Tag: pubmed

J Public Health Manag Pract. 2026 Jan 13. doi: 10.1097/PHH.0000000000002279. Online ahead of print.

ABSTRACT

OBJECTIVE: This systematized review aimed to identify the most common methods used to prioritize health needs among 501(c)(3) nonprofit hospital systems in the US since the implementation of the Affordable Care Act.

INTRODUCTION: Of the approximately 6000 hospitals in the US, 50% are 501(c)(3) nonprofits. These 501(c)(3)s are tax-exempt with surplus revenue serving their communities and must meet the community benefit standard provided by Internal Revenue Code (IRC) section 501(c)(3) and Revenue Ruling 69-545. Additionally, the Patient Protection and Affordable Care Act (ACA) (2010) requires all 501(c)(3) nonprofit hospitals to conduct a Community Health Needs Assessment (CHNA) every 3 taxable years. The Internal Revenue Service (IRS) provides broad guidelines for these needs assessments, but no guidance on prioritizing the needs identified.

METHODS: A systematized review was utilized to review commonly used methods in CHNAs. The PubMed database was utilized to find recent, peer-reviewed articles. A librarian was consulted for the generation of Boolean search terms. Filters included articles in English, peer-reviewed, and time-bound from 2010 to 2025. Data extracted focused on the type of prioritization method used by CHNAs.

RESULTS: Out of 1076 records initially identified, 37 peer-reviewed studies met the final inclusion criteria. Three broad categorical approaches of prioritizing needs were identified: community-driven approaches, structured prioritization frameworks, and a combination of approaches. Prioritization methods include the nominal grouping technique, multivoting technique, community-based participatory research, concept mapping, the Delphi technique, descriptive statistics & regressions, and the Hanlon method.

DISCUSSION: There are many evidence-based methods for prioritizing health needs. Some are better suited to specific situations and communities than others. Aggregating the examples of prioritization methods in CHNAs will aid hospitals and communities in selecting the right method to best serve their community. Ultimately, this research provides guidance to communities creating a useful CHNA and a healthier equitable community. Future research should investigate the effect of these prioritization methods on health outcomes and quantifying subsequent community benefit.

PMID:41528769 | DOI:10.1097/PHH.0000000000002279

Fam Pract. 2025 Dec 9;43(1):cmaf112. doi: 10.1093/fampra/cmaf112.

ABSTRACT

BACKGROUND: Unnecessary vitamin tests are among the most frequently mentioned low-value care practices among Dutch general practitioners (GPs). Understanding drivers for vitamin testing from a GP’s perspective is key for developing effective interventions.

OBJECTIVES: This study explored GPs’ perspectives on drivers of vitamin D and B12 testing, focusing on potential differences between GPs in practices with high and low testing rates, using the Capability, Opportunity, and Motivation Model of Behaviour (COM-B) behavioural science framework.

METHODS: Laboratory data from 57 primary care centres (PCCs) in the South of the Netherlands (2016-2019) identified the 15 PCCs with the lowest and highest vitamin testing rates. Thirty GPs, one per PCC, were purposively sampled to ensure variation in testing rate and background. Semi-structured interviews (May-July 2020) covered general perceptions, as well as social, cognitive, and motivational factors. Interviews were analysed by mapping factors driving vitamin testing to the COM-B model.

RESULTS: Several medical and non-medical factors affecting vitamin D and B12 test ordering in general practice were identified, which could be linked to all three COM-B components at the GP (e.g. education), patient (e.g. informational material), and service level (e.g. laboratory forms).

CONCLUSION: Education, feedback on testing behaviour, evidence-based patient informational material, clear evidence-based guidelines, and modification of laboratory request forms by adding test costs and indications of at-risk groups were identified by participants as promising strategies to reduce unnecessary vitamin testing.

PMID:41528763 | DOI:10.1093/fampra/cmaf112

Pain Med. 2025 Dec 4:pnaf170. doi: 10.1093/pm/pnaf170. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the effectiveness of ultrasound-guided percutaneous electrolysis and peripheral nerve stimulation in reducing pain, improving functional capacity, and modifying mechanosensitivity responses in patients with carpal tunnel syndrome compared to a sham intervention.

