Tag: pubmed

JAMA Netw Open. 2026 Apr 1;9(4):e264421. doi: 10.1001/jamanetworkopen.2026.4421.

ABSTRACT

IMPORTANCE: Low back pain (LBP) is a leading cause of disability, and there is limited evidence from clinical practice to support the effectiveness of alternative care models.

OBJECTIVE: To compare a sequenced care pathway (SCP) with a pain navigator pathway (PNP) for patients with LBP.

DESIGN, SETTING, AND PARTICIPANTS: In this embedded cluster randomized clinical trial, 19 primary care clinics in the Veterans Health Administration were randomized to deliver 1 of 2 multimodal guideline-supported care pathways, with primary outcomes assessed in their electronic health records (EHRs) at 3 months. Between February 8, 2021 (first enrolled), and January 31, 2024 (last enrolled), 1817 participants were referred by primary care clinicians and attended an initial AIM-Back trial visit. A subset of 799 participants consented to complete additional questionnaires for secondary analyses (March 8, 2021 [first survey collected], to January 10, 2025 [final secondary outcome collected by survey]).

INTERVENTIONS: The SCP included pain education and modulation, physical activity coaching, risk stratification, and psychologically informed physical therapy. The PNP included shared decision-making and facilitated referrals to nondrug treatments.

MAIN OUTCOMES AND MEASURES: Pain interference and physical function were coprimary outcomes, assessed with the Patient-Reported Outcomes Measurement Information Systems 4-item Short Forms (PROMIS-SF; potential score range for pain interference, 41.6-75.6, where lower scores indicated less interference with daily activities due to pain; and potential score range for physical function, 22.5-57.0, where higher scores indicated higher physical functioning during daily activities). Secondary EHR outcomes included sleep disturbance and National Institutes of Health pain intensity, and survey outcomes included the coprimary outcomes and additional measures of pain, function, and quality of life. Analysis was performed in the intent-to-treat population.

RESULTS: There were 1817 enrolled participants (SCP, 811; PNP, 1006; mean [SD] age, 53.0 [15.7] years; 1597 men [87.9%]). At 3 months, 461 of 811 patients (56.8%) in the SCP group and 537 of 1006 (53.4%) in the PNP group had analyzable primary outcomes. The estimated baseline mean PROMIS-SF score was 63.2 points (97.5% CI, 62.7-63.6 points) for pain interference and 37.1 points (97.5% CI, 36.7-37.4 points) for physical function. The 3-month mean PROMIS-SF score for pain interference was 60.5 points (97.5% CI, 59.7-61.3 points) in the SCP group and 61.1 points (97.5% CI, 60.4-61.8 points) in the PNP group. The 3-month mean PROMIS-SF score for physical function was 39.1 points (97.5% CI, 38.4-39.7 points) in the SCP group and 38.5 points (97.5% CI, 37.8-39.1 points) in the PNP group. There was no SCP superiority, with estimated 3-month differences of -0.6 points (97.5% CI, -1.6 to 0.4 points) for pain interference and 0.6 points (97.5% CI, -0.3 to 1.5 points) for physical function. There were no pathway differences in secondary outcomes.

CONCLUSION AND RELEVANCE: In this cluster randomized trial, the SCP was not superior for the primary outcomes of pain interference and physical function. Future research should consider designs that optimize pathway adherence, assess the effectiveness in other settings, and investigate patient-level factors indicative of a favorable response to the SCP or PNP.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04411420.

PMID:41926124 | DOI:10.1001/jamanetworkopen.2026.4421

JAMA Netw Open. 2026 Apr 1;9(4):e264636. doi: 10.1001/jamanetworkopen.2026.4636.

ABSTRACT

IMPORTANCE: Direct care workers (DCWs) provide essential support for millions of older individuals in the US, but high workforce turnover-the rate at which workers leave the DCW workforce-undermines care access and quality. Structural factors associated with DCW working conditions, such as unionization and employer ownership status, may play an important role in DCW retention, but their association with DCW workforce turnover is not known.

OBJECTIVE: To assess the association of unionization and ownership with workforce turnover among DCWs.

