Tag: pubmed

Am J Health Promot. 2026 Jun 8:8901171261458119. doi: 10.1177/08901171261458119. Online ahead of print.

ABSTRACT

PurposeThe study aimed to evaluate the effectiveness of a school-based health promotion program in reducing key risk factors for NCDs in Nepal.DesignA repeated cross-sectional, quasi-experimental study design.SettingSchool.SampleThe sample size for each of the intervention and control arms was 209.InterventionHealth education intervention.MeasuresMeasurement of change in metabolic equivalent of task (MET), body mass index, body fat percentage, fruit and vegetable servings per day, and other risk factors of non-communicable diseases.AnalysisData for both groups were summarized as frequencies and percentages at baseline (T0), after the first intervention (T1), and after the second intervention (T2). Intervention and control groups were compared using the Chi-square test, Mann-Whitney U test, independent-samples t-test, Mood’s median test, and Cluster-level Difference-in-Difference (DiD) analysis.ResultsA total of 423, 366, and 270 adolescents (intervention: 214, 176, 135; control: 209, 190, 125) from 9 schools (5 intervention, 4 control) participated at baseline, T1, and T2. Cluster-level DiD analysis to assess the effectiveness of the intervention found improvements in BMI, body fat percentage, fruit and vegetable purchase frequency, and school canteen fruit availability, but none were statistically significant.ConclusionAlthough not statistically significant, the intervention produced directionally favorable changes in physical activity, anthropometric measures, and dietary behaviors, suggesting potential public health benefits at the school level.

PMID:42258891 | DOI:10.1177/08901171261458119

West J Emerg Med. 2026 Apr 14;27(3):644-650. doi: 10.5811/westjem.48916.

ABSTRACT

INTRODUCTION: In-situ simulation offers a realistic training environment with a higher level of fidelity compared to other simulation models. It is associated with enhanced knowledge retention and a higher level of composure during real clinical encounters. One common barrier to undertaking in-situ simulation is the concern that it contributes to a delay in providing patient care. In this study we gave patients in the waiting room seven hypothetical emergency medical scenarios, two of which were training simulation scenarios, and we asked them how long they would be willing to delay their care if the different scenarios were actually occurring in the emergency department (ED). Our objective was to investigate whether patients in the ED waiting room would be willing to delay their care if they knew that there were simulation training scenarios occurring.

METHODS: This was a prospective convenience sample of participants conducted at a Level 1 trauma centre. Participants completed a survey that presented seven hypothetical scenarios, including two in-situ simulation scenarios. They were then asked to indicate the amount of additional wait time they would deem acceptable for each scenario.

RESULTS: Responses to the two in-situ simulation scenarios indicated that 342 (40%) and 335 (40.5%) of the 827 study participants, respectively, were willing to wait > 40 minutes for these to occur. In contrast, and after controlling for age, sex, waiting time, and time of recruitment, subjects reported they would tolerate shorter wait times for simulation scenarios than for real patient-care scenarios. [Willingness to wait > 40 minutes for the five real scenarios ranged from 70.5-79.9%, P < .05).

CONCLUSION: While patients demonstrated lower tolerance for simulation-related delays than for routine clinical care, our results showed that most were still willing to wait up to an additional hour to allow in-situ simulation to proceed. These findings indicate that in-situ simulation is broadly acceptable to patients and supports its continued use in clinical settings.

PMID:42258882 | DOI:10.5811/westjem.48916

West J Emerg Med. 2026 May 18;27(3):698-708. doi: 10.5811/westjem.50598.

ABSTRACT

INTRODUCTION: Program diversity impacts rank-list creation for emergency medicine (EM)-bound applicants, but how lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and other sexual and gender minorities (LGBTQIA+) identities influence residency selection is unknown. This study investigates general patterns in EM applicant LGBTQIA+ identities, disclosure of those identities, and how LGBTQIA+ factors impact residency selection. Additionally, we present data exploring the relationship between medical school location and the location of top-ranked programs for LGBTQIA+ and non-LGBTQIA+ identifying applicants.

