Tag: pubmed

JMIR Aging. 2026 Apr 30;9:e87070. doi: 10.2196/87070.

ABSTRACT

BACKGROUND: Falls are prevalent and serious health problems among older adults. Concerns about falling and reduced falls efficacy are common fall-related psychological impairments, representing 2 distinct emotional and cognitive constructs, respectively. The impact of digital-based exercise interventions on these specific constructs remains unclear.

OBJECTIVE: This systematic review and meta-analysis aimed to synthesize current evidence on digital-based exercise interventions for concerns about falling and falls efficacy among older adults, with a specific focus on determining their differential effects on emotional and cognitive constructs and evaluating their impact on physical performance.

METHODS: The PubMed, Web of Science, Cochrane Library, Embase, PsycINFO, CINAHL, CNKI, SinoMed, VIP, and Wanfang databases were systematically searched from their inception dates to May 2025. We searched for published randomized controlled trials on the effects of digital-based interventions on the fear of falling, concerns about falling, and falls efficacy among older adults. The study followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and was performed using Stata 17.0 software (StataCorp LLC).

RESULTS: Eighteen studies involving 2435 participants were included. Meta-analyses revealed significant effects of digital-based exercise interventions on falls efficacy (standardized mean difference 0.70, 95% CI 0.51-0.90; P<.001), balance function (mean difference [MD] 4.03, 95% CI 2.57-5.49; P<.001), functional mobility (MD -1.65, 95% CI -2.52 to -0.77; P<.001), and physical function (MD 0.57, 95% CI 0.12-1.02; P=.006) among older adults. However, digital-based exercise interventions had no significant effect on concerns about falling, which is the emotional construct related to falls (standardized MD -0.12, 95% CI -0.28 to 0.05; P>.05).

CONCLUSIONS: The meta-analysis assessed the efficacy of digital-based exercise interventions on fall-related psychological impairments among older adults and revealed that the effects differed across the constructs. These findings suggest that digital-based exercise interventions have potential benefits for improving falls efficacy and physical performance among older adults compared with controls. However, the effect of digital-based exercise interventions on concerns about falling, which is the emotional construct related to falls, remains uncertain among older adults.

PMID:42060908 | DOI:10.2196/87070

JMIR Form Res. 2026 Apr 30;10:e72604. doi: 10.2196/72604.

ABSTRACT

BACKGROUND: This study develops an open-source large language model-based chatbot tailored for Korean health consultations. The chatbot was implemented using the retrieval-augmented generation (RAG) technique alongside metadata filtering to enhance its performance.

OBJECTIVE: This study aims to analyze and compare the performance of a RAG-based chatbot with other leading language models in the context of Korean health consultations.

METHODS: A 10.4 GB Korean medical document corpus (487,277 segments) was constructed from official websites of major Korean hospitals, public health sources, and medical textbooks. This study quantitatively compared 5 open-source large language models (Qwen3:4B, Mistral:7B, Llama-3.1:8B, Gpt-Oss:20B, and Gemma3:27B) in 3 configurations: baseline (model only), RAG-only, and RAG with metadata filtering. The RAG system used a specialized Korean embedding model (upskyy/bge-m3-korean) and an Elasticsearch store. Performance was assessed by an emergency medicine specialist using a validation set of 226 questions across 7 common diseases and scoring responses based on accuracy, safety, and helpfulness.

RESULTS: The application of RAG alone failed to yield statistically significant performance improvements and, in some cases (Llama 3.1: 8B and Gemma 3: 27B), resulted in decreased scores. However, the combination of RAG with metadata filtering yielded statistically significant (P<.05) performance increases in most models. Notably, the average score for Mistral:7B increased from 3.79, SD 0.08, to 4.10, SD 0.10, and Gpt-Oss:20B increased from 4.43, SD 0.05, to 4.51, SD 0.04, with the latter achieving the highest safety score (4.61, SD 0.03). The Gemma3:27B model, which possessed a high baseline performance (4.42, SD 0.03), was an exception, exhibiting no significant improvement (P=.14) even with filtering.

CONCLUSIONS: The effectiveness of RAG for specialized domains such as Korean medical consultation is highly dependent on a metadata filtering process that controls the quality of retrieved information; simple information augmentation is insufficient. Furthermore, the benefit of RAG is limited when a model’s intrinsic knowledge (eg, Gemma3:27B) already meets or exceeds the quality of the external knowledge base. This finding indicates that performance enhancement strategies must account for both the retrieval mechanism’s quality and the model’s preexisting capabilities.

PMID:42060907 | DOI:10.2196/72604

MCN Am J Matern Child Nurs. 2026 May-Jun 01;51(3):172. doi: 10.1097/NMC.0000000000001196. Epub 2026 Apr 29.