DESIGN, SETTING, AND PARTICIPANTS: Data on DCW turnover for this cross-sectional study were obtained from the Outgoing Rotation Groups of the Current Population Survey, an annual survey of 60 000 US households, from January 1, 2009, to December 31, 2024. The study population included individuals aged 15 years or older who were employed as DCWs.

EXPOSURES: Unionization (whether the respondent was covered by a union through their DCW role) and employer ownership status (whether their employer was for profit, nonprofit, or publicly owned).

MAIN OUTCOMES AND MEASURES: The main outcome of interest was workforce turnover at 1 year, defined as reporting a non-DCW occupation or no occupation 1 year after the initial survey. Bivariate analyses and logistic regression were used to compare DCW turnover rates across union status and employer ownership type and test whether ownership type moderates the association between unionization and turnover.

RESULTS: The overall sample included 18 175 DCWs (mean [SD] age, 44.0 [14.7] years; 15 860 female DCWs [86.5%]). In the fully adjusted models, the estimated probability of turnover was significantly lower among unionized DCWs than nonunionized DCWs overall (37.4% vs 45.0%; odds ratio [OR], 0.72 [95% CI, 0.64-0.81]), at nonprofit organizations (33.6% vs 47.1%; OR, 0.56 [95% CI, 0.39-0.80]) and at for-profit organizations (35.2% vs 45.9%; OR, 0.63 [95% CI, 0.54-0.75]), but not at public employers (39.8% vs 41.0%; OR, 0.95 [95% CI, 0.78-1.16]). Public ownership was also directly associated with lower turnover (39.1% vs 41.8%; OR, 0.89 [95% CI, 0.80-1.00]) compared with for-profit ownership.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of DCWs, employer ownership status and unionization were independently and jointly associated with DCW workforce turnover rates, suggesting that these structural factors may play an important role in DCW retention. State and federal policies that facilitate DCW unionization or public employment of DCWs may significantly improve DCW retention.

PMID:41926123 | DOI:10.1001/jamanetworkopen.2026.4636

JAMA Netw Open. 2026 Apr 1;9(4):e264642. doi: 10.1001/jamanetworkopen.2026.4642.

ABSTRACT

IMPORTANCE: Thiazide diuretics are a cornerstone for the treatment of hypertension, but their use is associated with development of hyponatremia. Women and older adults are particularly vulnerable, but population-based estimates of absolute risk are largely absent. Such data are a prerequisite for a robust risk-benefit assessment in the clinical setting.

OBJECTIVE: To compare new use of thiazide diuretics with calcium channel blockers (CCBs) and subsequent risk of hyponatremia among different age groups and between the sexes.

DESIGN, SETTING, AND PARTICIPANTS: This propensity score-matched cohort study included 159 080 individuals 18 years or older in the Stockholm Sodium Cohort, a research database established to investigate the association between thiazide and hyponatremia among individuals in Stockholm, Sweden, between July 1, 2006, and December 31, 2018. Statistical analysis was performed between January 2025 and January 2026.

EXPOSURE: Newly initiated treatment with thiazide diuretics and CCBs.

MAIN OUTCOMES AND MEASURES: The primary outcome was profound hyponatremia (ie, a sodium concentration <125 mEq/L). Secondary outcomes were sodium concentrations less than 130 mEq/L and less than 135 mEq/L.

RESULTS: A total of 79 540 individuals (median age, 63 years [IQR, 54-72 years]; 41 275 women [51.9%]) initiating thiazide treatment were propensity score matched with 79 540 individuals (median age, 63 years [IQR, 54-72 years]; 41 168 women [51.8%]) receiving CCBs. The cumulative incidence of profound hyponatremia was 0.80% (95% CI, 0.74%-0.87%) for thiazide users and 0.46% (95% CI, 0.41%-0.51%) for CCB users during the first 2 years of treatment. The occurrence of profound hyponatremia with thiazide treatment was higher among women (cumulative incidence, 1.04% [95% CI, 0.94%-1.15%) and individuals 80 years or older (cumulative incidence, 2.40% [95% CI, 2.07%-2.73%]). Thus, among women 80 years or older, the number needed to harm (NNH) was 53 (95% CI, 41-73) for developing sodium concentrations less than 125 mEq/L, 28 (95% CI, 22-38) for concentrations less than 130 mEq/L, and 16 (95% CI, 13-20) for concentrations less than 135 mEq/L. This was in marked contrast with women younger than 65 years, for whom the corresponding NNH was 790 (95% CI, 408-11 966) for developing sodium concentrations less than 125 mEq/L, 818 (95% CI, 303-∞) for concentrations less than 130 mEq/L, and 120 (95% CI, 78-261) for concentrations less than 135 mEq/L.

