients aged 60 years and above attending a tertiary care hospital The cases were elderly patients with documented constipation, while the controls were elderly patients without constipation, selected in a 1:2 ratio. Data were extracted using a structured and validated proforma. Descriptive statistics, chi-square tests, and binary logistic regression were performed to examine associations. Crude and adjusted odds ratios with 95% confidence intervals were calculated, and a p-value ≤0.05 was considered statistically significant.

RESULTS: Results: Constipation was more frequently observed among males and in specific age groups. Participants aged 60-69 years constituted the largest proportion of cases (78.8%), while those aged 70-79 years were more commonly represented among controls. A significant association was observed between age group and constipation (p<0.01). Male participants accounted for 71.3% of cases compared to 37.4% of controls (p<0.01). In adjusted analysis, male gender remained a strong predictor of constipation (AOR: 4.41; 95% CI: 2.40-8.11).

CONCLUSION: Conclusions: Male gender and age group were key socio-demographic determinants of constipation among elderly patients in this tertiary care setting. These findings highlight the need for targeted screening, early recognition, and preventive strategies for constipation as part of routine geriatric care.

PMID:41962089 | DOI:10.36740/WLek/218266

Wiad Lek. 2026;79(3):491-499. doi: 10.36740/WLek/218230.

ABSTRACT

OBJECTIVE: Aim: This study aimed to find out predictors of chronic liver disease (CLD) in adults and evaluate key determinants that may influence healthy aging.

PATIENTS AND METHODS: Materials and Methods: A case-control study was conducted among adults who were receiving care at a tertiary care center. Demographics, lifestyle factors, and clinical variables like BMI were collected. Statistical analysis was performed using chi-square testing for association and logistic regression analysis to identify independent factors that predict CLD, p-value of <0.05 was used to identify significance for all information collected.

RESULTS: Results: Significant links were found between CLD and several factors. Males were significantly more affected with CLD (78.5%, p < 0.001), making gender one of the factors that predict CLD. Similarly, age was a significant factor, with those aged 40-60 being the most affected (33%, p = 0.039). Abnormal BMI was strongly associated with CLD, found in 84.6% cases (p = 0.008). Alcohol consumption demonstrated a marked association with chronic liver disease (p < 0.001), with former and current alcohol use substantially more common among cases. After logistics regression analysis, male gender, abnormal BMI, and alcohol consumption are significant independent predictors of CLD.

CONCLUSION: Conclusions: The study highlights gender (male), age (40-60), abnormal BMI and alcohol consumption as significant predictors of CLD in the studied population. These findings emphasize the urgent need for targeted screening and lifestyle-based preventive interventions, particularly focusing on metabolic health and weight management, to mitigate the rising burden of liver disease and promote healthy aging.

PMID:41962088 | DOI:10.36740/WLek/218230

Wiad Lek. 2026;79(3):482-490. doi: 10.36740/WLek/218273.

ABSTRACT

OBJECTIVE: Aim: This research aims to assess the clinical and epidemiological profile of elderly patients reported to a tertiary care centre in Ajman, UAE.

PATIENTS AND METHODS: Materials and Methods: A retrospective cross-sectional review of electronic medical records was conducted for patients diagnosed with constipation between January 2020 and July 2025. Sociodemographic characteristics, anthropometric measures, functional status, lifestyle factors, comorbidities, gastrointestinal history, and treatment outcomes were extracted using a structured proforma. Descriptive statistics were applied.

RESULTS: Results: Eighty elderly patients were included, predominantly male (71.3%) and aged 60-69 years (78.8%). Abnormal BMI was present in 76.3%. Chronic symptoms were common, with 52.5% reporting constipation ≥3 months and 47.5% >6 months. Low fluid intake (66.3%), low dietary fiber intake (67.5%), and sedentary lifestyle (62.5%) were highly prevalent. Cardiometabolic comorbidities were frequent, including hypertension (68.8%), diabetes mellitus (65.0%), and hypercholesterolemia (63.7%). Only 38.8% achieved good therapeutic response, while 61.3% had poor or partial improvement.

CONCLUSION: Conclusions: Constipation in elderly patients at this tertiary center represents a persistent, multifactorial condition requiring comprehensive, individualized, and lifestyle-integrated management strategies to improve outcomes.

PMID:41962087 | DOI:10.36740/WLek/218273

Wiad Lek. 2026;79(3):474-481. doi: 10.36740/WLek/218412.

ABSTRACT

OBJECTIVE: Aim: To describe the clinico-epidemiological profile, metabolic risk factors, and treatment outcomes of patients with chronic liver disease (CLD) at a tertiary care center in Ajman, UAE.