NO ABSTRACT

PMID:42060899 | DOI:10.1097/NMC.0000000000001196

MCN Am J Matern Child Nurs. 2026 May-Jun 01;51(3):154-161. doi: 10.1097/NMC.0000000000001186. Epub 2026 Apr 29.

ABSTRACT

PURPOSE: The purpose of this study was to gather information that can be used to help inform doula integration into the clinical care setting.

STUDY DESIGN AND METHODS: We conducted a convergent (parallel) mixed-methods online survey study to understand maternity care team members’ perceptions of doulas and their integration into the clinical setting.

RESULTS: One hundred and ten maternity care team members responded to the survey with both open-ended questions. The majority (90.0%) of respondents were nurses, female (94.5%), and White (90.0%). Three quarters (75.5%) reported prior experience working with a doula. Four primary themes related to barriers and facilitators were identified through thematic content analysis: Doula Support and Its Benefits; Uncertainty about Doulas’ Qualifications; Interference with the Maternity Care Team Member; and Integration into the Health Care System. Respondents discussed the benefits of doulas and the valuable support that doulas offered to patients, including: 1a) emotional, physical, and educational support and 1b) advocacy and communication. They expressed concerns about the potential interference with the maternity team, including: 3a) role confusion and influence on clinical decision-making and 3b) disrupting the patient-maternity care team member relationship. Recommendations for successful integration of doulas into the health care system included 4a) clear roles and boundaries, 4b) building relationships of trust and respect, 4c) collaborative communication, and 4d) education of maternity care team members.

CLINICAL IMPLICATIONS: The study will be used to develop a doula integration tool kit. Doulas and maternity care team members should work together to create clear guidelines about the role of doulas within the hospital. Collaborative development of doula-supportive hospital policies and formalized hospital-doula partnership agreements can help reduce role ambiguity and create a more supportive hospital environment.

PMID:42060896 | DOI:10.1097/NMC.0000000000001186

JMIR Aging. 2026 Apr 30;9:e79409. doi: 10.2196/79409.

ABSTRACT

BACKGROUND: As telehealth has become an increasingly common mode of care delivery, older adults may face structural, technological, and interactional barriers that limit their ability to engage with video-based care. Although digital ageism, defined as the presence of age-related stereotypes, lowered expectations, or assumptions about older adults’ technology-related competence, has been described in prior literature, less is known about how such dynamics surface during real-time telehealth encounters and how they may shape participation in technology-focused clinical trials.

OBJECTIVE: This formative ethnographic study aimed to (1) document real-world barriers encountered by older adults immediately before and during video telehealth visits and (2) inform recruitment and implementation procedures for a subsequent telepharmacy randomized controlled trial.

METHODS: We conducted in-home, real-time ethnographic observation of 20 community-dwelling veterans aged ≥65 years participating in pharmacist-led video visits for medication management. Recruitment occurred over approximately 6 to 10 months using mailed invitation letters (>300 sent), supplemented with outbound telephone calls. Data sources included structured field notes completed independently by an in-house anthropologist and the remote clinical pharmacist, as well as observational documentation of previsit preparation, visit navigation, and postvisit reflections. Data were analyzed using qualitative rapid analysis, with iterative team review and triangulation across data sources.

RESULTS: Participants had a mean age of 74 (SD 3.18) years; 19 of 20 (95%) were male, and 18 of 20 (90%) identified as White. All participants completed a video visit with technical support as needed. Structural barriers (eg, broadband access and device availability) and usability challenges (eg, audio-video setup and navigation) were common. Although digital ageism was not a predefined analytical category, age-related assumptions about technology emerged during observation, including participants attributing anticipated or experienced difficulties to age and expressing surprise or pride following successful completion of the visit. These age-related interpretations were analytically distinct from access and usability barriers and were interpreted as manifestations of digital ageism, particularly as internalized age-based expectations.

CONCLUSIONS: Formative ethnographic observation provided critical insights into how older adults experience telehealth encounters in real-world contexts and informed adaptations to recruitment and implementation procedures for a subsequent randomized controlled trial. Although digital ageism was not an original study aim, age-related assumptions about technology emerged as an important interpretive factor shaping engagement with video-based care. Incorporating ethnographic methods prior to trial implementation may help identify otherwise overlooked barriers and improve the inclusivity and feasibility of technology-focused clinical research involving older adults.

PMID:42060893 | DOI:10.2196/79409

Biol Res Nurs. 2026 Apr 30:10998004261445879. doi: 10.1177/10998004261445879. Online ahead of print.