CONCLUSIONS AND RELEVANCE: In this cohort study comprising 159 080 individuals, the association between newly initiated thiazide diuretics and hyponatremia was negligible among individuals younger than 65 years of age. In contrast, among older adults, especially among women, the association was substantial. The results may incentivize the prescriber toward choosing an alternative antihypertensive treatment. If thiazides are initiated, subsequent monitoring of serum sodium concentrations should be considered.

PMID:41926122 | DOI:10.1001/jamanetworkopen.2026.4642

JAMA Netw Open. 2026 Apr 1;9(4):e264780. doi: 10.1001/jamanetworkopen.2026.4780.

ABSTRACT

IMPORTANCE: Latino/a adults in the US are at higher risk for developing type 2 diabetes and are less likely to achieve goals in the National Diabetes Prevention Program (NDPP) than non-Latino/a White adults. Little is known about the barriers and facilitators to diabetes prevention behaviors among Latino/a adults.

OBJECTIVE: To describe the perspectives of Latino/a NDPP participants regarding barriers and facilitators to diabetes prevention behaviors.

DESIGN, SETTING, AND PARTICIPANTS: This qualitative study using semistructured phone interviews with Spanish-speaking Latino/a adults who participated in a community-based NDPP in an urban and suburban area of Colorado was conducted from June 2022 to August 2023.

MAIN OUTCOME AND MEASURES: The primary outcome was themes and subthemes reflecting individual and family support perspectives. Interviews were audio-recorded and transcribed. An inductive thematic analysis was conducted.

RESULTS: In total, 22 Spanish-speaking Latino/a participants, including 17 women (77%) and 5 men (22%) with a mean (SD) age of 44 (8) years, were interviewed. The interviews revealed 5 themes with respective subthemes. The first theme and subthemes described the perceived impact of culture and self-perception (frustration and presence of self-critical beliefs, perceived traditional gender roles, and internalized cultural biases of health behaviors) on diabetes prevention behaviors. The next 2 themes described family as reciprocal catalysts for diabetes prevention action (perceived family exercise engagement, dietary education influencing family eating habits, and collective emotional impact and accountability) and having a culturally and linguistically aligned program to support participants (perceived support and motivation from community health workers, culturally and linguistically concordant information as essential, and perceived peer support through shared experiences). The last 2 themes described reflection on personal motivation for behavior change (family diabetes lived experience awareness and motivation, desire to model lifestyle behaviors, and perceived mental health and spiritual appreciation) and desired program components for family inclusion (perceived role of knowledge for family participation, structured family-friendly wellness activities, and preventing diabetes among children).

CONCLUSIONS AND RELEVANCE: In this qualitative study of Spanish-speaking Latino/a adults, participating in a diabetes prevention program, gender roles and internalized cultural biases were perceived as barriers to engaging in diabetes prevention behaviors, while family support and culturally aligned programming served as key facilitators. These findings may be used to improve diabetes prevention programs in Latino communities.

PMID:41926121 | DOI:10.1001/jamanetworkopen.2026.4780

JAMA Netw Open. 2026 Apr 1;9(4):e264788. doi: 10.1001/jamanetworkopen.2026.4788.

ABSTRACT

IMPORTANCE: The Outcome and Assessment Information Set (OASIS) is essential for measuring home health quality and outcomes, and accurate linkage between OASIS, Medicare enrollment, and claims is crucial for monitoring utilization and informing payment policy. Preliminary documentation suggested a decrease in OASIS-beneficiary match rates beginning in 2019, but the extent and implications of this decrease have not been quantified.

OBJECTIVE: To quantify annual match rates between OASIS assessments and Medicare enrollment and fee-for-service (FFS) home health claims from 2017 through 2023.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used 100% OASIS assessments from 2017-2023 linked to the Master Beneficiary Summary File (MBSF) and FFS home health claims. OASIS assessments included patients receiving home health care in any payer category, while claims analyses were restricted to FFS beneficiaries. Data were analyzed from June 2025 to January 2026.