DESIGN: A multicenter, randomized controlled clinical trial.

SETTINGS: Double center pain clinic.

SUBJECTS: In brief, 46 patients diagnosed, with carpal tunnel syndrome, assigned to an intervention group or a sham group.

METHODS: Both groups received 3 sessions over 4 weeks. Primary outcomes included mean and worst pain intensity. Secondary outcomes assessed functional status and symptoms severity; Boston Carpal Tunnel Questionnaire, Upper Limb Neurodynamic Test 1, grip and pinch strength, two-point discrimination, sensory thresholds, pressure pain threshold and Global Rating of Change Scale. Follow-ups were conducted at 4, 12, and 24 weeks.

RESULTS: Statistically significant intergroup differences were observed for all evaluated variables across follow-ups, except for grip and pinch strength. The intervention group demonstrated significantly greater improvements in pain intensity, functional disability, sensory thresholds, and neural mobility, with large effect sizes ranging from 0.64 to 2.09. Notably, the improvements in pain and function were sustained at 6 months.

CONCLUSIONS: Ultrasound-guided percutaneous electrolysis and peripheral nerve stimulation significantly reduce pain and improve function in carpal tunnel syndrome, offering a promising minimally invasive alternative to standard care.

CLINICAL TRIAL REGISTRATION NUMBER: Effectiveness of an Invasive Physical Therapy Protocol in Carpal Tunnel Syndrome: Randomized Controlled Clinical Trial. Registration number: NCT05527743. Link to full trial record: https://clinicaltrials.gov/ct2/show/NCT05527743 Patient enrollment began on: April 1, 2023.

PMID:41528761 | DOI:10.1093/pm/pnaf170

J Health Psychol. 2026 Jan 13:13591053251395856. doi: 10.1177/13591053251395856. Online ahead of print.

ABSTRACT

Studying class stigma in the context of diabetes and socioeconomic inequalities may shed light on the societal factors influencing diabetes. Data from 1947 participants aged 49-88 who participated in the second phase of The Maastricht Study were used. SEP (education, income, occupation) and a six-item classism scale were measured through self-reported questionnaires. Prediabetes and T2D were defined through an oral glucose tolerance test. We conducted multinomial logistic regression analyses to investigate the associations between SEP, classism, and diabetes. About 20.9% (N = 406) of the study sample had T2D (Mean_age = 69.8 ± 6.8; 31.3% women). People with low SEP had T2D (e.g. income OR = 2.13, 95% CI: 1.54-2.82) and reported perceived classism (e.g. education OR = 2.07, 95% CI: 1.33-3.21) more often than people with high SEP. Classism was not statistically significantly associated with T2D. Social health inequalities are apparent in T2D; however, our results suggest that class stigma might not be a major factor in the underlying processes. Further research should investigate chronic stress and the intersection of stigmas.

PMID:41528758 | DOI:10.1177/13591053251395856

Psychol Rep. 2026 Jan 13:332941251415313. doi: 10.1177/00332941251415313. Online ahead of print.

ABSTRACT

Researchers have found that psychological well-being is independently correlated with both optimism and flow. Although the flow-optimism-well-being structure has been studied empirically, there hasn’t been much concentrated synthesis on optimism’s particular mediating mechanism. This review conducts a thorough analysis of peer-reviewed research on optimism as a specific mediator between flow and psychological health in adults between the ages of 18 and 65. PRISMA 2020 guidelines were adhered to in this systematic review. To find studies published between 2015 and 2025, six databases were searched: PsycINFO, Scopus, PubMed, Google Scholar, ScienceDirect, and ERIC. The following criteria must be met for inclusion: statistical mediation analysis of optimism between flow and well-being, adult samples, empirical research, and English language proficiency. To evaluate quality, the Mixed Methods Appraisal Tool (MMAT) was employed. All of the updated inclusion criteria were met by three studies. However, generalizability is constrained by measurement and design heterogeneity. With indirect effects ranging from .15 to.23, these studies consistently showed that optimism serves as a mediator in the relationship between flow and psychological well-being particularly. Although the majority of the included studies used cross-sectional designs, the evidence was especially strong in longitudinal and daily diary designs. Hence, the review reveals a consistent but moderate mediation effect where optimism acts as a significant psychological mechanism through which flow experiences enhance well-being.