PATIENTS AND METHODS: Materials and Methods: 149 individuals with confirmed CLD were included in a descriptive five-year retrospective study. Descriptive statistics (frequencies and percentages) were utilized for analyzing demographic data, lifestyle variables, metabolic comorbidities, and clinical outcomes.

RESULTS: Results: The male-to-female ratio in the cohort was 3.7:1, with a significant male preponderance (78.5%; n=117). In particular, most patients (91.3%) were under 60, with those under 40 making up the biggest group (46.3%; n=69). The Eastern Mediterranean Region was the place of origin for more than half of the participants (55.7%). In terms of lifestyle risk factors, 32.9% of respondents smoked, and 24.2% reported drinking alcohol (14.1% now, 10.1% previously). Although only 8.1% were classified as obese (BMI ≥30 kg/m²), 84.6% had abnormal BMI (overweight or obese). Fatty liver (41.6%), diabetes mellitus (38.9%), dyslipidaemia (37.6%), and hypertension (36.2%) were among the significant metabolic comorbidities. Nearly half (49.0%) of patients had incomplete or poor clinical outcomes to medications, whereas 51.0% had “good” results.

CONCLUSION: Conclusions: This tertiary-care cohort found a predominance of economically productive males who were affected by CLD, who also exhibited a high prevalence of metabolic risk factors. Origins of obesity and diabetes have highlighted the regional influence of metabolic (MAD) liver disease. To optimise the outcome of patients who have these diseases, there is an urgent need for early screening and comprehensive management of metabolic risk factors.

PMID:41962086 | DOI:10.36740/WLek/218412

Swiss Med Wkly. 2026 Feb 12;156:4892. doi: 10.57187/4892.

ABSTRACT

BACKGROUND AND AIM OF THE STUDY: Polypharmacy is common among older adults and associated with potentially inappropriate medications and potential prescribing omissions, which together constitute potentially inappropriate prescriptions, contributing to adverse outcomes and increased healthcare costs. Longitudinal data on potentially inappropriate prescriptions and differences across living environments are limited. Our aim was to analyse patterns and determinants of potentially inappropriate prescriptions in multimorbid, older adults across different living environments and their trends over 12 months.

METHODS: We used data from the control group (n = 1045) of the multi-country OPERAM trial (December 2015 – October 2018), a cluster-randomised controlled trial including older adults aged ≥70 years with ≥3 chronic conditions and ≥5 medications, which tested a software intervention to improve prescribing in these patients. The control group received pharmaceutical care in accordance with usual care. STOPP/START criteria were applied to detect potentially inappropriate prescriptions at hospital admission, discharge, and at 2-, 6- and 12-month follow-up. The outcomes were a priori defined as the prevalence of potentially inappropriate prescriptions at hospital admission, differences in potentially inappropriate prescriptions between living settings (nursing home versus community-dwelling) and number of medications (polypharmacy [5-9 medications] versus hyperpolypharmacy [≥10 medications]), changes in potentially inappropriate prescriptions over the 12-month follow-up and factors associated with potentially inappropriate prescriptions. Analyses included descriptive statistics and multivariable regression.

RESULTS: At admission, 664 (63.5%) patients had ≥1 potentially inappropriate medication and 754 (72.1%) had ≥1 potential prescribing omission. Potentially inappropriate prescriptions at admission were most strongly associated with hyperpolypharmacy (potentially inappropriate medication: incidence rate ratio [IRR] 1.54, 95% CI 1.35-1.76) and cognitive impairment (potentially inappropriate medication: IRR 1.44, 95% CI 1.16-1.79), and were also significantly associated with female sex, number of comorbidities, fall history, nursing home residency and older age. Although overall prevalence remained stable over 12 months, substantial individual-level changes occurred, with many patients experiencing increases or decreases in the number of potentially inappropriate medications or potential prescribing omissions, alongside notable shifts in specific potentially inappropriate medications/potential prescribing omissions. An increasing number of potentially inappropriate prescriptions over time was mostly associated with hyperpolypharmacy (potential prescribing omission: OR 1.71, 95% CI 1.20-2.42 at 12 months) and nursing home residency (potentially inappropriate medication: OR 1.94, 95% CI 1.12-3.36 at 12 months), while significant associations were found for fall history and number of comorbidities.

CONCLUSION: Potentially inappropriate prescriptions remain highly prevalent in multimorbid, older adults and do not clearly improve over time. Frequent changes at patient level and dynamic shifts in specific potentially inappropriate medications/potential prescribing omissions over time underscore the need for individualised, continuous medication reviews addressing both over- and underprescribing. Factors associated with increasing potentially inappropriate prescriptions over time may serve as indicators of high-risk patients and highlight the need for targeted interventions and further research.

STUDY REGISTRATION: This study is based on data from the OPERAM trial, which was registered at ClinicalTrials.gov (NCT02986425).

PMID:41962085 | DOI:10.57187/4892