METHODS: We surveyed 2,287 EM-bound United States MD/DO applicants who applied to one of five author EM programs and programs affiliated with the Emergency Medicine Education Research Alliance from May 16-June 30, 2024. The survey included multiple-choice, free-text, and Likert scale questions. Data were explored with descriptive statistics, and we used chi-square and Fisher exact tests to compare differences in proportions. We also analyzed applicants’ medical school state and a graphical representation of the top three positions on their residency rank lists, using inverse-proportional weighting.

RESULTS: Of 445 respondents (19.4%), 59 (13.3%) identified as LGBTQIA+. Gender identities included 173 cisgender men (38.9%), 254 cisgender women (57.1%), one transgender man (0.2%), one transgender woman (0.2%), four non-binary (0.9%), one genderqueer (0.2%), and seven “preferred not to answer” (1.6%). Among LGBTQIA+ respondents, seven (11.9%) disclosed their status within the application, nine (15.3%) during the interview, 18 (30.5%) in both, and 25 (42.4%) did not disclose. Among 56 respondents, 36 (64.3%) supported adding LGBTQIA+ status to the residency application; 20 (35.7%) did not. Of the program factors considered, program diversity (91.1%) and commitment to underserved communities (96.4%) were significantly more important for LGBTQIA+ respondents (P < .01), while proximity to partner(s) (64.3%; P < .01) and program length (66.1%; P = .02) were significantly less important compared with non-LGBTQIA+ respondents. Additional factors that influenced LGBTQIA+ applicants’ rank list included political environment, friendliness of the learning environment, and presence/absence of anti-LGBTQIA+ laws.

CONCLUSION: Many LGBTQIA+ applicants do not disclose their identities when applying for residency. LGBTQIA+ respondents value program diversity and commitment to underserved communities, and they consider LGBTQIA+-specific factors such as the presence of anti-LGBTQIA+ legislation. These insights can inform residency programs and recruitment practices.

PMID:42258874 | DOI:10.5811/westjem.50598

West J Emerg Med. 2026 May 15;27(3):669-675. doi: 10.5811/westjem.53133.

ABSTRACT

INTRODUCTION: Intravenous (IV) fluids are routinely administered empirically in the emergency department (ED) for patients presenting with stimulant intoxication (eg, cocaine, methamphetamine, synthetic marijuana), although the literature is sparse regarding the benefits and risks of this practice. Our primary objective in this study was to assess whether empiric administration of IV fluids in the ED is associated with increased discharge length of stay (LOS) among ED patients presenting for stimulant intoxication who were subsequently discharged.

METHODS: This single-center, retrospective cohort study included 100 patients 18-69 years of age who were discharged from the ED with a non-incidental diagnosis related to stimulant intoxication between May 29, 2020-December 31, 2023, based on International Classification of Diseases code and chart review, in addition to a triage heart rate ≥ 90 beats per minute. We excluded patients if the medical decision-making reflected a clear indication for IV fluids or the presence of pre-defined confounding diagnoses or an uncontrolled factor that would have inherently impacted discharge LOS. Our primary outcome measure was discharge LOS. A multiple linear regression model controlled for the potentially confounding secondary outcome measures of age, sex, alcohol involvement, advanced imaging, sedation, and discharge escort.

RESULTS: A total of 100 patients were included, including 50 (50%) patients who did not receive IV fluids and 50 (50%) patients who did. Median patient age was 35 (interquartile range [IQR] 29-41) and 73% of patients were male. Patients who received IV fluids had a median LOS of 345 minutes (IQR 260-470) vs 305 minutes (IQR 205-413), with multivariable linear regression showing no statistically significant difference (β = 40.3, 95% CI, -13.6 to 94.2, R² = 0.162).

CONCLUSION: This study suggests that empiric IV fluid administration in stimulant-intoxicated ED patients was not significantly associated with discharge length of stay. Although the observed difference and confidence interval suggest the possibility of a clinically meaningful increase in discharge LOS with empiric IV fluid, these findings should be interpreted cautiously. Time is an important resource in high-volume ED settings, and this study suggest the need for judicious use of IV fluids in the absence of a clear indication.