PMID:41528755 | DOI:10.1177/00332941251415313

JAMA Netw Open. 2026 Jan 2;9(1):e2551734. doi: 10.1001/jamanetworkopen.2025.51734.

ABSTRACT

IMPORTANCE: Over 1 million pulmonary nodules are discovered each year in the US, and many of these undergo molecular imaging-guided surgery to obtain a diagnosis. Locating a small nodule and determining its malignant potential is technically challenging and is prone to human error.

OBJECTIVE: To demonstrate use of a machine learning (ML) algorithm with molecular imaging to analyze imaging data during lung cancer surgery to determine malignant potential of nodules.

DESIGN, SETTING, AND PARTICIPANTS: Data were retrospectively analyzed from a prospectively collected database. Between 2014 and 2021, patients at the hospital of the University of Pennsylvania with lung nodules were included in the study. Patients in the model development set were randomly allocated into training and validation sets in an 8:2 ratio. Data were analyzed from January 2014 and December 2021.

MAIN OUTCOMES AND MEASURES: Algorithmic tumor to background ratio (TBR) detection was implemented for individual images using Image Processing Toolkit. Developed nomogram and artificial intelligence (AI) image analyzer were combined as an optical biopsy algorithm and tested prospectively between 2021 and 2024.

RESULTS: A total of 322 patients with lung nodules were included in the study, of whom 279 had complete clinical data for data analysis (175 [62.7%] female). The nomograms and image segmentation technology were developed using a large database of IMI videos (1014 video sequences) and demonstrated an area under the curve of 0.865 to 0.893 for malignant nodule assessment. On multivariate logistic regression analysis, patient smoking history of greater than 5 pack-years (patient pack-years [PPY] >5), ex vivo back table TBR greater than 2.0, ex vivo bisected tumor lesions TBR greater than 2.4, and in situ (inside the chest) fluorescence were found to have statistically significant associations with malignancy on final pathology. Prospective testing in an independent set of 61 consecutive patients during IMI-guided cancer surgery demonstrated a sensitivity of 93.8%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 71%. The study algorithm determined malignant potential of the lesion in less than 2 minutes (mean [SD], 1.8 [0.17] minutes) compared with a mean (SD) of 34 (11) minutes with frozen section analysis.

CONCLUSION: In this cohort study of patients with indeterminate lung nodules, intraoperative imaging data analyzed by AI accurately determined if a nodule was malignant. This has the potential to improve the diagnostic challenges that occur at the time of surgery.

PMID:41528749 | DOI:10.1001/jamanetworkopen.2025.51734

JAMA Netw Open. 2026 Jan 2;9(1):e2552787. doi: 10.1001/jamanetworkopen.2025.52787.

ABSTRACT

IMPORTANCE: Outcomes for people with low back pain (LBP) may be improved through targeting treatments to subgroups with particular experiences, characteristics, or symptoms and clinical factors.

OBJECTIVE: To investigate potential treatment effect modifiers of graded sensorimotor retraining affecting pain intensity and disability level in the short and long terms for people with chronic LBP.

DESIGN, SETTING, AND PARTICIPANTS: This post hoc exploratory secondary analysis of the RESOLVE randomized clinical trial in Sydney, Australia, was conducted from November 5, 2024, to May 27, 2025. Trial participants were recruited from primary care settings and randomly allocated (1:1) to receive either graded sensorimotor retraining (treatment group) or attention control and sham procedures (sham control group). Eligible participants were adults aged 18 to 70 years who reported chronic nonspecific LBP (lasting ≥12 weeks), with or without leg pain, that was rated at least a 3 out of 10 in pain intensity. Statistical analyses were conducted from November 11 to December 6, 2024.

INTERVENTIONS: The treatment group completed 12 weekly clinical sessions of the graded sensorimotor retraining package, which consisted of pain science education, premovement training, and graded movement and loading. The sham control group completed 12 weekly sessions, without advice or education, of sham electrotherapy to the back and sham noninvasive brain stimulation.

