Tag: pubmed

J Vet Intern Med. 2025 May-Jun;39(3):e70064. doi: 10.1111/jvim.70064.

ABSTRACT

BACKGROUND: While there is agreement that horses experience pain during the actual headshaking attacks, there is still a lack of research about the time between the individual episodes in this species.

OBJECTIVES: To evaluate the signs of pain in horses with TMHS at rest in the absence of common triggering factors.

ANIMALS: Twenty TMHS horses (not head shaking at the time of pain assessment), 20 horses with colic, and 20 clinically healthy horses.

METHODS: Descriptive study assessing pain in TMHS horses during the absence of clinical signs using the Horse Grimace scale (HGS). To grade the pain shown with TMHS, horses with moderate gastrointestinal pain conditions and a healthy horses’ group were also included. For evaluation, videos were taken on two consecutive days from both sides of the face (healthy, TMHS) or before analgesics were applied (colic). Eight photos per horse were extracted from the videos, randomized, and evaluated by three examiner groups, each comprising two persons: (a) last-year veterinary medicine students without previous use of the HGS, (b) experienced veterinarians without experience in using the HGS, and (c) experienced veterinarians who regularly apply the HGS. All examiners were blinded to the underlying condition.

RESULTS: Median HGS scores in the groups (healthy, gastrointestinal, TMHS) differed significantly from each other (p < 0.05). Healthy horses had median HGS scores below 2 (median 1.2, range: 0.1-2.4), whereas TMHS horses had higher median HGS scores (5.6, range 2.4-7.4), and colic horses had the highest HGS scores (6.6, range: 3.8-8.4). There was a statistically significant difference for all facial action units (FAU) when the different horse groups were compared (p < 0.05). Effect sizes were large for the healthy horses’ group (ES-1.23) and for the colic horses (ES 0.86), and small to medium for the TMHS horses (ES 0.37).

CLINICAL IMPORTANCE: The results of this study show that pain occurs between individual TMHS attacks in severely affected horses and that the quality of life of these horses must be questioned and evaluated individually.

PMID:40168040 | DOI:10.1111/jvim.70064

JMIR Ment Health. 2025 Apr 1;12:e65356. doi: 10.2196/65356.

ABSTRACT

BACKGROUND: Digital mental health interventions (DMHIs) are a promising approach to reducing the public health burden of mental illness. DMHIs are efficacious, can provide evidence-based treatment with few resources, and are highly scalable relative to one-on-one face-to-face psychotherapy. There is potential for DMHIs to substantially reduce unmet treatment needs by circumventing structural barriers to treatment access (eg, cost, geography, and time). However, epidemiological research on perceived barriers to mental health care use demonstrates that attitudinal barriers, such as the lack of perceived need for treatment, are the most common self-reported reasons for not accessing care. Thus, the most important barriers to accessing traditional psychotherapy may also be barriers to accessing DMHIs.

OBJECTIVE: This study aimed to explore whether attitudinal barriers to traditional psychotherapy access might also serve as barriers to DMHI uptake. We explored the relationships between individuals’ structural versus attitudinal barriers to accessing psychotherapy and their indicators of potential use of internet-delivered guided self-help (GSH).

METHODS: We collected survey data from 971 US adults who were recruited online via Prolific and screened for the presence of psychological distress. Participants provided information about demographic characteristics, current symptoms, and the use of psychotherapy in the past year. Those without past-year psychotherapy use (640/971, 65.9%) answered questions about perceived barriers to psychotherapy access, selecting all contributing barriers to not using psychotherapy and a primary barrier. Participants also read detailed information about a GSH intervention. Primary outcomes were participants’ self-reported interest in the GSH intervention and self-reported likelihood of using the intervention if offered to them.

RESULTS: Individuals who had used psychotherapy in the past year reported greater interest in GSH than those who had not (odds ratio [OR] 2.38, 95% CI 1.86-3.06; P<.001) and greater self-reported likelihood of using GSH (OR 2.25, 95% CI 1.71-2.96; P<.001). Attitudinal primary barriers (eg, lack of perceived need; 336/640, 52.5%) were more common than structural primary barriers (eg, money or insurance; 244/640, 38.1%). Relative to endorsing a structural primary barrier, endorsing an attitudinal primary barrier was associated with lower interest in GSH (OR 0.44, 95% CI 0.32-0.6; across all 3 barrier types, P<.001) and lower self-reported likelihood of using GSH (OR 0.61, 95% CI 0.43-0.87; P=.045). We found no statistically significant differences in primary study outcomes by race or ethnicity or by income, but income had a statistically significant relationship with primary barrier type (ORs 0.27-3.71; P=.045).