PMID:42258873 | DOI:10.5811/westjem.53133

West J Emerg Med. 2026 Apr 8;27(3):651-658. doi: 10.5811/westjem.48825.

ABSTRACT

INTRODUCTION: Emergency departments (ED) in the United States serve as a safety net for millions, including those with limited English proficiency (LEP). Eight percent of individuals living in the United States have LEP, placing them at risk for language barriers that can adversely affect the quality and safety of their care. Many hospitals lack language-concordant care, especially at the time of discharge. Miscommunication at discharge can lead to adverse health outcomes, including medication errors, poor compliance, and unnecessary return visits to the ED. Our objectives in this study were to evaluate the quality and safety of artificial intelligence (AI)-generated translations of physician-written, patient-specific ED discharge instructions and to assess performance across varying levels of instruction complexity.

METHODS: Emergency physicians wrote free-form discharge instructions, representing patient-specific guidance, which are typically provided at the time of ED discharge. Four topics were selected: abdominal pain; chest pain; wrist fracture; and vaginal bleeding in pregnancy. These instructions were intentionally developed to vary in linguistic complexity and were assessed using the Flesch Reading Ease and Flesch-Kincaid Grade Level scales. Instructions were translated into Albanian, Brazilian Portuguese, and Vietnamese using the AI-based translation tools ChatGPT-4, Microsoft Copilot, and Google Translate. Translations were evaluated for semantic and syntactic accuracy. Criteria included adequacy, fluency, meaning, and severity on a 5-point scale (1 = lowest accuracy, 5 = highest accuracy). Preference and formality were rated on a 3-point scale (1 = lowest, 3 = highest). The primary outcome was the quality and safety of AI-generated translations of patient-specific discharge instructions. Secondary outcomes included the ability to handle varying instruction complexity. Professional medical translators primarily responsible for the written translation of medical text evaluated and scored the translations for accuracy and quality metrics.

RESULTS: Overall adequacy, fluency, meaning, and severity scores were similar across models. ChatGPT-4 (3.79), Microsoft Copilot (3.60), and Google Translate (3.50), showed no statistically significant differences. Albanian translation was an exception, with ChatGPT-4 scoring significantly higher (3.75) than Google Translate (3.19) (P < .001). There were no other significant differences observed for Brazilian Portuguese or Vietnamese. ChatGPT-4 was also found to be the highest rated for Albanian and Brazilian Portuguese. Both Microsoft Copilot and Google Translate produced a total of five potentially harmful translation errors, whereas none were identified for ChatGPT-4.

CONCLUSION: Miscommunication during discharge can lead to negative patient outcomes. This study evaluated ChatGPT-4, Microsoft Copilot, and Google Translate in translating ED instructions into Albanian, Brazilian Portuguese, and Vietnamese. ChatGPT-4 performed best overall and produced no harmful translations, and significantly outperformed Google Translate in Albanian. While AI-based translation tools show promise, human oversight remains necessary to mitigate risks from translation inaccuracies.

PMID:42258871 | DOI:10.5811/westjem.48825

West J Emerg Med. 2026 Apr 8;27(3):753-758. doi: 10.5811/westjem.48818.

ABSTRACT

BACKGROUND: Musculoskeletal back pain is a common presenting complaint to emergency departments (ED) worldwide. In this study we aimed to evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) as an adjunct to standard care in reducing pain for patients presenting with acute low back pain.

METHODS: This study has a dual-center, open-label, cluster-randomized controlled trial design. Participants were recruited from two tertiary-care EDs in Canada. We included patients with acute or acute-on-chronic back pain of < 3 weeks duration. Participants were randomized to receive either TENS for 30 minutes plus standard care, or standard care alone. We measured pain scores using the Visual Analogue Scale (VAS) at baseline, 30 minutes, and 60 minutes after initiation of the intervention. The primary outcome was the difference in mean VAS pain scores at 60 minutes between the two groups.