MAIN OUTCOMES AND OUTCOME MEASURES: Primary outcomes were pain intensity (measured with the 11-point Numerical Rating Scale ranging from 0 [no pain] to 10 [worst imaginable pain]) and disability level (measured with the 24-item Roland-Morris Disability Questionnaire with scores ranging from 0-24 [higher scores indicating greater levels of disability]) assessed at 18 weeks and 52 weeks after randomization. A formal moderation analysis was performed using a test for statistical interaction. Eight baseline variables-psychoactive medication use, pain intensity, disability level, beliefs about back pain consequences, kinesiophobia, pain catastrophizing, pain self-efficacy, and back perception-were investigated for their potential treatment effect modification.

RESULTS: The study included 276 participants (mean [SD] age, 46 [14.3] years; 138 females [50.0%]), 138 of whom were randomized to the treatment group and 138 of whom were randomized to the sham control group. Pain self-efficacy, pain catastrophizing, pain intensity, and psychoactive medication use showed no evidence of modifying the effect of the intervention. Impaired back perception was identified as a potential treatment effect modifier of pain intensity (β-coefficient = 0.18 [95% CI, 0.05-0.32]; P = .007) at the 52-week follow-up time point. Hypothesis-generating evidence (P < .20) indicated potential effect modification by kinesiophobia (on pain intensity at 18-week follow-up: β-coefficient = 0.06 [95% CI, -0.02 to 0.14], P = .15; 52-week follow-up: β-coefficient = 0.07 [95% CI, -0.02 to 0.16], P = .12), baseline disability level (on disability level at 18-week follow-up: β-coefficient = -0.15 [95% CI, -0.38 to 0.07], P = .17), beliefs about back pain consequences (on disability level at 52-week follow-up: β-coefficient = 0.16 [95% CI, -0.05 to 0.37], P = .14) and back perception (on pain intensity at 18-week follow-up: β-coefficient = 0.10 [95% CI, -0.02 to 0.22], P = .09; on disability level at 18-week follow-up: β-coefficient = 0.22 [95% CI, -0.04 to 0.48], P = .10; 52-week follow-up: β-coefficient = 0.27 [95% CI, 0.00-0.55], P = .05).

CONCLUSIONS AND RELEVANCE: This secondary analysis found that the benefits of graded sensorimotor retraining are likely to be similar for all people with chronic nonspecific LBP presenting for care. Future clinical trials are needed to further explore and assess the role of the potential treatment effect modifiers identified in this analysis.

TRIAL REGISTRATION: ANZCTR Identifier: ACTRN12615000610538.

PMID:41528747 | DOI:10.1001/jamanetworkopen.2025.52787

JAMA Netw Open. 2026 Jan 2;9(1):e2553504. doi: 10.1001/jamanetworkopen.2025.53504.

ABSTRACT

IMPORTANCE: Black and Hispanic patients have lower survival rates for in-hospital cardiac arrest (IHCA) than White patients. Whether this is because do not attempt resuscitation (DNAR) orders for successfully resuscitated patients with IHCA are variable among different races and ethnicities remains unknown.

OBJECTIVE: To understand whether American Indian or Alaskan Native, Black, or Hispanic patients have different rates of early DNAR orders compared with White patients, and to examine whether survival differences by race and ethnicity persist among patients with early entry of DNAR orders.

DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study used data from the American Heart Association’s Get With the Guidelines – Resuscitation database, which includes IHCA data from more than 350 hospitals in the US from 2018 to 2013. Patients were aged at least 18 years, experienced an index IHCA, and were successfully resuscitated while on an admitted unit. Data were analyzed from September 26, 2024, through February 8, 2025.

EXPOSURE: IHCA.

MAIN OUTCOMES AND MEASURES: Main outcomes were associations of race and ethnicity with entry of early DNAR orders and, among patients early DNAR orders, the associations of race with survival to hospital discharge.

