Tag: pubmed

Clin Psychol Psychother. 2026 Jan-Feb;33(1):e70226. doi: 10.1002/cpp.70226.

ABSTRACT

Research into the differences across cognitive domains has been conducted to characterize the various presentations of schizophrenia-spectrum disorders. We aimed to identify distinct combined cognitive profiles with clinical relevance in patients with early psychosis (EP) by integrating neurocognition, social cognition and cognitive biases (CBs). Seventy-five outpatients attending an EP programme were assessed on neuropsychological performance, Theory of Mind (ToM), facial emotion recognition (FER), jumping to conclusions (JTC) bias and self-reported CBs through standardized tools. A two-step cluster analysis was performed to identify latent profiles. The optimal number of clusters was determined based on the Bayesian information criterion. Symptom dimensions, depression, global functioning, antipsychotic use, duration of untreated psychosis (DUP) and sociodemographic variables were compared across the resulting clusters. Two distinct profiles were identified. The first cluster (53.3%) was characterized by significant impairments in neurocognition, ToM and FER, as well as greater JTC and self-reported CBs. The second cluster (46.7%) was defined by relatively preserved performance across cognitive domains. Furthermore, the impaired cluster showed more severe positive, negative and disorganized symptoms, poorer functioning, lower premorbid intelligence and increased use of antipsychotics. No significant differences were found for depression, DUP or sociodemographic variables. Concluding, cognitive clustering revealed a clinically impaired subgroup of patients with more severe psychotic symptoms and poorer functioning. Our results may contribute to a better understanding of the distinct cognitive profiles of patients with EP. These findings may be relevant because several interventions targeting different cognitive domains have been shown to improve clinical and functional outcomes in EP.

PMID:41569600 | DOI:10.1002/cpp.70226

JAMA Otolaryngol Head Neck Surg. 2026 Jan 22. doi: 10.1001/jamaoto.2025.5077. Online ahead of print.

ABSTRACT

IMPORTANCE: Acute invasive fungal rhinosinusitis (AIFRS) is a rapidly progressive and potentially life-threatening infection that predominantly affects immunocompromised patients. Recent advances in diagnostic imaging, antifungal therapy, and surgical techniques may have altered its incidence, morbidity, and mortality.

OBJECTIVE: To evaluate temporal trends in the pooled proportion, morbidity, and mortality of AIFRS in immunocompromised patients and assess the association of diagnostic and therapeutic advances.

DATA SOURCES: Systematic searches of Ovid MEDLINE, Ovid Embase, PubMed, Scopus, Web of Science, Cochrane, and Google Scholar from 1977 through October 20, 2025, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

STUDY SELECTION: Prospective, retrospective, and cross-sectional studies and case series reporting pooled proportion, morbidity, or mortality of AIFRS in immunocompromised patients were included. Non-English articles, reviews, editorials, and studies with fewer than 10 patients were excluded.

DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data using standardized templates; disagreements were resolved by consensus. Risk of bias was assessed using the Newcastle-Ottawa Scale and Murad tool for case series. Random-effects meta-analysis generated pooled proportion, morbidity, and mortality rates with 95% CIs. Heterogeneity was quantified using I2 statistics. Meta-regression and sensitivity analyses evaluated temporal trends and study-level effects.

MAIN OUTCOMES AND MEASURES: Pooled proportion, morbidity, and mortality rates of AIFRS stratified by publication period (1983-2012 vs 2013-2025).

RESULTS: A total of 205 studies comprising 48 437 immunocompromised patients (median [range] age, 49.4 [5.2-68.8] years), including 10 311 (21.3%) with AIFRS, were analyzed. The pooled proportion was 11.8% (95% CI, 7.9%-17.2%), rising to 16.6% (95% CI, 8.7%-29.2%) in studies from 2013 to 2025. Overall mortality was 31.2% (95% CI, 28.3%-34.3%), declining from 41.9% (95% CI, 35.0%-49.1%) before 2013 to 28.2% (95% CI, 25.1%-31.4%) after 2013. Morbidity was 37.0% (95% CI, 32.9%-41.4%), with similar rates across periods (39.3% before 2013 vs 36.4% after 2013). The most common complications were vision loss, exophthalmos/proptosis, and orbital exenteration.

CONCLUSIONS AND RELEVANCE: This systematic review and meta-analysis suggests that the pooled proportion of AIFRS among immunocompromised patients has increased while mortality has declined, reflecting advances in diagnostic and therapeutic approaches. Early detection and aggressive management remain critical to improving outcomes.