RESULTS: Of 94 patients considered, we enrolled 25 participants (15 control and 10 intervention). The group receiving TENS plus standard care showed a statistically significant reduction in pain scores compared to the standard care alone group at both the 30-minute (relative mean difference: 22.6%; absolute difference: 1.7 points on 10-point VAS (95% CI, -31.9%, -13.4%, P < .001) and 60-minute timepoints (relative mean difference 18.2%, absolute difference 1.4 points (-32.7%, -3.8%, P = .04). There were two return visits in the intervention group within two weeks from the index visit, and two patients reported slight discomfort with using TENS, although they kept the device on for the duration of the trial period.

CONCLUSION: The addition of transcutaneous electrical nerve stimulation to standard care resulted in a modest but statistically significant reduction in pain scores for patients with acute back pain in the ED setting, although it did not meet our predefined threshold of clinical significance. Further research with larger sample sizes is required to clarify the effect size and role of TENS for acute back pain in the ED waiting room.

PMID:42258870 | DOI:10.5811/westjem.48818

Emotion. 2026 Jun 8. doi: 10.1037/emo0001674. Online ahead of print.

ABSTRACT

Alexithymia is an important risk factor for psychopathology. However, it is not yet clear why. Here, we examine alexithymia’s relationship with both ill-being and well-being outcomes and test whether emotion regulation patterns are a key mechanism explaining these links. Based on contemporary affective science frameworks, we predicted that people high (vs. low) in alexithymia would more frequently use maladaptive emotion regulation strategies that involve disengaging from negative emotions and less frequently use adaptive strategies that involve engaging with negative emotions. We also predicted that emotion regulation strategy choice should, in turn, statistically mediate relationships between alexithymia and ill- and well-being. We conducted two cross-sectional survey studies with mediation modeling, one exploratory (N = 427) and one preregistered (N = 600). In both studies, results indicated that (a) alexithymia is associated with higher ill-being and lower well-being, (b) alexithymia is associated with greater use of maladaptive disengagement emotion regulation strategies and less use of adaptive engagement strategies, and (c) the relationships between alexithymia and ill- and well-being outcomes are statistically partially explained by this profile of emotion regulation. Conceptually, these findings are well aligned with the attention-appraisal model of alexithymia and process model of emotion regulation, empirically supporting the claim that interactions between alexithymia and emotion regulation have important implications for people’s ill-being and well-being. Clinically, these findings highlight the importance of targeting both alexithymia and emotion regulation patterns in treatment to help facilitate desirable affective outcomes. Our findings suggest that such work may help reduce ill-being and enhance well-being. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

PMID:42258281 | DOI:10.1037/emo0001674

Am J Manag Care. 2026 Jun 1;32(Spec. No. 6):eSP12-eSP21. doi: 10.37765/ajmc.2026.89974.

ABSTRACT

OBJECTIVES: Guillain-Barré syndrome (GBS) is a rapidly progressive neuromuscular disorder that often requires intensive care and immunomodulatory therapy. Despite standardized treatment approaches, access to care and outcomes may be influenced by social determinants of health. We evaluated associations between socioeconomic and racial factors and inpatient interventions and outcomes in GBS in the US.

STUDY DESIGN: Retrospective cohort study.

METHODS: This retrospective cohort study used data from the National Inpatient Sample (2016-2021) to identify hospitalizations with a primary diagnosis of GBS ( International Statistical Classification of Diseases, Tenth Revision code G61.0). Multivariable logistic regression models assessed associations between demographic and socioeconomic variables and 5 prespecified outcomes: in-hospital mortality, nonroutine discharge, prolonged hospitalization, receipt of intravenous immunoglobulin (IVIG), and receipt of plasmapheresis.