ABSTRACT

IntroductionAn imbalance between pro- and anti-inflammatory factors is implicated in the pathogenesis of preeclampsia (PE). Although IL10 (rs1800896) and IL6 (rs1800795) genotypes are known to influence circulating cytokine levels, their associations with longitudinal inflammatory profiles across pregnancy have not been well characterized.MethodsWe conducted a retrospective case-control study to longitudinally compare nine pro- and four anti-inflammatory cytokines across pregnancy based on IL6 and IL10 genotype. The cohort included 111 women with overweight/obesity (37 with PE; 74 without PE), matched 2:1, and predominantly Black (72%). Separate 3 × 3 mixed multivariate analyses of variance (MANOVAs) assessed interactions between IL6 or IL10 genotype (between-subjects’ factor) and pregnancy trimester (within-subjects factor). Pro- and anti-inflammatory cytokines were analyzed in separate models for each genotype. Due to the exploratory nature of the study and the examination of clinical relevance, statistical significance was set at p = .10.ResultsPro-inflammatory cytokine levels changed over pregnancy (p < .05) but were not associated with IL6 or IL10 genotype (all p > .10). Anti-inflammatory cytokine levels also varied across pregnancy (p < .05). IL6 genotype was not associated with anti-inflammatory cytokine levels (p > .10). In contrast, IL10 genotype was significantly associated with differences in anti-inflammatory cytokine levels across genotypes (V = 0.22, F (8,162) = 2.48, p = .014, η_p² = 0.11) and demonstrated an interaction effect with pregnancy trimester (V = 0.28, F (16,154) = 1.56, p = .087, η_p² = 0.14).ConclusionIL10 genotype may influence circulating anti-inflammatory cytokines across pregnancy and, as such, may contribute to preeclampsia by influencing anti-inflammatory cytokine expression across pregnancy.

PMID:42060858 | DOI:10.1177/10998004261445879

Diabet Med. 2026 Apr 30:e70341. doi: 10.1111/dme.70341. Online ahead of print.

ABSTRACT

BACKGROUND: Older adults with type 2 diabetes mellitus are at elevated risk for severe pneumococcal disease, experiencing higher rates of complications and mortality. However, the evidence for the protective benefits of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) against mortality in this demographic remains limited.

METHODS: This retrospective study included 8649 elderly people with type 2 diabetes mellitus in Soochow, China, comprising 3247 PPSV23-vaccinated individuals and 5402 unvaccinated patients. Cox proportional hazards analyses were performed to calculate the adjusted hazard ratios (HRs) of the association between PPSV23 vaccination and the risk of all cause mortality, pneumonia-related mortality, cardiovascular disease-related mortality and cancer mortality. Inverse probability weighting (IPW) was applied to estimate the average treatment effect (ATE) of universal PPSV23 vaccination compared to unvaccinated.

RESULTS: During the follow-up period, a total of 1557 deaths were recorded. Compared to unvaccinated elderly people with type 2 diabetes mellitus, those receiving PPSV23 vaccine exhibited significantly lower risks of all-cause mortality (HR: 0.47; 95% CI: 0.42-0.53), with reductions also observed in deaths related to cardiovascular disease (HR: 0.50; 95% CI: 0.41-0.62), pneumonia (HR: 0.62; 95% CI: 0.43-0.89) and cancer (HR: 0.54; 95% CI: 0.42-0.70). Furthermore, IPW estimates indicated that universal PPSV23 vaccination among the elderly people with type 2 diabetes mellitus could prevent an average of 11.4% of all-cause deaths (p < 0.001), 4.0% of cardiovascular disease-related deaths (p < 0.001), 0.8% of pneumonia-related deaths (p = 0.005) and 1.9% of cancer deaths (p < 0.001).

CONCLUSIONS: PPSV23 vaccination is associated with a reduced risk of all cause mortality, cardiovascular disease-related mortality, pneumonia-related mortality and cancer mortality in elderly people with type 2 diabetes mellitus.

PMID:42060856 | DOI:10.1111/dme.70341

Mol Biol Evol. 2026 Apr 30:msag111. doi: 10.1093/molbev/msag111. Online ahead of print.

