Tag: pubmed

J Med Syst. 2025 Oct 16;49(1):140. doi: 10.1007/s10916-025-02273-1.

ABSTRACT

Cancer treatments might lead to several long-term effects. In this work we investigate their causal role on ischemic heart disease and their potential precursors (i.e. hypertension and dyslipidemia) of the ovarian suppression therapy in adolescent and young adult (AYA) breast cancer (BC) survivors. Additionally, we assess the external validity of our findings through comparative analysis of regional data. We take advantage of a causal network model that leverage on observational data on 1-year AYA BC survivors living the Lombardy region in Italy. Using a structural causal model (SCM) and counterfactual analysis within Pearl’s causal inference framework, we estimate the Average Causal Effect (ACE), Probability of Necessity (PN), and Probability of Sufficiency (PS) for the cause-effect relationships. Data of a regional cohort of AYA BC patients living in the Veneto region were used to externally validate results. Ovarian suppression was found to be a necessary but not sufficient cause for ischemic heart disease (PN > 97.8%; PS < 1.97%). While PN is high for both hypertension and dyslipidemia, PS varied suggesting ovarian suppression alone could induce hypertension in about 30% of cases but was rarely sufficient for dyslipidemia onset. External validation confirmed the robustness of findings across regions. Our experimental results may be of interest for clinicians who aim at personalizing the follow-up of AYA BC survivors, with particular attention to be paid in monitoring the hypertension onset or in its prevention. The study demonstrates the value of counterfactual reasoning and causal inference when working with real-world data.

PMID:41099942 | DOI:10.1007/s10916-025-02273-1

Atherosclerosis. 2025 Oct 10;410:120545. doi: 10.1016/j.atherosclerosis.2025.120545. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: The atherogenic index of plasma (AIP) has been linked to hypertension in general populations. However, the existing evidence concerning its association with preeclampsia risk remains limited. This study aimed to assess the relationship between first-trimester AIP level and preeclampsia risk.

METHODS: 6028 singleton pregnant women from a birth cohort, all under 14 weeks of gestation and without a history of hypertension, were included. AIP was calculated as log₁₀ (triglycerides/high-density lipoprotein cholesterol). Generalized linear models and restricted cubic spline regression were utilized to estimate the associations between AIP and preeclampsia risk. A random forest model was employed to determine the relative importance of parameters for predicting preeclampsia risk.

RESULTS: 235 (3.90%) incident preeclampsia cases were confirmed. A linear relationship was found between AIP and preeclampsia risk, and each 1-standard deviation increase in AIP was associated with a 21% higher risk of preeclampsia (RR: 1.21, 95% CI: 1.06-1.38). A significant interaction was identified between AIP and uric acid (UA) level (P for interaction = 0.009). Elevated AIP was linked to an increased preeclampsia risk (RR: 1.32, 95% CI: 1.13-1.54) when UA level exceeded 198 μmol/L, and the highest combined level indicated the greatest risk. Moreover, AIP was identified as the strongest predictor among all variables in the prediction model.

CONCLUSIONS: Elevated first-trimester AIP was associated with an increased preeclampsia risk, particularly at the higher UA level. These findings highlight the clinical significance of pro-atherogenic dyslipidemia as both a risk marker and a potential target for early screening in preeclampsia prevention strategies.

PMID:41092517 | DOI:10.1016/j.atherosclerosis.2025.120545

Int J Nurs Stud. 2025 Oct 1;173:105242. doi: 10.1016/j.ijnurstu.2025.105242. Online ahead of print.

ABSTRACT

BACKGROUND: Suicidal ideation and self-harm among nurses with depressive symptoms are public health concerns, given their elevated prevalence and potentially severe outcomes. Prior studies predominantly examined negative life events either as isolated variables within broader exploratory analyses or as a single continuous measure, without assessing distinct patterns. This study aimed to identify distinct patterns of negative life events among Chinese nurses with depressive symptoms and examine their associations with suicidal ideation and self-harm.