CONCLUSIONS: Our findings suggest that attitudinal barriers to traditional psychotherapy use may also serve as barriers to DMHI use, suggesting that disregarding the role of attitudinal barriers may limit the reach of DMHIs. Future research should seek to further understand the relationship between general treatment-seeking attitudes and attitudes about DMHIs to inform the design and marketing of DMHIs.

PMID:40168039 | DOI:10.2196/65356

JAMA Netw Open. 2025 Apr 1;8(4):e252728. doi: 10.1001/jamanetworkopen.2025.2728.

ABSTRACT

IMPORTANCE: There are several apparent research gaps based on the intersectional sociodemographic dimensions of drug-related mortality disparities. Relatively marginal evidence exists on the potential roles of intersecting forms of race and sexual marginalization on the disparities across drug-related mortality.

OBJECTIVE: To examine intersectional sex-specific White and Black racial disparities in drug poisoning mortality across states from 2010 to 2020.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used unintentional fatal drug poisoning mortality data from the Centers for Disease Control and Prevention’s Web-Based Injury Statistics Query and Reporting System. Trends from 2010 through 2020 were analyzed by Black men, Black women, White men, and White women across states. One-sided Mann-Kendall trend analysis was used to examine statistically significant increasing or decreasing trends in age-adjusted mortality rates. Statistical analysis was performed from June to July 2024.

EXPOSURES: White and Black groups intersecting with male and female sex.

MAIN OUTCOMES AND MEASURES: Analysis of age-adjusted mortality rates, excess years of potential life lost (reference group: White men), years of potential life lost ratios (reference group: White men), and percentage change to highlight state differences.

RESULTS: From a total sample of 518 724 unintentional fatal drug poisoning deaths (9.0% in Black men, 3.9% in Black women, 29.0% in White women, and 58.1% in White men), 11 820 781 years of potential life lost were recorded. Black men had the highest mean (SD) age-adjusted mortality rate (23.25 [22.65]), followed by White men (22.49 [14.32]), with lower rates for White women (11.71 [5.96]) and Black women (9.01 [8.04]) (P < .001). Compared with White men, both Black men (τ = 0.298, slope = 0.002, intercept = 0.381, P < .001) and Black women (τ = 0.157, slope = 0.0004, intercept = 0.271, P < .001) had worsening YPLL over time, while White women (τ = -0.146, slope = -0.0003, intercept = 0.5252, P < .001) showed improvement in their YPLL over time compared with White men. At the state level, there was a disproportionate burden of deaths due to drug poisonings, with Maryland showing the highest increase in mortality rates among Black men (485.4%), while decreases were observed for White women in states such as Alaska (-23.0%).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of overdose deaths, disparities in overdose mortality were evident, with Black men and Black women experiencing a pronounced and increasing burden of mortality compared with their White counterparts. Addressing these disparities will require a multipronged approach targeting the social, physical, economic, and policy risk environments.

PMID:40168026 | DOI:10.1001/jamanetworkopen.2025.2728

JAMA Netw Open. 2025 Apr 1;8(4):e252834. doi: 10.1001/jamanetworkopen.2025.2834.

ABSTRACT

IMPORTANCE: Medicare beneficiaries, particularly those dually eligible for Medicaid, must navigate complex coverage options. The State Health Insurance Assistance Program (SHIP) provides counseling on Medicare options, but little is known about the quality of counseling sessions.

OBJECTIVE: To characterize experiences connecting to SHIP counselors, and to characterize the accuracy and completeness of information provided by counselors in response to questions about Medicare coverage options.

DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study of 131 SHIP sites across the US, mystery shoppers posed as individuals newly eligible for Medicare. Shops occurred via telephone, in-person, and videoconference encounters from September 2023 to August 2024. Statistical analysis was performed from August to September 2024.

EXPOSURE: Mystery shoppers followed scripts with questions about coverage decisions corresponding to general Medicare eligibility and dual eligibility for Medicare and Medicaid.

MAIN OUTCOMES AND MEASURES: Responses were categorized as (1) accurate and complete, (2) accurate but incomplete, (3) not substantive, and (4) incorrect. This was a descriptive study without hypotheses.

RESULTS: Shoppers attempted 306 encounters. Of these, 122 (39.9%) could not be completed, most often because shoppers did not receive return calls. Within the 184 completed shops, the mean (SD) percentage of accurate and complete answers was 40.0% (25.7%). The percentage of responses with accurate answers (whether complete or incomplete) ranged from 26.1% (when asked whether a specific clinician was in network for a specific plan) to 94.3% (when asked about differences between traditional Medicare [TM] and Medicare Advantage [MA]). Responses were unlikely to be inaccurate (mean [SD], 6.7% [5.4%]). Fewer than half of counselors (44.8% [43 of 96]) mentioned Dual-Eligible Special Needs Plans (D-SNPs) as an option for mystery shoppers posing as dual eligibles.

