Tag: pubmed

Early Interv Psychiatry. 2025 Oct;19(10):e70095. doi: 10.1111/eip.70095.

ABSTRACT

BACKGROUND: Trauma exposure is pervasive in people with an At Risk Mental State (ARMS) and is associated with adverse clinical and functional outcomes. While promising developments have been made in treating trauma in psychosis, evidence regarding the efficacy of trauma therapies in ARMS individuals is limited. This trial aims to evaluate the feasibility of conducting a future randomised controlled trial (RCT) to determine the efficacy of Eye Movement Desensitisation and Reprocessing (EMDR) and trauma focused cognitive behavioural therapy (TF-CBT) in people with ARMS.

METHOD: Seventy ARMS individuals with a history of trauma will be randomised to receive 24 sessions of EMDR plus treatment as usual (TAU), 24 sessions of TF-CBT+TAU, or TAU alone. Feasibility will be determined against pre-specified thresholds for recruitment, retention, treatment engagement, and fidelity. To examine the promise of efficacy of EMDR and TF-CBT, participants will complete a battery of clinical and mechanistic measures at baseline and 9-month post-randomisation, including assessments of attenuated psychotic symptoms and post-traumatic symptoms. Clinical notes will be reviewed to identify transitions to first episode psychosis up to 12 months post-randomisation. Qualitative interviews with trial participants, therapists, and professional stakeholders will explore the acceptability of EMDR and TF-CBT and factors to facilitate future implementation of trauma therapies in routine practice.

CONCLUSIONS: If a large-scale RCT is deemed feasible, it will be possible to establish whether EMDR and/or TF-CBT represent beneficial treatments to augment existing evidence-based care for individuals at ultra-high risk for future psychosis, potentially reducing transition rates and improving clinical outcomes for ARMS individuals.

PMID:41045040 | DOI:10.1111/eip.70095

Int J Gynaecol Obstet. 2025 Oct 4. doi: 10.1002/ijgo.70571. Online ahead of print.

ABSTRACT

OBJECTIVE: Domestic violence (DV) is a major public health concern with profound emotional, psychological, and medical consequences for women and their families. This study assessed the prevalence, associated factors, and proffered solutions to domestic violence in pregnancy (DVP) among married women in Enugu, southeastern Nigeria.

METHODS: A cross-sectional study was conducted among 447 pregnant married women attending antenatal care at the University of Nigeria Teaching Hospital, Enugu. Data were collected using an interviewer-administered, pretested questionnaire (with supplementary validated tools) and analyzed with IBM SPSS Statistics (version 22.0). Descriptive and inferential statistics were applied, with significance set at P < 0.05.

RESULTS: The prevalence of DVP was 27.1%. Husbands or intimate partners were the main perpetrators (66.2%). Emotional/psychological abuse was the most common form of violence (60.3%), while sexual abuse was least reported. On multivariable logistic regression, factors independently associated with DVP included rural residence, maternal age ≥ 30 years, lower maternal educational status, and partners with tertiary education or social habits such as alcohol use, infidelity, and keeping late nights (P < 0.05). Most respondents (40.2%) believed prayer was the solution, while 31.1% felt no solution existed.

CONCLUSION: Domestic violence in pregnancy remains prevalent in Enugu, Nigeria with emotional abuse being most frequent. The reliance on prayer or resignation as “solutions” reflects deep-rooted cultural and religious influences. Routine screening during antenatal care, coupled with culturally sensitive counseling, referral pathways, and community-based interventions, is urgently needed to address the burden and prevent associated complications.

PMID:41045037 | DOI:10.1002/ijgo.70571

Health Serv Res. 2025 Oct 4:e70048. doi: 10.1111/1475-6773.70048. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine the impact of private equity (PE) hospital acquisitions on maternal health for Medicaid patients.

STUDY SETTING AND DESIGN: This quasi-experimental study focuses on 66 PE acquisitions of hospitals between 2014 and 2018, analyzing national Medicaid claims data from 2011 to 2020. Using a difference-in-differences (DiD) framework, the study compares labor and delivery (L&D) outcomes at PE-acquired hospitals with matched control hospitals to evaluate the effects on patient volume, process of care, and quality outcomes for Medicaid patients.

DATA SOURCES AND ANALYTIC SAMPLE: The analysis uses data from the Transformed Medicaid Statistical Information System (T-MSIS) and Medicaid Analytic eXtract (MAX), including over 1 million L&D hospitalizations. The analytic sample comprises 66 PE hospitals and 290 matched control hospitals.