METHODS: This cross-sectional study analyzed data from 73,371 nurses with depressive symptoms from the Nurses’ Mental Health Study in China. Latent class analysis identified patterns of ten negative life events experienced in the past year. Two binomial logistic regression models were used to examine associations between negative life event patterns and suicidal ideation (n = 64,569) and self-harm (n = 68,038), adjusting for demographic, work-related, health-related, and childhood experience covariates. Sensitivity analyses included stratified logistic regressions by levels of depressive symptom severity and multinomial logistic regressions that treated “prefer not to answer” responses as a separate category, to assess the robustness of associations and potential underreporting bias.

RESULTS: Four distinct negative life event patterns emerged: Low-Stress Life Events (59.7 %), Health and Family Crisis (12.4 %), Economic and Relationship Struggles (23.1 %), and Widespread Life Crises (4.7 %). Compared to the Low-Stress group, nurses in the Economic and Relationship Struggles group had statistically significantly higher odds of suicidal ideation (AOR = 1.25, 95 % CI: 1.14 to 1.37) and self-harm (AOR = 1.20, 95 % CI: 1.04 to 1.39). The Widespread Life Crises group showed even stronger associations with suicidal ideation (AOR = 1.68, 95 % CI: 1.46 to 1.92) and self-harm (AOR = 1.86, 95 % CI: 1.54 to 2.24). The Health and Family Crisis group showed no statistically significant associations with either outcome. Sensitivity analyses supported the main findings, with consistent associations observed across depression severity subgroups. The multinomial logistic regression also showed elevated risk ratios for suicidal ideation and self-harm among respondents in the Widespread Life Crises group, including those who selected “prefer not to answer.”

CONCLUSIONS: This study identified distinct patterns of negative life events among nurses with depressive symptoms and demonstrated that economic and relationship challenges, especially when occurring across multiple life domains, are significantly associated with the risk of suicidal ideation and self-harm. Targeted interventions addressing specific life stressor patterns may help reduce suicidality in this high-risk population.

PMID:41092511 | DOI:10.1016/j.ijnurstu.2025.105242

Int J Nurs Stud. 2025 Sep 30;173:105238. doi: 10.1016/j.ijnurstu.2025.105238. Online ahead of print.

ABSTRACT

BACKGROUND: Family involvement in advance care planning is important to achieve patients’ wishes and reduce the surrogate burden, particularly in family-centric cultures. Informal caregivers play an important role in helping patients with cancer plan their current and future care, and they serve as surrogate decision makers when patients are unable to make decisions themselves.

OBJECTIVES: To assess surrogate engagement levels in advance care planning and to identify the challenges for surrogate engagement in advance care planning.

DESIGN: A mixed-method design was adopted in which quantitative data collection was followed by qualitative interviews.

SETTING/PARTICIPANTS: Cancer caregivers nominated as potential surrogate decision makers were recruited via convenience sampling from a single cancer centre in Guangzhou, China. In total, 170 participants completed the survey, 25 of whom were interviewed individually.

METHODS: Surrogate-reported engagement levels were assessed quantitatively using in-person surveys. A subset of the participants underwent semi-structured in-depth interviews to share their healthcare experiences and perspectives on advance care planning. Quantitative data were analysed using descriptive statistics and univariate analyses, whereas qualitative data were thematically analysed and interpreted in the context of the quantitative findings.

RESULTS: During their prior experience, 95.3 % of the participants were involved in cancer patients’ medical care discussions, whereas 27.6 % actively engaged in advance care planning. Concerningly, most of them had insufficient knowledge and lacked self-efficacy, contemplation, and readiness regarding the surrogate role and end-of-life issues. Three key challenges influencing surrogate engagement in advance care planning were identified: (1) limited awareness of advance care planning, (2) ambivalent motivation arising from surrogate experiences and responsibilities, and (3) lack of support for surrogates’ needs.

CONCLUSION: This study revealed that cancer caregivers serving as potential surrogates reported limited engagement in advance care planning, with three key challenges: lack of awareness, motivation, and support. To overcome these challenges, early engagement strategies should focus on clarifying the concepts and potential benefits of advance care planning, resolving surrogate ambivalence, and facilitating access to support.