MAIN OUTCOMES AND MEASURES: The yearly number and proportion of OASIS assessments that can be matched to a person in the MBSF and the yearly number and proportion of FFS home health claims that can be matched to an OASIS assessment.

RESULTS: Across 2017-2023, approximately 18 million OASIS assessments and 6 million unique assessed beneficiaries were recorded annually. The proportion of assessments linked to a Medicare beneficiary decreased from 89.8% in 2017 to 76.4% in 2023. Among unmatched assessments, the share with Medicare as the recorded payer increased, while the share with Medicaid decreased. For FFS beneficiaries, the number of claims increased due to payment cycle changes, yet the number of unique FFS claimants decreased from 3 424 394 in 2017 to 2 636 931 in 2023. The match rate of FFS claims to an OASIS assessment decreased from 96.8% to 73.9%, with variation across states; by 2023, all state match rates were below 90%.

CONCLUSIONS AND RELEVANCE: The findings of this study suggest a reduced ability to accurately attribute OASIS assessments to individual Medicare beneficiaries or matching claims to corresponding OASIS assessments using Centers for Medicare & Medicaid Services (CMS) Research Identifiable Files. Until these issues are addressed by CMS, researchers should cautiously interpret findings utilizing individually linked Medicare claims and OASIS assessment data.

PMID:41926120 | DOI:10.1001/jamanetworkopen.2026.4788

JAMA Netw Open. 2026 Apr 1;9(4):e265039. doi: 10.1001/jamanetworkopen.2026.5039.

ABSTRACT

IMPORTANCE: Liver transplants are performed around the clock, often associated with substantial disutility for patients and clinicians. While short-duration dual hypothermic oxygenated machine perfusion (short-DHOPE) mitigates ischemia-reperfusion injury and related complications, prolonged DHOPE (DHOPE-PRO) may further extend preservation time and facilitate daytime liver transplant.

OBJECTIVE: To assess whether the use of DHOPE-PRO is associated with an increased proportion of daytime liver transplants without compromising graft or patient outcomes.

DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study conducted at a large academic liver transplant center in the Netherlands included adult and pediatric recipients of liver grafts received from donation after brain death (DBD), donation after circulatory death (DCD), or living donors. The study compared all liver transplants performed between January 1, 2023, and December 31, 2024, following routine DHOPE-PRO implementation, with a control cohort of all consecutive liver transplants performed between January 1, 2021, and December 31, 2022. Follow-up continued through December 31, 2025. Outcomes were stratified by graft type.

EXPOSURES: Grafts underwent DHOPE-PRO, with or without viability assessment depending on graft risk, or short-DHOPE (for DCD livers) or no perfusion (for DBD livers).

MAIN OUTCOMES AND MEASURES: The primary outcome was the difference in the percentage of daytime liver transplants, defined as surgery starting at or after 8 am and either (1) reperfusion occurring before 8 pm or (2) completion by midnight, between the 2021-2022 and 2023-2024 cohorts. Secondary outcomes included 1-year patient and graft survival, intraoperative parameters, and postoperative complications, stratified by graft type.

RESULTS: A total of 330 liver transplants (median [IQR] age, 45 [13-62] years; 186 [56.4%] male) were included in the analyses: 155 transplants in the 2021-2022 cohort and 175 transplants in the 2023-2024 cohort. Following DHOPE-PRO implementation, the percentage of daytime transplants increased from 48.4% (75 of 155) to 84.6% (148 of 175) for reperfusion (P < .001) and from 53.5% (83 of 155) to 89.1% (156 of 175) for completion (P < .001). Median (IQR) DHOPE duration increased from 2.1 (1.6-4.1) to 10.2 (5.1-13.1) hours (P < .001), with total preservation times up to 31.4 hours. Use of DHOPE-PRO showed no association with postoperative complications (eg, new-onset acute kidney injury; odds ratio, 0.64 [95% CI, 0.37-1.07]; P = .09]). One-year patient survival exceeded 90% in all subgroups. Use of DHOPE-PRO was not associated with either graft (hazard ratio, 1.28 [95% CI, 0.59-2.74]; P = .53) or patient (hazard ratio, 2.05 [95% CI, 0.75-5.59]; P = .16) survival.