PRINCIPAL FINDINGS: PE acquisition was associated with a significant 12% decrease in Medicaid L&D market share (p < 0.05). The reduction was more pronounced in states with larger Medicaid-to-commercial payment gaps (-15.8% vs. -7.2%). However, no significant changes were observed in low-risk cesarean rates, number of procedures, length of stay, or severe maternal morbidity.

CONCLUSIONS: PE acquisitions of hospitals are associated with reduced Medicaid market share, particularly in states with lower Medicaid reimbursement relative to commercial insurance. Policymakers should consider addressing these issues by adjusting Medicaid payment rates to support vulnerable populations in PE-acquired hospitals.

PMID:41045029 | DOI:10.1111/1475-6773.70048

J Magn Reson Imaging. 2025 Oct 4. doi: 10.1002/jmri.70140. Online ahead of print.

ABSTRACT

BACKGROUND: Accurate tumor staging and treatment response evaluation (TRE) are critical for nasopharyngeal carcinoma (NPC) clinical decisions. Conventional methods relying on manual imaging analysis are expertise-dependent, time-consuming, and prone to inter-observer variability and errors.

PURPOSE: To assess the performance of two large language models (LLMs): ChatGPT-4o-latest and DeepSeek-V3-0324 in automating T, N staging and TRE for NPC patients.

STUDY TYPE: Retrospective.

POPULATION: Three hundred seven NPC patients from three centers (mean age: 45.5 ± 11.3 years; 216 men, 91 women).

FIELD STRENGTH/SEQUENCE: All imaging was conducted using 3.0T or 1.5T scanners. The imaging sequence included axial T1-weighted fast spin-echo, T2-weighted fast spin-echo, T2-weighted fat-suppressed spin-echo, and Contrast-Enhanced T1-weighted fast spin-echo.

ASSESSMENT: Two radiologists established the reference standards for TN staging at baseline and for TRE at two time points: post-induction chemotherapy (TRE-1) and post-concurrent chemoradiotherapy (TRE-2), based on the 9th version of AJCC/UICC guidelines and the RECIST1.1 criteria. LLMs were via few-shot chain-of-thought prompting and tested on 277 patients with 831 reports. Additionally, four radiologists independently assessed 68 cases both with and without the assistance of LLMs and compared the performance and efficiency in both conditions.

STATISTICAL TESTS: McNemar-Bowker test, Wilcoxon signed-rank test. p < 0.05 was considered statistically significant.

RESULTS: DeepSeek-V3-0324 significantly outperformed GPT-4o-latest in TRE-1 staging (96.5% vs. 82.9%, p < 0.001). For T staging (95.3% vs. 93.5%, p = 0.24), N staging (93.8% vs. 89.6%, p = 0.265), and TRE-2 (94.9% vs. 93.2%, p = 0.556), the accuracy between DeepSeek-V3-0324 and ChatGPT-4o-latest showed no significant difference. DeepSeek-V3-0324 also showed stronger agreement with expert annotation (κ = 0.85-0.90), compared to ChatGPT-4o-latest (κ = 0.49-0.86). Significant improvements in time efficiency were observed across all radiologists with LLM assistance (p < 0.001).

DATA CONCLUSION: LLMs, particularly DeepSeek-V3-0324, can automate NPC TN staging and TRE with high accuracy, enhancing clinical efficiency. LLMs integration may improve diagnostic consistency, especially for junior clinicians.

TECHNICAL EFFICACY: Stage 4.

PMID:41045017 | DOI:10.1002/jmri.70140

Pediatr Int. 2025 Jan-Dec;67(1):e70224. doi: 10.1111/ped.70224.

ABSTRACT

BACKGROUND: The COVID-19 pandemic led to significant epidemiological shifts in various diseases due to reduced interpersonal contact. This study examined changes in pediatric intestinal intussusception incidence, a disease with unclear etiology, during the pandemic.

METHODS: Weekly intussusception cases in children ≤10 years old in Seoul (2009-2022) were collected from the Health Insurance Review and Assessment Service (HIRA). Trends were analyzed using spline functions, and breakpoints were identified via student methods. Bayesian Structural Time Series (BSTS) models assessed incidence changes relative to predicted values. Cases were stratified by surgical intervention, and the complicated-to-uncomplicated case ratio was evaluated.

RESULTS: A sharp decline in intussusception incidence was observed around 2020, with breakpoints aligning with the first reported COVID-19 case. Post-breakpoint, total cases decreased by 58.8% (95% CrI: -79.0%, 7.8%), with reductions of 62.4% (95% CrI: -78.9%, -20.2%) for uncomplicated cases and 51.1% (95% CrI: -62.6%, -33.8%) for complicated cases. The complicated-to-uncomplicated ratio increased by 43.3% (95% CrI: 13.0%, 87.1%). When analyzing only the post-COVID-19 period, total and uncomplicated cases increased by 23.1% (95% CrI: 5.7%, 45.5%) from May 2022, but the change in ratio was not statistically significant.