RESULTS: From 2018 to 2023, 93 843 patients (25 386 patients [27.1%] aged 60-69 years; 56 533 [60.2%] male) achieved ROSC after IHCA, including 2380 American Indian or Alaska Native patients (2.5%), 764 Asian patients (0.8%), 21 261 Black patients (22.7%), 6998 Hispanic patients (7.5%), and 56 989 White patients (60.7%). Overall, 25.3% and 37.4% of White patients had DNAR orders at 12 hours and 72 hours, respectively, compared with 21.3% and 33.4% of American Indian or Alaska Native patients, 21.4% and 32.7% of Black patients, and 22.2% and 33.2% of Hispanic patients. Compared with White patients, American Indian or Alaska Native, Black, and Hispanic patients were less likely to have DNAR orders entered within 12 hours (American Indian or Alaska Native: odds ratio [OR], 0.78 [95% CI, 0.67-0.91]; Black: OR, 0.74 [95% CI, 0.69-0.79]; Hispanic: OR, 0.90 [95% CI, 0.82-0.99]) or within 72 hours (American Indian or Alaska Native: OR. 0.86 [95% CI, 0.76, 0.98]; Black: OR, 0.73, [95% CI, 0.69-0.77]; Hispanic: OR, 0.89 [95% CI, 0.83, 0.97]). A total of 813 American Indian or Alaska Native patients (34.2%), 7168 Black patients (33.7%), and 2417 Hispanic patients (34.5%) with return of spontaneous circulation survived to discharge, compared with 22 226 White patients (39.0%). In adjusted analyses, among patients with an early DNAR order entered before 72 hours, there was no significant difference in survival to hospital discharge compared with White patients.

CONCLUSIONS AND RELEVANCE: In this cohort study of patients successfully resuscitated from IHCA, American Indian or Alaska Native, Black, and Hispanic patients were less likely to have early DNAR orders than White patients. There were no differences in survival among patients with early DNAR orders placed.

PMID:41528746 | DOI:10.1001/jamanetworkopen.2025.53504

JAMA Netw Open. 2026 Jan 2;9(1):e2553687. doi: 10.1001/jamanetworkopen.2025.53687.

ABSTRACT

IMPORTANCE: Excess body weight, which is associated with poor survival after breast cancer (BC) diagnosis, is a heritable trait.

OBJECTIVE: To investigate whether genetic predisposition to excess body weight is associated with the risk of mortality among BC survivors.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study is part of the Cancer Prevention Study-II Nutrition Cohort, a large study in which participants responded to a survey in 1992 and to biennial follow-up surveys starting in 1997. The cohort includes adults residing in 21 US states. Women diagnosed with a first primary nonmetastatic BC between 1992 and 2017 with genetic data were included in this study. Analyses were restricted to postmenopausal women at the time of cancer diagnosis who had genetically determined European ancestry. Data analysis was conducted from July 2023 to July 2025.

EXPOSURE: A polygenic score for body mass index (BMI-PGS), computed using summary statistics from 941 single nucleotide variants reported in a meta-analysis of genome-wide association studies that included approximately 700 000 individuals.

MAIN OUTCOMES AND MEASURES: Deaths through 2020 were identified via linkage with the National Death Index. Cox proportional hazards regression models were used to calculate hazard ratios (HRs) for the association between BMI-PGS and all-cause mortality.

RESULTS: This analysis included 4177 women diagnosed with BC. The median (IQR) age at diagnosis was 71.5 (66.3-76.7) years. BC survivors with a BMI-PGS in the top tertile were more likely to have a BMI of 30 or greater (345 [24.8%]) compared with survivors in the lowest tertile (172 [12.4%]). During a median (IQR) follow-up time of 14.5 (9.7-19.7) years, 2114 BC survivors (50.6%) died. Compared with BC survivors in the lowest tertile of the BMI-PGS, those in the highest tertile had a 15% increased risk of all-cause mortality (HR, 1.15, 95% CI, 1.04-1.28). BC survivors with BMI-PGS in the highest tertile needed to walk approximately 1.7 hours per week more to be at a similar risk level as BC survivors in the lowest tertile of the BMI-PGS, which corresponds to approximately an extra 15 minutes of walking each day of the week.

CONCLUSIONS AND RELEVANCE: In this cohort of nonmetastatic BC survivors, women who were genetically predisposed to having a higher BMI were at increased risk of all-cause mortality. Targeted lifestyle recommendations to mitigate their genetic predisposition should be considered to lower this risk.