PMID:41092510 | DOI:10.1016/j.ijnurstu.2025.105238

MCN Am J Matern Child Nurs. 2025 Nov-Dec 01;50(6):357-361. doi: 10.1097/NMC.0000000000001146. Epub 2025 Oct 15.

ABSTRACT

BACKGROUND: Maternal mortality rates in the United States are alarmingly high, especially in rural areas with limited access to care. Clinicians in rural hospitals are challenged to maintain their obstetric knowledge and skills due to low patient volumes and limited educational opportunities. The purpose of this project was to improve maternity care in rural Texas by providing tailored obstetric education and simulations to enhance emergency response and team collaboration.

INTERVENTIONS: A team of five nurses provided simulation-based perinatal education to clinicians in 10 rural facilities and maternity deserts, including county emergency services. Tailored simulations conducted in situ addressed various obstetric emergencies and were designed to match each facility’s staffing ratios. Post-simulation surveys were sent to evaluate participants’ understanding, recognition, communication, and collaboration.

RESULTS: Surveys from 48 participants, including nurses, technicians, and other health care professionals, indicated significant improvements in understanding, recognition, communication, and preparedness for obstetrical emergencies after simulation training. Qualitative feedback underscored the project’s success, highlighting the increased confidence, knowledge, and multidisciplinary collaboration among the participants. The simulation education effectively addressed facility-specific needs, enhancing overall effectiveness and engagement, despite challenges with participant attendance and group sizes.

DISCUSSION: Perinatal outreach has improved rural health care teams’ confidence, preparedness, and competence in managing obstetric emergencies through specialized education and hands-on simulations. To ensure continued success, it is crucial to continually reassess and adapt educational programs to meet the evolving needs of rural health care facilities, thereby enhancing patient care and outcomes.

PMID:41092467 | DOI:10.1097/NMC.0000000000001146

Int J Surg. 2025 Oct 16. doi: 10.1097/JS9.0000000000003696. Online ahead of print.

ABSTRACT

BACKGROUND: Stress Urinary Incontinence (SUI) is one of the top five chronic diseases globally. The traditional theory of SUI does not adequately explain certain subgroups of patients. This study aims to investigate the risk factors and potential mechanisms underlying female SUI.

MATERIALS AND METHODS: A dual-tertiary center, cross-sectional study was conducted. A finite element model (FEM) was developed using data from a female volunteer. A total of 42 rats were utilized as animal models. Female participants presenting with lower urinary tract symptoms were recruited and categorized into four groups based on their SUI and Levator ani avulsion (LAA) status: SUI +/LAA +, SUI +/LAA-, SUI-/LAA +, and SUI-/LAA-. Data were collected from the FEM, animal models, and human participants.

RESULTS: The FEM demonstrated that in simulations of unilateral LAA, the ipsilateral urethra exhibited deviation and displacement toward the site of avulsion, accompanied by distortion. Rats with LAA showed a significantly higher incidence of SUI (P = 0.031), particularly those with unilateral LAA (P = 0.011). A total of 1629 women were ultimately included in the study. Statistical significance was observed specifically in patients with unilateral LAA (OR = 1.87 (95% CI,1.389-2.481), P < 0.001). Measurements of the levator-urethral gap (LUG) indicated that the closer the avulsion site was to the urethral opening, the higher the likelihood of SUI occurrence, which aligns with the urethral deviation patterns observed in the FEM analysis.

CONCLUSION: Unilateral LAA is a significant risk factor for SUI. The urethral deviation induced by unilateral LAA may represent an additional etiological mechanism of SUI, beyond the traditional fascial hammock theory.

PMID:41092446 | DOI:10.1097/JS9.0000000000003696

J Econ Entomol. 2025 Oct 15:toaf271. doi: 10.1093/jee/toaf271. Online ahead of print.