CONCLUSIONS AND RELEVANCE: In this study of the accuracy of Medicare information provided by SHIP counselors, shoppers encountered challenges in reaching SHIP sites, indicating possible capacity constraints; responses varied in accuracy and completeness, with better performance on questions about TM vs MA comparisons, and weaker performance on questions about integrated care plans and specific MA plan details. Given recent growth in MA and federal efforts to counter deceptive marketing practices from agents or brokers-in part by directing beneficiaries to SHIPs-policymakers should consider providing SHIP with additional resources for training and capacity improvements.

PMID:40168025 | DOI:10.1001/jamanetworkopen.2025.2834

JAMA Netw Open. 2025 Apr 1;8(4):e252861. doi: 10.1001/jamanetworkopen.2025.2861.

ABSTRACT

IMPORTANCE: The resurgence of invasive group A streptococcal (iGAS) infections and progress in GAS vaccine development emphasize the importance of understanding current trends in the epidemiology of iGAS.

OBJECTIVE: To describe the epidemiology of pediatric iGAS over a 32-year period.

DESIGN, SETTING, AND PARTICIPANTS: This case series uses population-based surveillance data for iGAS in Toronto and Peel Region, Canada, including emm typing from Canada’s National Microbiology Laboratory and population data from Statistics Canada. All children (age <18 years) with iGAS from January 1, 1992, to December 31, 2023, were included. Data were analyzed from July 15, 2023, to September 1, 2024.

MAIN OUTCOMES AND MEASURES: Outcomes of interest were disease incidence over time and by age; variation in clinical presentation, disease severity, outcomes and infecting emm types; and antimicrobial resistance.

RESULTS: Overall, 498 iGAS cases (300 [60.2%] male; median [IQR] age, 5.1 [2.7-8.6] years) occurred, including 151 (30.7%) in children with comorbidities. The most common presentations were soft tissue infection (140 cases [28.1%]) and bacteremia without focus (131 cases [26.3%]). iGAS incidence increased from 1.8 events per 100 000 population per year in 1992 to 2011 to 2.4 events per 100 000 population per year in 2012 to 2019 (incidence rate ratio, 1.3 [95% CI, 1.1-1.6]), with the increase occurring in GAS infections of the respiratory tract. Incidence declined to 1.2 events per 100 000 population per year in 2020 and 0.5 events per 100 000 population per year in 2021 before increasing to 6.0 events per 100 000 population per year in 2023. In 2022 to 2023, 18 of 56 children with iGAS (32.0%) had a viral respiratory coinfection. Varicella-associated iGAS cases declined from 23 of 137 children (16.8%) in 1992 to 2001 to 2 of 223 children (0.9%) in 2012 to 2023 (P < .001), after routine varicella vaccination implementation in 2004. Streptococcal toxic shock syndrome occurred in 29 children (5.8%), necrotizing fasciitis in 12 children (2.4%); 10 children (2.0%) died. The most common emm types were emm1 (182 of 471 isolates [38.6%]), emm12 (75 isolates [15.9%]), and emm4 (31 isolates [6.6%]). The M1UK subtype was first identified in 2019 and comprised 32 of 46 emm1 isolates (70.0%) from 2019 to 2023. Compared with other emm types, emm1 was more likely to be associated with pneumonia (odds ratio [OR], 1.99 [95% CI, 1.16-3.40]), bone and joint infections (OR, 1.70 [95% CI, 1.08-2.68]), and intensive care unit admission (OR, 1.67 [95% CI, 1.03-2.68]); emm4 was more likely to be associated with bacteremia without focus (OR, 6.10 [95% CI, 2.83-13.16]). Overall, 437 isolates (92.8%) were of emm types included in the 30-valent GAS vaccine.

CONCLUSIONS AND RELEVANCE: This case series found that pediatric iGAS incidence increased in south-central Ontario prior to and after the COVID-19 pandemic in association with increased iGAS infections of the respiratory tract. Respiratory viral coinfections were common. Different emm types were associated with differing presentations and severity.

PMID:40168022 | DOI:10.1001/jamanetworkopen.2025.2861

Environ Sci Technol. 2025 Apr 1. doi: 10.1021/acs.est.4c09065. Online ahead of print.

