Tag: pubmed

Sante Ment Que. 2025 Spring-Summer;50(1):211-230.

ABSTRACT

Introduction Supported employment, financed by the French Government since 2016, has demonstrated its positive impact on employment access and retention for people declaring a mental health disorder (40% of people supported in 2022). Objective The objective of the analysis of avoided costs, led by the Agence nouvelle des solidarités actives (Ansa) in 2021 and 2022, was to measure the economic impact of supported employment on public finances. This analysis focused on three types of costs: social benefits, psychiatric hospitalizations, and medical leave. Method The method consisted of collecting information from supported employment clients to compare these costs over three years (the year before supported employment and the following 2 years). In total, 462 people responded to the questionnaire, including 136 people over 2 consecutive years. These 2 samples were representative of the entire population of supported employment clients (9,300 people at the end of 2022). Results This analysis demonstrates significant avoided costs with, on average, a saving of 802 euros per person during the first year and 1,213 euros per person during the second year of supported employment. If we extrapolate to the total number of clients at the end of 2023, this constitutes a saving of 7.3 million euros for the year 2022 alone and this only on the 3 types of costs observed. The largest part of avoided costs can be attributed to a significant drop in the cost of psychiatric hospitalizations (-56% over 2 years) and in the cost of social benefits (-8.5% over two years). This analysis also demonstrates that the avoided costs are greater for people declaring a mental health disorder (average avoided cost amounts around 2,200 euros per year). This difference is largely explained by the drop in the number of psychiatric hospitalizations, whether as a percentage of people hospitalized (from 18% the year preceding entry to 9% and 12% over the following 2 years) and by the reduction in the average number of days of hospitalization (from 31 days in the year preceding entry to 20 days in subsequent years). For this public, we also see a slight decrease in the cost of medical leave (-16% over 2 years). Conclusion From a purely economic point of view, this analysis demonstrates a greater impact of supported employment for people suffering from mental health disorders and the need to strengthen links with mental health professionals to orient people towards supported employment.

PMID:41296899

Sci Adv. 2025 Nov 28;11(48):eady5457. doi: 10.1126/sciadv.ady5457. Epub 2025 Nov 26.

ABSTRACT

Urban environments may alter the landscape of disease transmission with implications for control. Yet, it is unclear whether urban-rural differences exist in the dynamics of childhood respiratory diseases, given specific mixing patterns in younger age groups. Here, we leverage county-level data on respiratory syncytial virus (RSV) from the United States to reveal an urban-rural gradient in both the intensity and age structure of the RSV epidemic, where urban locations experience more prolonged epidemics with higher burden in infants (under 1 year of age). We develop a mechanistic epidemiological model to show that these differences can be explained by daycare utilization rates in children under 5. Using our model to consider control measures, we find that expanding seasonal immunization access in urban and rural areas may limit the risk of off season RSV epidemics.

PMID:41296869 | DOI:10.1126/sciadv.ady5457

Sci Adv. 2025 Nov 28;11(48):eadx0255. doi: 10.1126/sciadv.adx0255. Epub 2025 Nov 26.

ABSTRACT

Animal movements affect their exposure to threats and the efficacy of conservation measures, such as marine protected areas (MPAs). However, many species’ movements are difficult to reconstruct from available datasets, hampering conservation efforts. This is especially the case for aquatic species that rarely surface, for which data are often limited to observations from acoustic telemetry (detections) and ancillary sensors. Here, we pioneer the use of state-of-the-art particle algorithms to model movements, integrate datasets, and assess MPA design, leveraging a case study of a Critically Endangered elasmobranch. Our algorithms led to 5-fold improvements in space-use maps and 30-fold improvements in residency estimates compared to prevailing methods. By integrating tracking datasets, we were uniquely able to examine movements beyond acoustic receivers, MPA-scale residency, and specific habitats beyond protected areas that warrant protection. This work reveals a modeling framework that enhances the conservation value of acoustic telemetry, supporting analyses of MPA efficacy worldwide.

PMID:41296860 | DOI:10.1126/sciadv.adx0255

Sci Adv. 2025 Nov 28;11(48):eadz7419. doi: 10.1126/sciadv.adz7419. Epub 2025 Nov 26.