PMID:41569597 | DOI:10.1001/jamaoto.2025.5077

Stat Med. 2026 Jan;45(1-2):e70383. doi: 10.1002/sim.70383.

ABSTRACT

Derived variables are variables that are constructed from one or more source variables through established mathematical operations or algorithms. For example, body mass index (BMI) is a derived variable constructed from two source variables: weight and height. When using a derived variable as the outcome in a statistical model, complications arise when some of the source variables have missing values. In this paper, we propose how one can define a single fully integrated Bayesian model to simultaneously impute missing values and sample from the posterior. We compare our proposed method with alternative approaches that rely on multiple imputation (MI), with examples including an analysis to estimate the risk of microcephaly (a derived variable based on sex, gestational age, and head circumference at birth) in newborns exposed to the ZIKA virus.

PMID:41569594 | DOI:10.1002/sim.70383

Nutr Hosp. 2026 Jan 19. doi: 10.20960/nh.05908. Online ahead of print.

ABSTRACT

BACKGROUND: disordered eating behaviors (DEBs) encompass altered eating behaviors that do not meet the diagnostic criteria to be considered eating disorders, yet, like the latter, are associated with multiple medical, psychological, and social complications.

OBJECTIVE: this study aimed to analyze the influence of the internalization of beauty ideals (specifically thinness and muscularity), depressive symptoms, body mass index (BMI), and type of university on DEBs.

METHODS: a correlational, cross-sectional study was conducted with two independent samples of university students from two universities, one public and one private, in Mexico City (n = 1571; 20.8  2.07 years). Data analysis included frequency and percentage estimation, mean comparison, and linear regression analysis.

RESULTS: students enrolled at the private university scored higher for all the variables studied, with statistically significant differences, except for BMI, where public university students scored higher. When compared by BMI, overweight and obese students scored higher for DEBs and internalization. In women, DEBs were predicted by thin-ideal internalization, BMI, and type of university. In male participants, predictors included BMI, depressive symptoms, and type of university.

CONCLUSIONS: the results confirmed previous findings in the literature, with socioeconomic status being a determining factor for the presence of DEBs.

PMID:41569591 | DOI:10.20960/nh.05908

Br J Surg. 2025 Dec 24;113(1):znaf293. doi: 10.1093/bjs/znaf293.

ABSTRACT

BACKGROUND: Health system performance assessment helps identify areas for improvement and guides policy initiatives. Although well-validated indicators exist for measuring organ donation and transplantation performance at the facility level, consensus on indicators for assessing national programmes is lacking. The aim of this study was to develop a comprehensive scorecard for evaluating national organ donation and transplantation programmes.

METHODS: A three-step approach was used. First, a targeted literature review identified potential indicators from regulatory documents, national transplant organization reports, and databases. Second, indicators were mapped to an established transplant system framework and refined through preliminary expert consultations. Third, a modified Delphi consensus process validated the indicators. The Delphi panel comprised international experts in health policy, organ donation, transplantation, and patient representation. Participants rated 168 indicators using a five-point Likert scale across two rounds (24 experts completed round 1 and 22 experts completed round 2). Consensus for inclusion required 80% agreement.

RESULTS: Of 168 indicators evaluated, 103 achieved consensus for inclusion. After consolidation of organ-specific indicators, the final set contained 84 indicators across seven domains: monitoring and reporting (8 indicators), prevention and need (9 indicators), waiting lists (11 indicators), consent (4 indicators), donation (28 indicators), transplantation (14 indicators), and follow-up (10 indicators). The indicator set incorporates established metrics such as waiting list statistics, donation rates, and complication rates alongside novel system-level indicators addressing structural factors, patient-centredness, and equity in care delivery.

CONCLUSION: This validated indicator set provides a standardized tool for assessing and comparing transplant system performance across European countries, supporting performance benchmarking and evidence-informed policy development.

PMID:41569582 | DOI:10.1093/bjs/znaf293

Nutr Hosp. 2026 Jan 21. doi: 10.20960/nh.06109. Online ahead of print.

ABSTRACT

OBJECTIVES: this cross-sectional study investigated the association between the Cardiometabolic Index (CMI) and heart failure (HF) prevalence in hypertensive individuals.

METHODS: this cross-sectional study analyzed dataset from the National Health and Nutrition Examination Survey (NHANES) 2009-2018, focusing on hypertensive adults with complete information on CMI and HF prevalence, employed CMI based on the following formula: [waist circumference (cm)/height (cm)] × [TG (mmol/L)/HDL-C (mmol/L)]. The relationships between CMI and HF prevalence were assessed using weighted multivariable logistic regression and subgroup analysis. Additionally, the threshold effect was determined by applying a two-piece linear regression model.