CONCLUSIONS AND RELEVANCE: In this prospective cohort study, routine implementation of DHOPE-PRO was associated with increased proportions of daytime liver transplants and with improved surgical logistics. It was also associated with outcomes similar to those after short-duration DHOPE, supporting its broader application in clinical practice.

PMID:41926119 | DOI:10.1001/jamanetworkopen.2026.5039

JAMA Otolaryngol Head Neck Surg. 2026 Apr 2. doi: 10.1001/jamaoto.2026.0166. Online ahead of print.

ABSTRACT

IMPORTANCE: Malnutrition, common in patients with head and neck squamous cell carcinoma (HNSCC), may impair the effectiveness of immunotherapy. Understanding whether nutritional status affects outcomes can emphasize the importance of pretreatment nutritional optimization.

OBJECTIVE: To evaluate the associations of body mass index (BMI), pretreatment BMI change, and prognostic nutritional index (PNI) with progression-free survival (PFS) in patients with advanced HNSCC treated with immunotherapy.

DESIGN, SETTING, AND PARTICIPANTS: Cohort study using deidentified electronic health records from the Flatiron Health database between January 2014 to January 2024, with follow-up of 3000 days in multiple cancer institutions across the US. Patients were from community and academic practices in the US, diagnosed with all types of advanced head and neck cancer who received immunotherapy (nivolumab, pembrolizumab, cemiplimab, durvalumab, atezolizumab, avelumab, or ipilimumab) between January 2014 and January 2024. Exclusion criteria included age younger than 18 years, patients without a diagnosis of squamous cell carcinoma, missing stage information, missing treatment information (eg, a gap in documented care of ≥90 days or more), and incomplete data needed to calculate BMI or PNI prior to initiation of therapy.

EXPOSURES: Baseline BMI, pretreatment BMI change (≥2% decrease vs stable), and PNI (low <45 vs normal ≥45).

MAIN OUTCOMES AND MEASURES: PFS following treatment with immunotherapy.

RESULTS: Among 1108 patients (mean [SD] age, 66.2 [10.2] years; 236 [21.3%] female; 872 [78.7%] male), 214 (79%) experienced 2% or more pretreatment BMI loss. BMI loss was associated with worse PFS (hazard ratio, 1.17; 95% CI, 1.02-1.35); median PFS was 271 (IQR, 121-603) days with loss vs 415 days with stable BMI. In the 471 patients with laboratory data, 320 (67.9%) had a low PNI. Low PNI was associated with shorter PFS (adjusted hazard ratio, 1.58; 95% CI, 1.39-1.79); median PFS was 213 (IQR, 98-445) days for low vs 566 (IQR, 307-1094) days for patients with a normal PNI. Baseline BMI category was not independently associated with PFS.

CONCLUSIONS AND RELEVANCE: In this large, nationally representative cohort of patients with advanced head and neck squamous cell carcinoma treated with immunotherapy, pretreatment BMI loss and low PNI were independently associated with PFS, while baseline BMI was not. These findings suggest that dynamic measures of nutrition and immune status provide more meaningful prognostic information than static measures. Nutritional optimization may represent a modifiable factor to improve outcomes in patients receiving immunotherapy for advanced head and neck squamous cell carcinoma.

PMID:41926098 | DOI:10.1001/jamaoto.2026.0166

Child Dev. 2026 Apr 2:aacaf053. doi: 10.1093/chidev/aacaf053. Online ahead of print.

ABSTRACT

Methodological challenges diminish the number and reliability of longitudinal studies on executive functions (EFs) starting in infancy. To address this, the current study used latent profile analysis (LPA) to examine EF task performance across three age points: 8 months, 2.5 years, and 5 years. Participants were children (N = 830; 55.5% boys; > 95% White) from the FinnBrain Birth Cohort Study. Three profiles were identified: constant below average EF profile (14.2%), and two average EF profiles differentiated by Spin the Pots performance (working memory) at 5 years (above average 29.8%, below average 56%). Expected associations between the below average EF profile, male sex, and lower general cognitive performance were found, further supporting the validity of the profiles.