ABSTRACT

Space plasma thermodynamics is thought to be affected by wave activity. Here, we show that solar radio bursts (SRBs) can transfer entropy to solar energetic protons (SEPs), affecting their thermodynamics. In particular, our analysis (i) detects the statistically significant SEP density fluctuations, associated with SRB activity that triggers a systematic increase in the thermodynamic kappa; (ii) estimates the polytropic index of SEPs, which is anticorrelated with kappa, serving as an independent measure to validate the increase in kappa; (iii) derives the entropy transfer by using its theoretical relationship with kappa; and (iv) compares SRB wave intensity with the entropy transferring to SEPs to demonstrate their wave-particle coupling. We lastly expose the thermodynamic association between type III SRB wave intensity and SEP entropy transfer as well as their respective coupling, thus developing a paradigm for further systematic investigations among other types of wave activity and particle populations.

PMID:41296850 | DOI:10.1126/sciadv.adz7419

J Bone Joint Surg Am. 2025 Nov 26. doi: 10.2106/JBJS.25.00529. Online ahead of print.

ABSTRACT

BACKGROUND: Understanding the sources of patients’ expectations of total knee arthroplasty (TKA) can foster realistic expectations. Sources of expectations may be influenced by clinical and psychological variables, including general disposition or attitude.

METHODS: Patients undergoing TKA completed a 19-item survey preoperatively that addressed the amount of improvement expected (i.e., “complete” to “a little”) for symptoms and physical and psychological well-being. Patients reported the sources of these expectations, which were grouped into categories. Disposition or attitude was assessed for positive affect (e.g., openness to change) and negative affect (e.g., irritability) with use of the Positive and Negative Affect Schedule (PANAS). Clinical status was assessed using the Knee injury and Osteoarthritis Outcome Score-Joint Replacement (KOOS-JR). Expectations and sources of expectations were compared with KOOS-JR and PANAS scores and demographic and clinical characteristics (e.g., symptom duration) with use of statistical analyses.

RESULTS: A total of 232 patients (mean age, 65 years; 60% women; 17% Latino ethnicity or non-White race) were enrolled 17 ± 8 days preoperatively. Seventy-two percent expected ≥15 of the survey items; complete improvement was expected for 59% of items. Expecting more items was associated with better preoperative KOOS-JR scores (p < 0.0001), more negative affect (p = 0.003), a shorter duration of symptoms (p = 0.01), and not being a college graduate (p = 0.04). Patients volunteered multiple sources of expectations, including favorable outcomes from a previous orthopaedic surgery (11% of patients), knowledge of favorable (56%) and unfavorable (7%) TKA outcomes in others, their current surgeon (15%), avoidance of further knee deterioration (10%), internet information (16%), and general optimism (18%). Citing more sources was associated with worse KOOS-JR scores (p = 0.02) and less positive affect (p = 0.009). Sources of expectations were associated with patient variables; specifically, knowledge of favorable outcomes was associated with better KOOS-JR scores (p = 0.04), knowledge of unfavorable outcomes was associated with more negative affect (p = 0.04), optimism was associated with more positive affect (p = 0.01), and information from the internet was associated with longer symptom duration (p = 0.04) and less negative affect (p = 0.02).

CONCLUSIONS: Patients had high expectations of TKA and derived these expectations from diverse sources spanning personal and social network experiences. Patients’ expectations and/or sources of expectations were associated with functional status and positive and negative affect.

LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

PMID:41296833 | DOI:10.2106/JBJS.25.00529

PLOS Glob Public Health. 2025 Nov 26;5(11):e0004867. doi: 10.1371/journal.pgph.0004867. eCollection 2025.

ABSTRACT

Armed conflicts severely impact healthcare systems leading to medication shortages and restricted access to essential services. The ongoing war in Sudan has disrupted healthcare infrastructure affecting patients particularly those with chronic diseases. This study examines the accessibility of medications and the consequences of limited healthcare access during the conflict. A descriptive cross-sectional study was conducted among individuals affected by the Sudan war. Data were collected through an online questionnaire assessing medication accessibility, healthcare service availability, and socioeconomic factors. Statistical analysis was performed using SPSS to examine correlations between accessibility and health outcomes. Out of 300 participants, 56.7% reported poor medication accessibility while 43.3% had to relocate due to a lack of medical care. 65.7% experienced worsening health condition and 61.3% believed medication shortages contributed to increased mortality. Low-income and unemployed individuals faced the greatest challenges in accessing medications. The Sudan war has significantly disrupted healthcare access with severe consequences for medication availability and patient health. Urgent humanitarian interventions and policy measures are needed to restore medication supply chains and improve healthcare access for conflict-affected populations.