RESULTS: a total of 3,706 subjects with hypertension were enrolled, with heart failure being reported in 6.77 % of cases. A positive relationship was observed between CMI and HF prevalence. In the fully adjusted model, a one-unit rise in CMI corresponded to a 14 % increased likelihood of HF (OR = 1.14, 95 % CI: 1.03-1.26). Subjects in the top CMI tertile were 49 % more likely to progress to HF than those in the bottom tertile (OR = 1.49, 95 % CI: 1.01-2.21). We did not detect statistically significant interactions across subgroups. An inverted U-shaped correlation was identified between CMI and HF prevalence. The breakpoint was identified at 6.00. On the left of the breakpoint, a positive relationship between CMI and HF prevalence (OR = 1.56, 95 % CI: 1.35-1.79) was observed.

CONCLUSIONS: these findings suggest a positive association between elevated CMI levels and a higher prevalence of HF in hypertensive adults.

PMID:41569581 | DOI:10.20960/nh.06109

JAMA Netw Open. 2026 Jan 2;9(1):e2553518. doi: 10.1001/jamanetworkopen.2025.53518.

ABSTRACT

IMPORTANCE: Unhealthy alcohol use is a leading cause of preventable deaths and is associated with many societal and health problems. Fewer than one-third of people who visit primary care practices in the US are asked about or ever discuss alcohol use with a health professional.

OBJECTIVE: To evaluate the association between primary care practice facilitation and adoption of evidence-based screening and brief counseling for unhealthy alcohol use.

DESIGN, SETTING, AND PARTICIPANTS: The Stop Unhealthy Alcohol Use Now (STUN) single arm, multi-site implementation study was performed at 21 primary care practices across North Carolina between February 1, 2020, and September 1, 2023.

INTERVENTION: Enrolled practices received 12 months of the practice facilitation implementation strategy, including quality improvement coaching, electronic health record support (eg, creating smart phrases or flowsheets, retrieving data), and clinician training on screening and counseling for unhealthy alcohol use.

MAIN OUTCOMES AND MEASURES: Implementation outcomes reflected adoption of evidence-based screening and counseling, including number and percentage of adult patients who were screened for unhealthy alcohol use and who received brief counseling after a positive screening result.

RESULTS: The 21 practices served 54 294 adult patients (mean [SD], 3386.2 [3418.0] per practice). Mean screening rates increased significantly, from 17.4% (95% CI, 6.0%-28.9%) per practice to 57.6% (95% CI, 29.1%-86.1%) by the end of the second quarter of practice facilitation (primary outcome; P < .001). Among screened patients, a weighted 13.9% (95% CI, 6.8%-21.1%) had positive results. The percentage of adult patients with documentation of receiving brief counseling after a positive screening result increased from 0 to 32.3% (95% CI, 13.3%-51.4%) by the end of the second quarter of practice facilitation (P < .001). After month 6, assessment of the implementation outcomes showed sustainment. There was significant variability across participating practices for screening and counseling outcomes.

CONCLUSIONS AND RELEVANCE: The findings of this quality improvement study suggest that practice facilitation was associated with increased adoption of evidence-based screening and counseling for unhealthy alcohol use when provided to small and medium-sized primary care practices. This increase is projected to substantially reduce the harms of unhealthy alcohol use.

PMID:41569565 | DOI:10.1001/jamanetworkopen.2025.53518

JAMA Netw Open. 2026 Jan 2;9(1):e2553530. doi: 10.1001/jamanetworkopen.2025.53530.

ABSTRACT

IMPORTANCE: Nutritional status is a key determinant of child health. While undernutrition and stunting persist among vulnerable populations, overweight and obesity have emerged as growing public health concerns. Quantifying these conditions across subpopulations is essential for guiding interventions.

OBJECTIVE: To describe and compare height-for-age and body mass index (BMI)-for-age adequacy, including the prevalence of overweight, obesity, and stunting, among low-income children in Brazil by region, age, sex, and ethnoracial group.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used administrative health records of 6 494 753 Brazilian children aged 0 to 10 years who were born between January 1, 2001, and December 31, 2015, and were enrolled in the public primary health care system. Data were obtained from 3 administrative databases-the Unified Registry, Live Birth Information System, and Food and Nutrition Surveillance System-and evaluated at 9 years of age until December 31, 2018. Descriptive statistics were used to summarize baseline characteristics, and prevalence estimates were presented with SEs. Data were analyzed from December 1, 2024, to June 31, 2025.

EXPOSURE: Demographic characteristics (age, sex, and ethnoracial group) and geographic region of residence.