ABSTRACT

Drosophila suzukii (Diptera: Drosophilidae) is a major pest of soft-skinned fruits, inflicting economic losses through pre-harvest infestation. Among reduced-risk strategies, Attract-and-Kill (A&K) presents an alternative to full-cover insecticide sprays by concentrating exposure to insecticide-laced lures. However, compatibility of insecticides and attractants, as well as application volume, requires optimization to improve efficacy. We evaluated A&K formulations that combined organic Entrust SC (spinosad), Pyganic (pyrethrin), and conventional Gowan Malathion-8 Flowable (malathion), Mustang Maxx (zeta-cypermethrin) insecticides with 2 attractants, Combi-Protec (4:1, plant extract: sugar) and Decoy (citric acid), under laboratory conditions using blueberries. Each attractant-insecticide tank mix was applied at 5 droplet levels (0, 2, 6, 10, and 14). Compared to the 0 droplet, spinosad reduced fruit damage with Decoy, while malathion reduced fruit damage with Combi-Protec and Decoy, demonstrating strong synergism. Spinosad, malathion, and zeta-cypermethrin induced adult mortality depending on the attractant used. A&K achieved a rapid mortality rate within 5 h, at 85.4%, when applied as droplets in Munger cells, significantly faster than simulated full-cover sprays (33.9%) applied across glass plates, thereby limiting the window for oviposition and resistance development. A dose-response trend was observed, where 6 or more droplets consistently resulted in higher mortality and reduced egg-laying, although not always statistically significant. These findings highlight the potential of A&K systems, particularly those incorporating malathion or spinosad with Decoy, to achieve rapid and effective control of D. suzukii. Optimized A&K formulations can enhance integrated pest management (IPM) by minimizing environmental exposure, reducing reliance on full-cover applications, and slowing resistance evolution.

PMID:41092437 | DOI:10.1093/jee/toaf271

JMIR Cancer. 2025 Oct 15;11:e68411. doi: 10.2196/68411.

ABSTRACT

BACKGROUND: Mobile health (mHealth) apps are playing an increasingly important role in health care, including in radiotherapy. However, adherence remains low. One way to increase adherence is to tailor app features to the patients’ preferences.

OBJECTIVE: This study aimed to explore the importance of patient preferences regarding the features of a therapy-supporting app in radiotherapy. In addition, we examined factors associated with the perceived importance of these features.

METHODS: A cross-sectional questionnaire study was conducted with patients undergoing radiotherapy between summer 2021 and winter 2022. The subjective importance of 18 features of a treatment-accompanying app was explored using a 5-point Likert scale from 1=not so important to 5=extremely important. Descriptive analyses were used to show the rated importance of app functions. Associations with possible predictors were examined using multiple hierarchical regressions, with age (interval-scaled), gender (dichotomous), previous experience with mHealth apps (dichotomous), education (3-level nominal), and supportive care needs (interval-scaled) as predictors.

RESULTS: A total of 84 radiotherapy patients participated. The average age was 62 (SD 12.5) years. The feature with the highest importance was security against hacking (46/77, 60% extremely important). Explained variances in the regression analyses ranged between R2=0.25 (The app should give me tips on suitable sporting activities that are possible with my illness) and R2=-.07 (The app should provide me with information about suitable self-help offers). Previous mHealth usage predicted the importance of 6 features, such as managing appointments (β=.275; P<.05). Decreasing age was related to 6 features, for example, showing test results and laboratory values (β=-.358; P<.05). Other predictors were an increasing age and greater supportive care needs.

CONCLUSIONS: Patients undergoing radiotherapy rated app features as having varying levels of importance. The findings may help to tailor mHealth apps in radiotherapy, potentially improving adherence to app usage.

PMID:41092423 | DOI:10.2196/68411

JMIR Med Educ. 2025 Oct 15;11:e68697. doi: 10.2196/68697.

ABSTRACT

BACKGROUND: Improving the quality of education in clinical settings requires an understanding of learners’ experiences and learning processes. However, this is a significant burden on learners and educators. If learners’ learning records could be automatically analyzed and their experiences could be visualized, this would enable real-time tracking of their progress. Large language models (LLMs) may be useful for this purpose, although their accuracy has not been sufficiently studied.