PMID:41296819 | DOI:10.1371/journal.pgph.0004867

Plast Reconstr Surg. 2025 Nov 27. doi: 10.1097/PRS.0000000000012648. Online ahead of print.

ABSTRACT

INTRODUCTION: Injectable lipolytic agents have gained popularity as a non-invasive approach to localized fat reduction. While deoxycholic acid (DCA) remains the only FDA-approved agent for submental fat reduction, its application for non-submental regions is an emerging area of interest. This systematic review evaluates existing literature on injectable lipolytic agents beyond the submental region.

METHODS: A systematic review was conducted using PubMed, MEDLINE, EMBASE, Scopus, and Cochrane Central Register of Controlled Trials. Studies evaluating the use of injectable lipolytic agents for non-submental fat reduction were included. Extracted data included treatment outcomes, patient satisfaction, adverse events, and cost considerations. Bias was assessed using the ROBINS-I and RoB 2 tools.

RESULTS: Twenty-five studies met inclusion criteria, encompassing 3,178 patients treated with various agents, including DCA, phosphatidylcholine (PC), and emerging formulations such as CBL-514 and caffeine-hyaluronic acid. Significant reductions in localized adiposity were reported in 93.75% of studies, with 37.5% achieving statistical significance. Adverse events were generally mild and transient. Patient satisfaction varied from 57.1% to 86%. Cost comparisons indicated injectable treatments require multiple sessions, making them costlier than single-session surgical liposuction but competitive with non-invasive modalities like cryolipolysis.

CONCLUSIONS: Injectable lipolytic agents offer a promising, minimally invasive alternative for fat reduction in non-submental regions. However, further clinical trials are needed to standardize treatment protocols, evaluate long-term efficacy, and assess the cost-effectiveness of combining injectables with other weight management strategies. Expanding FDA approval for additional indications remains a potential future direction.

PMID:41296813 | DOI:10.1097/PRS.0000000000012648

Int J Dermatol. 2025 Nov 26. doi: 10.1111/ijd.70142. Online ahead of print.

ABSTRACT

Erysipeloid cutaneous leishmaniasis (ECL) is a rare presentation of cutaneous leishmaniasis that classically presents as erythematous, infiltrated lesions on the centrofacial region. We conducted a systematic review on the demographic characteristics, clinical presentations, laboratory findings, and treatment of ECL in the Old World. A systematic literature search was performed using the terms (“erysipeloid” OR “erysipelas”) AND “leishmaniasis” across Web of Science, PubMed, Scopus, Embase, and Google Scholar. Only studies reporting cases from the Old World were included. Based on the anatomic location of lesions, we defined three clinical distributions of ECL: (1) centrofacial involvement, (2) non-centrofacial lesions involving the face and/or scalp, and (3) lesions on the neck, trunk, and extremities. Our search yielded 3290 publications, of which 24 met the inclusion criteria. In total, 103 patients with ECL, including 73 females (70.9%) and 30 males (29.1%) with a mean age ± standard deviation of 52.1 ± 12.3 years, were included. Seventy-two patients (57 females, 15 males) had centrofacial lesions. Females comprised 83.8% of this subgroup, a difference that was statistically significant (p < 0.005). ECL was more common in postmenopausal females. ECL lesions on the trunk and extremities were reported in five patients. Sixty-five patients (63.1%) were treated with pentavalent antimonials alone or in combination with other drugs. In conclusion, ECL is a rare presentation of cutaneous leishmaniasis, most often affecting elderly women and primarily localizing to the mid-face. Old age and menopause might predispose to ECL development. Clinical suspicion is necessary for the diagnosis of lesions suggestive of ECL in endemic regions.

PMID:41293903 | DOI:10.1111/ijd.70142

Womens Health (Lond). 2025 Jan-Dec;21:17455057251392349. doi: 10.1177/17455057251392349. Epub 2025 Nov 26.