MAIN OUTCOMES AND MEASURES: Anthropometric adequacy was assessed using height-for-age and BMI-for-age z scores, classified according to World Health Organization standards. Outcomes included the prevalence of stunting (height-for-age z scores less than -2), overweight (BMI-for-age z scores greater than 1), and obesity (BMI-for-age z scores greater than 2), reported overall and by subgroups.

RESULTS: Among the 6 494 753 million children, 51.48% were female, with a mean (SD) age of 3.6 (2.8) years. In terms of race and ethnicity, 0.26% were Asian; 3.84%, Black; 0.90%, Indigenous; 61.71%, Parda; and 28.72%, White; 4.57% had missing or inconsistent data. Overall, 433 754 children (6.68%) experienced stunting, 818 967 (12.61%) had overweight, and 489 541 (7.54%) had obesity. Estimated obesity prevalence (SE) at 5 years of age was 8.48% (0.02%), increasing to 10.09% (0.05%) at 9 years of age. Obesity was more frequent boys (14.12% [0.12%]) than girls (10.09% [0.05%]) at 9 years of age. Among girls, obesity prevalence (SE) was 11.8% (0.09%) among those who identified as White, 9.12% (0.06%) among those who identified as Parda, and 7.46% (0.48%) among those who identified as Indigenous.

CONCLUSIONS AND RELEVANCE: This large-scale cohort study highlights persistent regional and ethnoracial disparities in both growth faltering and excess weight gain. The coexistence of undernutrition and obesity in the same population underscores the urgency for targeted nutrition and health policies in early childhood.

PMID:41569564 | DOI:10.1001/jamanetworkopen.2025.53530

JAMA Netw Open. 2026 Jan 2;9(1):e2554972. doi: 10.1001/jamanetworkopen.2025.54972.

ABSTRACT

IMPORTANCE: Since 2012, the Hospital Readmissions Reduction Program (HRRP) has penalized hospitals for excess, risk-adjusted 30 day readmissions among traditional Medicare (TM) beneficiaries. While risk adjustment may address observable differences in patient severity, it cannot account for unobservable differences. Medicare Advantage (MA) enrollment has continued to increase, and MA beneficiaries have been found to be both observably and unobservably healthier than their TM counterparts. Because relatively lower-severity patients are increasingly likely to enroll in MA, hospitals with higher MA penetration may have unobservably higher-severity TM patients, resulting in higher-than-estimated readmission risk and excessive HRRP penalties.

OBJECTIVE: To determine whether unobserved selection, as proxied by MA penetration, could be associated with distorted HRRP penalties and how associations may be moderated by peer grouping, which was incorporated into HRRP’s 2019 revision to penalty calculations.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included hospitals serving Medicare beneficiaries from fiscal years 2019 to 2022 for 6 HRRP-targeted conditions, including acute myocardial infarction, chronic obstructive pulmonary disease, heart failure, pneumonia, coronary artery bypass graft surgery, and elective primary total hip or knee arthroplasty. Data were analyzed from January 2024 to October 2025.

EXPOSURE: MA penetration at the hospital-year level.

MAIN OUTCOMES AND MEASURES: Excess readmission ratios (ERRs) and calculated HRRP penalties at the hospital-year level. To test whether HRRP penalties could have been distorted by unobserved selection, the association between the share of hospital admissions for MA patients (MA penetration) and excess readmission ratios (ERRs) for all patients was estimated, controlling for county-level variation and hospital-level covariates. The ERRs were rescaled by MA penetration to account for unobserved selection, and the rescaled ERRs were used to reestimate HRRP penalties under non-peer grouping and peer grouping paradigms.

RESULTS: This study included 3203 hospitals and 12 135 hospital-years. After adjusting for MA penetration, estimates indicated that hospitals in the first quintile of MA penetration would be penalized by a mean (SD) of $30 736 ($24 819.75) more, while hospitals in the fifth quintile would be penalized by a mean (SD) of approximately $26 915 ($42 017.23) less. Peer grouping does not mitigate these penalty distortions. Across hospitals, penalty redistributions would amount to $284 to $297 million annually.

CONCLUSIONS AND RELEVANCE: The findings of this study suggest that including MA penetration explicitly in risk adjustment or in peer group definitions may dampen distortions from unobservable patient severity in HRRP penalty calculations.

PMID:41569562 | DOI:10.1001/jamanetworkopen.2025.54972

Nutr Hosp. 2026 Jan 20. doi: 10.20960/nh.06129. Online ahead of print.

NO ABSTRACT

PMID:41569559 | DOI:10.20960/nh.06129