CONCLUSION: Pediatric intussusception incidence significantly declined following COVID-19 onset, supporting a link between disease occurrence and contact or infectious exposure.

PMID:41045014 | DOI:10.1111/ped.70224

Pediatr Int. 2025 Jan-Dec;67(1):e70214. doi: 10.1111/ped.70214.

ABSTRACT

BACKGROUND: Postural stability is a prerequisite for the performance of daily gross motor functions. It is usually impaired in children with cerebral palsy. The aim of this study was to compare the effect of robotic-assisted gait training and body weight supported treadmill training on postural stability in ambulatory children with cerebral palsy.

METHODS: A randomized clinical trial involved 40 ambulatory children with cerebral palsy (5-14 years old). They were randomly allocated to one of two locomotor treadmill-training groups: (1) robotic-assisted gait training (RAGT) and (2) body weight supported treadmill training (BWSTT). All participants completed 24 training sessions within 8 weeks. Postural stability was measured by a computer dynamic posturography (NeuroCom EquiTest®) before and after the intervention.

RESULTS: A two-way repeated measures ANOVA revealed that there was a statistically significant interaction between group and time [F(15, 24) = 3.02, p = 0.008]. The study found that RAGT is more effective than BWSTT on some variables of static and dynamic postural stability. RAGT showed more improvement in weight symmetry at 60° knee flexion, limit of stability, velocity composite (front/back), and directional control composite for both left/right and front/back (p < 0.05).

CLINICALTRIALS: gov (identifier: NCT06719271).

CONCLUSION: Ambulatory children with CP can improve their postural stability after intensive RAGT.

PMID:41045011 | DOI:10.1111/ped.70214

Glob Chang Biol. 2025 Oct;31(10):e70533. doi: 10.1111/gcb.70533.

ABSTRACT

In large river basins, migratory fish populations are threatened by the combination of hydropower and climate change. With river temperatures rising and hydropower development increasing globally, the longstanding monitoring programs for threatened Pacific salmon populations in the Columbia River Basin present an opportunity to study these impacts over extended time scales. We fit a statistical model to 20 years of PIT-tagging data to jointly model the effects of temperature and dam operations (spill management) on the movement of Steelhead (anadromous Oncorhynchus mykiss) during their adult pre-spawn migration. We modeled the relationship between these factors and behaviors that pose mortality risks, including natal tributary overshoot (ascending a dam upstream of a natal tributary) and non-natal tributary use. We then used the posterior distributions of model-estimated parameters to predict the homing success of fish to natal tributaries under different climate and hydropower scenarios. Across the populations in our study, movement decisions were consistently thermally influenced, with temperature having a negative relationship with natal homing and a positive relationship with both natal tributary overshoot and non-natal tributary use. Another consistent finding across the populations in our study was that higher overshoot rates were associated with lower homing rates. Despite data limitations associated with the PIT-tag array network, we found evidence for population-specific benefits of winter spill on natal homing success, which is currently being implemented to assist the downstream migration of overshooting Steelhead. We demonstrate how integrating the effects of climate and hydropower management actions with movement ecology provides powerful insights into how species may respond to future scenarios. In our case study, we found that pre-spawn mortality of Steelhead is likely to increase with future climate change due to temperature-driven interactions with the hydrosystem, but there is potential for hydropower managers to partially offset these impacts.

PMID:41045009 | DOI:10.1111/gcb.70533

J Oral Rehabil. 2025 Oct 4. doi: 10.1111/joor.70068. Online ahead of print.

ABSTRACT

AIM: Systematically evaluate the previous literature on the association between insomnia and sleep bruxism (SB) in adults.

METHODS: Advanced searches were performed in different databases (PubMed, Embase, LILACS, Scopus and Web of Science) and grey literature until March 2025. Two trained reviewers independently conducted all stages of the review to identify observational studies evaluating the association between insomnia and SB in adults. Methodological quality was assessed using the Newcastle-Ottawa Scale (NOS). A narrative synthesis summarised the main characteristics of the included studies. Meta-analyses were performed to obtain pooled estimates separately for self-reported and polysomnography (PSG)-based SB. Available data on insomnia and SB were converted into odds ratio (OR) with corresponding 95% confidence intervals (CIs).