ABSTRACT

At the molecular level, selection pressures often act on protein structural features, yet most evolutionary analyses remain confined to linear sequences. Early structure-informed approaches improved interpretability by mapping single-site metrics onto protein structures, and later methods introduced 3D sliding windows to capture spatially clustered signals missed by linear window approaches. These frameworks, however, are restricted to predefined statistics and narrowly defined 3D window types, limiting the scope of questions that can be addressed. We developed an R package, evo3D, as a new framework for structure-informed evolutionary analysis that supports a wide range of downstream statistics and scales from simple to complex structures. evo3D extracts structure-informed multiple sequence alignment subsets (spatial haplotypes), making the structure-informed unit of analysis directly available to users. The framework supports fixed-count and fixed-distance spatial windows, introduces residue and codon analysis modes, and extends to multimers, interfaces, and multiple structural models through a single wrapper, run_evo3d(). We demonstrate evo3D’s utility by performing an epitope-level diversity scan of Hepatitis C virus E1/E2 complex, identifying conserved spatial neighbourhoods missed by linear sliding windows, and by evaluating evo3D’s scalability on the octameric Chikungunya virus E1/E2 assembly. Importantly, evo3D formalises the core components of structure-informed analysis of molecular evolution and removes technical barriers. As a result, the framework streamlines the evaluation of evolutionary patterns directly within 3D structural contexts, and we anticipate its wide application in molecular evolution studies. The package is available at github.com/bbroyle/evo3D.

PMID:42060840 | DOI:10.1093/molbev/msag111

Eur J Endocrinol. 2026 Apr 30;194(5):567-577. doi: 10.1093/ejendo/lvag054.

ABSTRACT

OBJECTIVE: Dysnatremia is the most common electrolyte abnormality detected during hospitalizations and outpatient visits and is associated with adverse outcomes in older adults. However, data on its prevalence and incidence in community-dwelling older individuals remain limited. This study aimed to estimate the prevalence and incidence of dysnatremia in this population across 5 European countries (Austria, France, Germany, Portugal, and Switzerland).

DESIGN: Observational analysis of DO-HEALTH, a 3-year multicenter clinical trial including 2157 community-dwelling, generally healthy adults aged 70 years and older.

METHODS: Sodium blood levels were collected at baseline, 12, 24, and 36 months. Dysnatremia was defined as sodium levels <135 mmol/L (hyponatremia) or >145 mmol/L (hypernatremia). Baseline prevalence and 3-year incidence were estimated overall and by predefined subgroups based on sex, age, country of residence, body mass index, prevalent chronic conditions, polypharmacy, and use of thiazide-like diuretics.

RESULTS: At baseline, 2141 participants (99.3%) had available sodium data. The prevalence of dysnatremia was 3.4% (2.4% hyponatremia; 1.0% hypernatremia), with higher prevalence in participants aged ≥75 years (4.8%) and those using thiazide or thiazide-like diuretics (5.4%). Over 3 years, 150 participants (7.0%) experienced at least 1 episode of dysnatremia (3.8% hyponatremia; 3.2% hypernatremia). Higher incidence of dysnatremia was observed among participants living in Switzerland, using thiazide or thiazide-like diuretics, and with prevalent dysnatremia at baseline.

CONCLUSIONS: Dysnatremia, previously linked to adverse outcomes in older adults, was observed in a non-negligible proportion of generally healthy, community-dwelling older individuals. These findings provide valuable epidemiologic data and identify subgroups that may warrant closer clinical attention.

PMID:42060832 | DOI:10.1093/ejendo/lvag054

Indian J Pharmacol. 2026 May 1;58(3):239-249. doi: 10.4103/ijp.ijp_924_25. Epub 2026 May 1.

ABSTRACT

OBJECTIVES: The objective of the study was to assess the burden of polypharmacy and potentially inappropriate medications (PIMs) among geriatric patients and evaluate the impact of a structured deprescribing approach in these patients.

SUBJECTS AND METHODS: Elderly outpatients (≥60 years) with polypharmacy were included. Data on prescribed, over-the-counter (OTC), and traditional medicines were collected through a structured questionnaire and detailed patient interviews. Deprescribing was carried out using Sivagnanam G’s “S and S” approach (Seek, Screen, Save, Sever, Sensitize, and Supervise) adapted from Scott et al.

RESULTS: Among 385 participants, polypharmacy was prevalent in 182 participants (47.27%) with a mean of 6.5 drugs/prescription. Among participants with polypharmacy, PIMs were noted in 131 (72%) with an average of 1.64 PIMs identified per each inappropriate prescription. PIMs increased with an increase in the number of comorbidities and medication count. A total of 215 PIMs were identified and recommended for deprescribing. These were mainly drugs to be avoided in the elderly (34.88%), OTC PIMs (17.21%), traditional medicines (13.02%), and drug-drug interactions (9.77%). Deprescribing reduced the mean drug count per prescription to 4.86 with a potential to decrease adverse drug reactions by 16.4%, and also lowered daily prescription costs from INR 51.91 to INR 32.70, saving INR 576.42 per patient per month.

CONCLUSION: Polypharmacy and PIMs are widely prevalent among elderly patients, significantly increasing the risk of ADEs. Structured deprescribing effectively reduced medication burden, improved safety, and decreased healthcare costs. These findings highlight the need for routine deprescribing interventions to optimize geriatric medication management.

PMID:42060808 | DOI:10.4103/ijp.ijp_924_25