RESULTS: We analyzed 45,515 GBS-related hospitalizations (patients’ mean age, 50.7 years; 46.0% female). After adjusting for covariates, higher zip code income was associated with reduced inpatient mortality (OR per quartile, 0.80; 95% CI, 0.66-0.98). Admission to private investor-owned hospitals was associated with lower IVIG or plasmapheresis use, an effect not seen when analyzing only privately insured patients. Black patients were less likely to receive plasmapheresis (OR, 0.75; 95% CI, 0.59-0.95). Black and Native American patients had higher odds of nonroutine discharge (Black: OR, 1.26; 95% CI, 1.06-1.51; Native American: OR, 2.16; 95% CI, 1.20-3.88). Medicare coverage was associated with higher odds of nonroutine discharge (OR, 1.90; 95% CI, 1.62-2.23), and Medicaid coverage was associated with prolonged hospitalization (OR, 1.73; 95% CI, 1.48-2.02). Self-pay was linked to reduced odds of nonroutine discharge but longer hospitalization (OR, 0.53; 95% CI, 0.43-0.66).

CONCLUSIONS: This study reveals socioeconomic, racial, and institutional disparities in GBS hospitalization outcomes despite standardized treatment guidelines. These findings highlight the need for equity-focused strategies to ensure timely and consistent care for patients with acute neurologic conditions.

PMID:42258266 | DOI:10.37765/ajmc.2026.89974

Psychol Aging. 2026 Jun 8. doi: 10.1037/pag0000999. Online ahead of print.

ABSTRACT

To date, few studies have explored the role of older adults’ self-perceptions of aging (SPA) in the context of volunteering and how SPA might shape or be shaped by volunteering. Using random-intercept cross-lagged panel models and data from the German Ageing Survey, this study examined the bidirectional associations between different gain- and loss-related facets of older adults’ SPA (i.e., perceptions of physical losses, social losses, and ongoing development) and their engagement in volunteering over a 9-year period. Gender differences in these associations were also examined. The study sample comprised 4,512 older adults (ages 65-93 years at baseline). At the between-person level, individuals with overall higher scores on SPA of social losses reported overall fewer hours of volunteering per week, whereas participants’ scores on the other two SPA scales were not significantly associated with volunteering at the between-person level. With regard to within-person cross-lagged associations, paths from prior volunteering to subsequent SPA were statistically nonsignificant. However, higher than one’s average SPA of physical losses was associated with less volunteering than one’s average at the subsequent measurement occasion, whereas scoring higher than one’s average SPA of ongoing development showed the opposite association with volunteering at subsequent occasions. Findings also revealed gender differences in the associations between SPA of social losses and volunteering. In summary, the findings of this study showed that different dimensions of older adults’ SPA are differentially associated with their volunteering over time and that it may be important to take a gender-specific perspective on volunteering. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

PMID:42258264 | DOI:10.1037/pag0000999

Rehabil Psychol. 2026 Jun 8. doi: 10.1037/rep0000678. Online ahead of print.

ABSTRACT

PURPOSE/OBJECTIVE: Brain injuries often have lifelong consequences that include long-term impairments and disability. Policy-, community-, and society-level interventions are a critical path to survivor impact. A recent qualitative study highlighted the potential of a new tool, Brain Injury Identification Cards, for enhancing survivor safety, self-advocacy, and well-being. The primary purpose of our study was to conduct a quantitative assessment of perceived benefits and self-reported credibility, expectancy, and acceptability to inform future trials.

RESEARCH METHOD/DESIGN: In this cross-sectional study, we assessed the impressions of current owners (N = 99) of Brain Injury Identification Cards. We administered online self-report questionnaires and characterized perceived experiences, acceptability, and utility using descriptive statistics.

RESULTS: Most (>67%) had favorable impressions about their own use of the Brain Injury Identification Cards, although approximately 19% perceived the cards as stigmatizing or embarrassing, and 22% said the cards were not helpful for their stress and anxiety surrounding traumatic brain injury symptoms. Overall, participants rated treatment credibility and expectancy as high, and all respondents who completed survey items (n = 96) indicated that they would recommend cards to others with traumatic brain injury and other medical conditions.

CONCLUSIONS/IMPLICATIONS: Our findings highlight the perceived benefits of using a Brain Injury Identification Card among established Card owners. Future studies in representative samples of survivors assessing user experiences before and after the receipt of Brain Injury Identification Cards are needed to assess potential intervention effects. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

PMID:42258251 | DOI:10.1037/rep0000678