OBJECTIVE: This study aimed to explore the accuracy of predicting the actual clinical experiences of medical students from their learning log data during clinical clerkship using LLMs.

METHODS: This study was conducted at the Nagoya University School of Medicine. Learning log data from medical students participating in a clinical clerkship from April 22, 2024, to May 24, 2024, were used. The Model Core Curriculum for Medical Education was used as a template to extract experiences. OpenAI’s ChatGPT was selected for this task after a comparison with other LLMs. Prompts were created using the learning log data and provided to ChatGPT to extract experiences, which were then listed. A web application using GPT-4-turbo was developed to automate this process. The accuracy of the extracted experiences was evaluated by comparing them with the corrected lists provided by the students.

RESULTS: A total of 20 sixth-year medical students participated in this study, resulting in 40 datasets. The overall Jaccard index was 0.59 (95% CI 0.46-0.71), and the Cohen κ was 0.65 (95% CI 0.53-0.76). Overall sensitivity was 62.39% (95% CI 49.96%-74.81%), and specificity was 99.34% (95% CI 98.77%-99.92%). Category-specific performance varied: symptoms showed a sensitivity of 45.43% (95% CI 25.12%-65.75%) and specificity of 98.75% (95% CI 97.31%-100%), examinations showed a sensitivity of 46.76% (95% CI 25.67%-67.86%) and specificity of 98.84% (95% CI 97.81%-99.87%), and procedures achieved a sensitivity of 56.36% (95% CI 37.64%-75.08%) and specificity of 98.92% (95% CI 96.67%-100%). The results suggest that GPT-4-turbo accurately identified many of the actual experiences but missed some because of insufficient detail or a lack of student records.

CONCLUSIONS: This study demonstrated that LLMs such as GPT-4-turbo can predict clinical experiences from learning logs with high specificity but moderate sensitivity. Future improvements in AI models, providing feedback to medical students’ learning logs and combining them with other data sources such as electronic medical records, may enhance the accuracy. Using artificial intelligence to analyze learning logs for assessment could reduce the burden on learners and educators while improving the quality of educational assessments in medical education.

PMID:41092407 | DOI:10.2196/68697

JMIR Pediatr Parent. 2025 Oct 15;8:e74964. doi: 10.2196/74964.

ABSTRACT

BACKGROUND: Health care systems face challenges of inconsistent quality, inefficiency, and rising costs. Fragmented applications of clinical decision support systems (CDSSs), clinical pathways (CPs), and diagnosis-related group (DRG) payment systems have limited their synergistic potential.

OBJECTIVE: This study proposed a CDSS-CP-DRG closed-loop model enabled by digital health technologies; specifically, the CDSS optimized CP execution through real-time data, the CP standardized workflows to support DRG cost control, and DRG payment pressures drove iterative improvements in both technology and processes. This research aimed to validate the model’s effectiveness in clinical efficacy, cost control, and standardized diagnosis and treatment of bronchopneumonia in children and provide evidence for value-based health care transformation.

METHODS: A total of 4543 children with bronchopneumonia were selected and divided into the experimental or control group based on whether the intelligent diagnosis and cost control system was used in the diagnostic process. Chi-square test, 1-way analysis of variance, paired t test, multiple regression analysis, and other mathematical statistical methods were used to verify the difference between the outcomes of the two groups of patients.

RESULTS: This study demonstrated comparably high cure rates in both groups (P>.05). However, the experimental group exhibited a 0.4-day reduction in average length of stay, 12.3% lower total hospitalization costs, RMB 135.3 (US $19) higher medical insurance reimbursement surplus, and a reduction of 0.16 defined daily doses of antibiotic use intensity versus the control group (P<.05 for all significant differences).

CONCLUSIONS: The novel intelligent diagnosis and cost control system demonstrated significant improvement in clinical effect, cost control, and standardized treatment for pediatric bronchopneumonia, but the CP for pediatric pneumonia requiring intensive care still needs further attention and adjustment.

PMID:41092402 | DOI:10.2196/74964