ABSTRACT

BACKGROUND: Person-centered maternity care (PCMC) is a model that prioritizes respect, dignity, and responsiveness to each woman’s needs, values, and preferences during childbirth. It promotes open communication and personalized care, which is crucial for improving maternal satisfaction and increasing hospital-based deliveries. While recognized as a key element of quality maternal care, the implementation of PCMC varies across different countries. This review aims to assess the pooled mean score and key predictors of PCMC in Ethiopia.

OBJECTIVES: This review aims to assess the pooled mean score and key predictors of PCMC in Ethiopia.

DESIGN: Systematic review and meta-analysis.

DATA SOURCES AND METHODS: This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A comprehensive search was performed in international databases, and registers including: PubMed, Cochrane Library, Google Scholar, HINARI, Scopus, Web of Science, and African Journals Online databases. The quality of included studies was evaluated using the Joanna Briggs Institute tool. Heterogeneity was measured with the I² statistic and its p-value, and publication bias was examined through funnel plots and Egger’s test. A random effects model was applied to compute the pooled mean score of PCMC, and adjusted β with results presented as 95% confidence interval (CI).

RESULTS: Seven studies, involving 3383 women, were included in the review. The pooled mean PCMC score was 56.75% (95% CI: 55.08, 58.41). The highest scores were reported in Oromia (60.2) and Addis Ababa (59.2), while the lowest was in South Gondar (52.3). Key factors influencing PCMC included educational status (β: -2.7, 95% CI: -3.98, -1.45), complications during childbirth (β: -5.34, 95% CI: -7.24, -3.44), and time of delivery (β: -3.10, 95% CI: -4.10, -2.11).

CONCLUSION: The pooled mean score of PCMC in Ethiopia is lower than in many other countries. Key determinants include women’s education, complications during childbirth, and the timing of delivery. Addressing these factors is crucial for improving the quality of PCMC in Ethiopia.PROSPERO registration number:CRD42024603854.

PMID:41293902 | DOI:10.1177/17455057251392349

Emerg Microbes Infect. 2025 Nov 26:2595793. doi: 10.1080/22221751.2025.2595793. Online ahead of print.

ABSTRACT

Integrase strand transfer inhibitors (INSTIs) have emerged as cornerstone agents in global antiretroviral therapy, though growing drug resistance presents clinical challenges. Conventional Sanger sequencing may underestimate the burden of low-frequency variants. This global meta-analysis systematically assesses the actual INSTI resistance burden among people living with HIV (PLWH) through deep sequencing technology. Our comprehensive search across Web of Science, PubMed, Cochrane Library, Embase, and Scopus (PROSPERO ID: CRD42023495535) identified studies utilizing deep sequencing for HIV integrase resistance detection. Through meta-analysis and individual participant data (IPD) analysis using HIVdb (v9.8), we differentiated pretreatment (PDR) and acquired (ADR) drug resistance, quantifying mutation rates, resistance rates, and missed detection across thresholds (above-threshold, high-frequency, low-frequency). The analysis incorporated 40 studies with 46 datapoints involving 10,778 patients. Treatment-naïve PLWH demonstrated above-threshold, high-frequency, and low-frequency mutation rates of 9.92%, 7.29%, and 5.88%, respectively, corresponding to resistance rates of 2.60%, 0.09%, and 3.90%. Treated patients showed elevated mutation rates of 19.02%, 16.64%, and 10.23%, with resistance rates reaching 16.10%, 8.67%, and 6.95%. IPD analysis of 394 mutation-positive individuals revealed 8.52% low-frequency resistance to dolutegravir and bictegravir in treatment-naïve populations, while treated patients exhibited significantly increased intermediate/high-level resistance to first-generation INSTIs, including raltegravir and elvitegravir. Conventional sequencing thresholds missed 3.61% pretreatment and 2.46% acquired drug resistance. These findings demonstrate that deep sequencing reveals substantially underestimated INSTI resistance burdens in PLWH. Although second-generation INSTIs maintain lower resistance rates, cross-resistance risks necessitate clinical vigilance. Optimized resistance surveillance strategies incorporating low-frequency mutation detection offer critical evidence for advancing global HIV control efforts.

PMID:41293884 | DOI:10.1080/22221751.2025.2595793