ABSTRACT

How to scientifically and efficiently quantify the impact and hazards of volatile organic compounds (VOCs) pollution and volatilization from complex groundwater systems on surface air environments is a critical environmental issue. This paper employed an integrated modeling approach, incorporating numerical simulations, statistical analyses, and machine learning to address this issue. We comprehensively accounted for the different driving mechanisms, along with the various migration and transformation processes of groundwater VOCs. This investigation identified 11 key factors influencing surface pollutant flux. The data-enhanced statistical surrogate models and sampling-fusion-based support vector machine (SVM) surrogate models were established for appropriate generic modeling applications in which the high computation burden and difficulty could be avoided of the complicated numerical modeling. Those models would enable accurate prediction of surface fluxes and reliable classification of environmental risks. Notably, the pollutant fluxes through the soil-air interface over a short period could be sufficient to cause slow-airflow space air concentrations to exceed acceptable levels. Particularly, the established generic statistical surrogate models and SVM surrogate models have significant implications in efficiently and rapidly assessing the VOCs surface fluxes and environmental risk with meaningful quantified uncertainties for specific site conditions.

PMID:40168018 | DOI:10.1021/acs.est.4c09065

Crit Care Nurse. 2025 Apr 1;45(2):50-59. doi: 10.4037/ccn2025404.

ABSTRACT

BACKGROUND: Critically ill patients may have pressure injuries upon admission, increasing the need for nursing care and resources.

LOCAL PROBLEM: An increase in pressure injuries during the COVID-19 pandemic required implementation of 2-nurse skin assessments for pressure injury identification and prevention.

METHODS: A quality improvement initiative incorporating tele-intensive care unit (tele-ICU) nurses and wound, ostomy, and continence nurses using camera technology in collaboration with bedside intensive care unit nurses was conducted in 3 intensive care units within a multi-institutional health care system from 2021 through 2023. Sites included an academic medical center and 2 community hospitals. The team implemented the following bundle: (1) tele-ICU nurses provided second skin assessments, (2) tele-ICU and bedside intensive care unit nurses reviewed pressure injury prevention measures on admission, and (3) tele-ICU nurses documented pressure injuries. Customized daily dashboards and automated reporting were implemented. Crude data descriptive analysis and segmented regression analysis were used.

RESULTS: For 4723 admissions, 2-nurse skin assessment compliance increased from 46.9% during the 9-month preimplementation period to 80.8% during the 18-month postimplementation period, showing that compliance increased by 72.3%. Overall, 1153 pressure injuries were identified on intensive care unit admission or transfer, a mean of 20.6 per month before implementation and 64.1 per month after implementation. In the segmented regression analysis, the number of pressure injuries identified as present on admission significantly increased after implementation (P = .02).

CONCLUSION: Integrating tele-ICU nurses, bedside intensive care unit nurses, and wound, ostomy, and continence nurses with camera technology increased compliance with 2-nurse assessments, leading to identification of present-on-admission pressure injuries, prompt treatment, and preventive interventions.

PMID:40168011 | DOI:10.4037/ccn2025404

Gigascience. 2025 Jan 6;14:giaf024. doi: 10.1093/gigascience/giaf024.

ABSTRACT

BACKGROUND: Electric eels evolved remarkable electric organs that enable them to instantaneously discharge hundreds of volts for predation, defense, and communication. However, the absence of a high-quality reference genome has extremely constrained the studies of electric eels in various aspects.

RESULTS: Using high-depth, multiplatform sequencing data, we successfully assembled the first telomere-to-telomere high-quality reference genome of Electrophorus electricus, which has a genome size of 833.43 Mb and comprises 26 chromosomes. Multiple evaluations, including N50 statistics (30.38 Mb), BUSCO scores (97.30%), and mapping ratio of short-insert sequencing data (99.91%), demonstrate the high contiguity and completeness of the electric eel genome assembly we obtained. Genome annotation predicted 396.63 Mb repetitive sequences and 20,992 protein-coding genes. Furthermore, evolutionary analyses indicate that Gymnotiformes, which the electric eel belongs to, has a closer relationship with Characiformes than Siluriformes and diverged from Characiformes 95.00 million years ago. Pairwise sequentially Markovian coalescent analysis found a sharply decreased trend of the population size of E. electricus over the past few hundred thousand years. Furthermore, many regulatory factors related to neurotransmitters and classical signaling pathways during embryonic development were significantly expanded, potentially contributing to the generation of high-voltage electricity.

CONCLUSIONS: This study not only provided the first high-quality telomere-to-telomere reference genome of E. electricus but also greatly enhanced our understanding of electric eels.