PMID:41926095 | DOI:10.1093/chidev/aacaf053

J Mol Endocrinol. 2026 Mar 25:JME-25-0171. doi: 10.1530/JME-25-0171. Online ahead of print.

ABSTRACT

Physiologic mechanisms underlying metabolic and renal diseases interact and are highly comorbid, yet their genetic associations and underlying mechanisms have not been systematically elucidated. Using Genome-Wide Association Study (GWAS) summary statistics from UK Biobank, FinnGen, and CKDGen, we integrated and analyzed gout, serum urate, chronic kidney disease, kidney stones, and metabolic syndrome. Using genomic structural equation modeling (GSEM), we created the first genetic linkage map for “Gout-Urate-Kidney-Metabolism” (GUKM) to explore shared genetic architecture. Post-GWAS analyses for GUKM-GSEM GWAS, including functional annotation, enrichment, fine-mapping, causal inference, and gsMap, identified key genetic loci, pathways, tissues/cell types, and potential drug targets. We identified 164 lead SNPs, including rs1260326 (chr2) and rs73607783 (chr8), with GSEA showing significant enrichment of GUKM-GSEM GWAS in cholesterol metabolism and lipid pathways (adjP < 0.05). Tissue and cell enrichment highlighted the liver, renal cortex, pancreas, proximal tubular epithelial cells, and hepatocytes (P < 0.05). Mendelian randomization indicated a potential causal role of GCKR (FDR < 0.05), which gsMap showed to be highly expressed in hepatocytes and liver tissue. The present study revealed the common genetic basis of metabolic and renal diseases and emphasized that lipid metabolism may be a key intermediary pathway connecting the “metabolic-renal axis.” The liver, renal cortex, and pancreas were the primary enriched tissues, and GCKR was identified as a core gene and potential drug target. Overall, this study provides an important reference for the genetic mechanisms, key mechanisms, and intervention targets of related diseases.

PMID:41926080 | DOI:10.1530/JME-25-0171

Spine Deform. 2026 Apr 2. doi: 10.1007/s43390-026-01354-6. Online ahead of print.

ABSTRACT

PURPOSE: Evaluate the utility of intraoperative traction (IOT) during posterior spinal fusion (PSF) in a matched cohort at a high-volume neuromuscular scoliosis (NMS) center.

METHODS: A nested case-control study was performed on a single-center retrospective database of NMS patients. Those diagnosed with cerebral palsy were pair-matched by age (± 1 year), preoperative curve magnitude (± 10°), preoperative traction curve magnitude (± 10°), and flexibility index (± 5%). Paired t tests or Wilcoxon signed-rank tests were used to analyze continuous variables between groups. Fisher’s Exact tests were used to compare categorical variables by group.

RESULTS: Thirty-one unique case-control matches were identified (n = 62). IOT and non-IOT groups were similar in terms of EBL 855 (IQR 500-1200) vs. 800 (IQR 650-1350) cc (p = 0.60), length of ICU stay 1.7 (IQR 1.0-2.7) vs. 2.3 (IQR 1.7-3.1) days (p = 0.14), BMI 18.0 (IQR 14-20) vs. 15.5 (IQR 14-18) (p = 0.10), sex distribution 54.8% vs. 51.6% (p > 0.99), and changes in neuromonitoring signals 4/31 (13%) vs. 3/31 (10%) (p > 0.99). Complication rate was 22.6% (7/31) for IOT and 25.8% (8/31) for non-IOT (p > 0.999). There were no statistical differences in surgical time 414 ± 131 vs. 397 ± 133 min (p = 0.64) or anesthesia time 551 ± 136 vs. 529 ± 135 min (p = 0.56). Both groups had similar postoperative curve magnitude IOT = 37° vs. non-IOT = 42° (p = 0.28) and percent curve correction IOT = 60% vs. non-IOT = 56% (p = 0.30). Percent correction of pelvic obliquity was also similar 78% (IQR 67-90) vs. 68% (IQR 60-91) (p = 0.18) between groups.

CONCLUSION: There was no difference in postoperative curve correction or pelvic obliquity between those treated with IOT versus those without during PSF.

LEVEL OF EVIDENCE: III.

PMID:41926074 | DOI:10.1007/s43390-026-01354-6