PMID:41528745 | DOI:10.1001/jamanetworkopen.2025.53687

JAMA Netw Open. 2026 Jan 2;9(1):e2553704. doi: 10.1001/jamanetworkopen.2025.53704.

ABSTRACT

IMPORTANCE: Hospital closures pose persistent concerns about health care access, yet the extent to which closures are associated with cancer surgical care and patient outcomes remains unknown.

OBJECTIVE: To examine the association between undergoing colon or lung cancer surgery in hospitals that subsequently closed and postoperative and travel outcomes among Medicare beneficiaries.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used Medicare administrative data from 2008 to 2019. A national sample of hospital closures was identified using the Provider of Service files from the Centers for Medicare & Medicaid Services. Closed cancer surgical hospitals were those performing at least 1 colon or lung cancer surgery in the period from 2008 to 2019 and that also stopped inpatient care in 2008 to 2019. Participants were Medicare fee-for-service beneficiaries who underwent colon or lung cancer surgery from 2008 to 2019. Analyses were conducted separately by cancer type. Data were analyzed from December 2023 through February 2025.

EXPOSURE: Undergoing cancer surgery at hospitals that subsequently closed.

MAIN OUTCOMES AND MEASURES: The primary outcomes were postoperative outcomes, including 90-day mortality, 90-day complications, and length of stay. Secondary outcomes were travel measures, including distance to surgical hospital and distance to the nearest alternative surgical hospital. Logistic regression was used to analyze 90-day postoperative mortality and complications, and linear regression was used to analyze length of stay. Travel measures were analyzed descriptively.

RESULTS: The total sample was 558 708 participants, with 360 564 beneficiaries (64.5%) who underwent colon cancer surgery (median [IQR] age, 77 [71-83] years; 195 862 [54.3%] female) and 198 144 beneficiaries (35.5%) who underwent lung cancer surgery (median [IQR] age, 73 [69-78] years; 102 418 [51.7%] female) from 2008 to 2019. Of those, 6018 beneficiaries (1.7%) who underwent colon cancer surgery and 1938 beneficiaries (1.0%) who underwent lung cancer surgery underwent those surgical procedures at hospitals that subsequently closed. Beneficiaries treated at hospitals that subsequently closed were more often dually eligible (colon: 1047 [17.4%] closing vs 37228 [10.5%] nonclosing; lung: 234 [12.1%] closing vs 14426 [7.4%] nonclosing) and Black, Hispanic, or other race (ie, American Indian or Alaska Native, Asian, other, and unknown) (colon: 1450 [24.1%] closing vs 53640 [15.1%] nonclosing; lung: 388 [20.0%] closing vs 22048 [11.2%] nonclosing), with urgent admission (colon: 2559 [42.5%] closing vs 123830 [34.9%] nonclosing; lung: 228 [11.8%] closing vs 13394 [6.8%] nonclosing) than those treated at hospitals that did not close. Most beneficiaries bypassed their nearest hospital, but the majority treated at their nearest hospital that subsequently closed (colon, 1967 beneficiaries [79.0%]; lung, 465 beneficiaries [90.6%]) had an alternative surgical hospital within a 15-minute driving distance. Undergoing surgery at hospitals that subsequently closed was significantly associated with higher likelihood of 90-day mortality for colon cancer (adjusted odds ratio [aOR] 1.11; 95% CI, 1.01-1.22) and 90-day complications for both cancer types (colon aOR, 1.10; 95% CI, 1.01-1.21; lung aOR, 1.43, 95% CI, 1.17-1.76). The odds ratio for 90-day mortality after lung cancer surgery was not statistically significant, 1.26 (95% CI, 0.96-1.64). Lengths of stay were similar for both cancers.

CONCLUSIONS AND RELEVANCE: In this cohort study, undergoing colon and lung cancer surgery at hospitals that subsequently closed was associated with worse postoperative outcomes, but most beneficiaries treated at their nearest hospital had a nearby alternative hospital, suggesting that hospital closures may improve postoperative outcomes for cancer surgery, with minimal increase in travel burden, by directing patients to nearby, better-performing hospitals.

PMID:41528743 | DOI:10.1001/jamanetworkopen.2025.53704