RESULTS: Of the 1135 records initially identified, 931 were screened by title and abstract, and 23 were assessed in full text. Eight studies met the inclusion criteria for the systematic review, and six were eligible for meta-analysis, comprising a total sample of approximately 6990 adults. The meta-analysis of four studies investigating the association between insomnia and self-reported SB found no statistically significant association under the random-effects model (OR 1.17; 95% CI 0.79-1.72). Likewise, the pooled analysis of studies assessing PSG-based SB also showed no significant association with insomnia (OR 0.91; 95% CI 0.43-1.95).

CONCLUSION: Our findings indicate a lack of consistent evidence for a significant association between insomnia and SB. This conclusion is further limited by the small number of included studies, the moderate risk of bias in some studies, and the observed heterogeneity.

PMID:41044999 | DOI:10.1111/joor.70068

Pediatr Int. 2025 Jan-Dec;67(1):e70209. doi: 10.1111/ped.70209.

ABSTRACT

BACKGROUND: Epilepsy often begins in childhood or adolescence, a period marked by significant hormonal changes. Antiepileptic drugs (AEDs) like valproic acid (VPA) and levetiracetam (LEV) are commonly used, but VPA is associated with notable endocrine side effects, particularly in adolescent girls. This raises concerns about drug choice during puberty.

OBJECTIVE: To compare the effects of VPA and LEV monotherapy on pubertal hormone profiles, menstrual characteristics, physical development, and gynecologic ultrasound findings in adolescent girls with primary epilepsy.

METHODS: This prospective, cross-sectional study included 61 adolescent girls (16 on VPA, 15 on LEV, 30 controls) at a tertiary hospital from January 2018 to January 2019. Participants underwent anthropometric measurements, hormonal evaluations (FSH, LH, estradiol, testosterone, SHBG, TSH, 17-OH progesterone, DHEASO₄), menstrual assessments, and pelvic ultrasound. Statistical analysis was performed with a significance level of p < 0.05.

RESULTS: VPA users had significantly higher TSH levels than LEV users and controls (p = 0.036), suggesting possible subclinical thyroid dysfunction. They also had lower 17-OH progesterone and DHEASO₄ levels (p = 0.008 and p = 0.022, respectively). No significant differences were observed between groups in weight, height, BMI, pubertal hormone levels, menstrual cycle characteristics, or ultrasound findings. Treatment duration did not significantly affect hormone levels.

CONCLUSION: VPA appears to negatively impact thyroid and adrenal hormones in adolescent girls, whereas LEV has a safer endocrine profile. Given the hormonal sensitivity during puberty, LEV may be a safer alternative for adolescent girls with epilepsy to reduce potential endocrine disturbances.

PMID:41044995 | DOI:10.1111/ped.70209

Orthod Craniofac Res. 2025 Oct 3. doi: 10.1111/ocr.70038. Online ahead of print.

ABSTRACT

OBJECTIVE: Temporomandibular disorders (TMDs) are heterogeneous conditions of unclear aetiology involving the temporomandibular joint, masticatory muscles and neural tissues. Limited understanding of their pathogenesis hampers accurate diagnosis and targeted treatment. Therefore, this study aimed to identify salivary microRNA (miRNA) signatures associated with TMDs to support future diagnostic, therapeutic and prognostic applications.

MATERIALS AND METHODS: Unstimulated cell-free saliva (5 mL) was collected from 9 adult female TMD subjects (using Diagnostic Criteria/TMD) and eight healthy female controls of similar ages. Total RNA was extracted, small RNA libraries were prepared, and sequencing was performed using Illumina NovaSeq 6000. Reads were aligned to the human genome (GRCh38) via STAR. Differential expression analysis was conducted using DESeq2, followed by functional enrichment via miEAA 2.1.

RESULTS: A total of 187 salivary miRNAs were significantly differentially expressed between TMD and control groups (adjusted p < 0.05; log2-fold change > +1 or < -1), with 125 upregulated and 62 downregulated in TMD subjects. Several differentially expressed miRNAs were linked to the negative regulation of cadherin-mediated cell-cell adhesion, neurogenesis and chemokine production. Some overlapped with miRNAs implicated in rheumatoid arthritis and osteoarthritis, suggesting shared mechanisms. While no clear association was found between miRNA and TMD phenotypes, 5 miRNAs were strongly (R = 0.67-0.77) and significantly (p < 0.05) correlated with pain intensity and chronic pain grade.

CONCLUSIONS: Salivary miRNA profiling offers promise as a non-invasive diagnostic tool for TMDs, with the potential to uncover molecular endotypes and disease mechanisms not evident through clinical evaluation. Future studies with larger, more diverse cohorts are needed to validate these findings and assess their clinical utility.

PMID:41044994 | DOI:10.1111/ocr.70038