PMID:40167991 | DOI:10.1093/gigascience/giaf024

Drugs. 2025 Apr 1. doi: 10.1007/s40265-025-02171-3. Online ahead of print.

ABSTRACT

BACKGROUND: Neurogenic lower urinary tract dysfunction (NLUTD), a complex abnormality caused by multiple neurologic disorders, is a serious threat to patients’ prognosis and quality of life. However, benefit and safety for various treatments are inconsistent. The aim of the current study was to investigate the available trials of adult NLUTD treatments and provide valuable insights for clinical practice.

METHODS: The data sources were Medline, Embase, and Cochrane databases up to 31 December 2023. A Bayesian network meta-analysis was conducted with randomized controlled trials in patients who were diagnosed with NLUTD, reporting clinical symptoms and urodynamic data. The main outcomes were incontinence episodes frequency (IEF) and maximum cystometric capacity (MCC). Secondary outcomes included frequency, maximum detrusor pressure, bladder compliance, volume of involuntary detrusor contraction, voided volume, incontinence, quality of life, and adverse events.

RESULTS: A total of 54 articles were eligible, evaluating 28 treatments and 4478 patients for efficacy and safety. Compared with the control group, the oxybutynin instillation demonstrated a mean reduction in IEF of – 2.65 episodes (95% confidence interval [CI]: – 4.64 to – 0.67), with a surface under the cumulative ranking curve (SUCRA) value of 85.8%. Botulinum toxin trigone-combined injection resulted in a reduction of -2.30 episodes (95% CI: -3.23 to – 1.44; SUCRA 84.2%). Additionally, intravesical therapies significantly increased MCC: oxybutynin instillation (mean 227.75 mL, 95% CI 147.00 to 311.42, SUCRA 99.1%) and BTX300U (mean 147.88 mL, 95% CI 100.45-190.32, SUCRA 83.2%). Botulinum toxin injection emerged as the preferred option for improving most urodynamic outcomes and quality of life. However, the incidence of adverse events associated with intravesical injections was higher compared with oral medications and other noninvasive therapies. The three types of botulinum toxins (onabotulinum toxin, abobotulinum toxin, and incobotulinum toxin) demonstrated consistent efficacy in treating both IEF and MCC. Individual studies were sequentially excluded for analysis of network stability. Most results from the alternative networks were consistent with the original analysis, although specific trials influenced certain therapy rankings.

CONCLUSIONS: Overall, oxybutynin instillation and intravesical botulinum toxin injection demonstrated significant advantages in improving symptoms and urodynamic parameters. Our findings support intravesical treatment as a safe and effective option, provided that patients are fully informed about their treatment choices. Clinically, intravesical therapies, oral medications, nerve stimulation, and other treatments should be integrated into shared decision-making processes, while some options require further research to bolster the supporting evidence.

PMID:40167970 | DOI:10.1007/s40265-025-02171-3

Dig Dis Sci. 2025 Apr 1. doi: 10.1007/s10620-025-09022-x. Online ahead of print.

ABSTRACT

PURPOSE: The differences in the animal model construction of different subtypes of gastroesophageal reflux disease (GERD) have not been clearly demonstrated at present. We aim to reveal the characteristics and differences between them.

METHODS: The literature related to GERD animal model construction in the past decade was searched and data on animal strains, modeling modes, modeling cycles, and detection indices were extracted, and the results were presented by using descriptive statistical methods of frequency and relative frequency.

RESULTS: 88 papers finally met the criteria. Sprague-Dawley (68.25%) rats were most often used to induce reflux esophagitis (RE), whereas Swiss mice (50.00%) and C57BL/6 mice (57.89%) for non-erosive reflux disease (NERD) and Barrett’s esophagus (BE), respectively. RE and NERD were most frequently constructed using fore-stomach-glandular transition ligation together with pyloric insufficiency (37.68%, 50.00%), yet their median modeling cycles were 14 and 7 days, respectively. BE was most frequently constructed using L2-IL-1β transgenic mice (27.27%), and the median modeling cycle over 270 days. Determining esophageal mucosal permeability was common in NERD, while finding intestinal chemotaxis markers, squamous epithelium, and columnar epithelium was common in BE. In animal models of RE, researchers tended to look for markers associated with the inflammatory response and oxidative stress.

CONCLUSIONS: The induction methods vary among the animal models of GERD’s three subtypes. Inflammatory stimulation is crucial for inducing RE and BE, differing in modeling cycle. In contrast, Visceral hypersensitivity draws more attention in NERD animal models, reflecting researchers’ thoughts on distinct pathogenesis.

PMID:40167947 | DOI:10.1007/s10620-025-09022-x