Tag: pubmed

JAMA Netw Open. 2025 Aug 1;8(8):e2526643. doi: 10.1001/jamanetworkopen.2025.26643.

ABSTRACT

IMPORTANCE: Both commitment to patient welfare and conflict of interest management are important components of physician professionalism. However, the interplay between them has not been well explored.

OBJECTIVE: To examine the association between unsolicited patient complaints, measured by Patient Advocacy Reporting System (PARS) Index, and acceptance of general (nonresearch) payments from industry, including significant payments, defined as exceeding $5000 annually.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional study included physicians at health care sites participating in the PARS program. General payments accepted by physicians from industry were identified from the Open Payments Program database. Data were collected from July 1, 2015, through June 30, 2020, and linked using National Provider Identifier numbers. Data were analyzed from April 5, 2024, to May 12, 2025.

EXPOSURE: The physician’s highest PARS Index score, categorized as 0, 1 to 20, 21 to 50, and 51 or greater.

MAIN OUTCOMES AND MEASURES: The outcome of interest was acceptance of general payments, any or exceeding $5000 annually. Ordinal regression was used to assess the association between PARS Index scores and general payments.

RESULTS: This analysis included 71 944 physicians (27 065 [37.6%] female; mean [SD] age in 2015, 45 [12.5] years), with 44 296 (61.6%) practicing in academic settings. The most common specialties were internal medicine (30 043 physicians [41.8%]), general surgery (6819 physicians [9.5%]), and anesthesiology (4461 physicians [6.2%]). Of the included physicians, 49 169 (68.3%) received at least 1 general payment, and 8067 (11.2%) received more than $5000 in a year; 30 979 physicians (43.1%) received unsolicited patient complaints. Median (IQR) PARS Index score was 2 (0-17). A higher PARS Index score was significantly associated with higher general payments accepted per year (eg, PARS Index score ≥51: odds ratio [OR], 1.69; 95% CI, 1.56-1.82; P < .001). This association remained significant after adjusting for physician gender, age, region, practice setting, and specialty. Male physicians (OR, 1.90; 95% CI, 1.84-1.97) and physicians practicing at nonacademic settings (OR, 1.15; 95% CI, 1.10-1.19) were also more likely to receive higher general payments per year.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of nearly 72 000 physicians across the US, physicians with higher PARS Index scores, indicative of a higher risk of medical malpractice claims, worse patient outcomes, and well-being concerns, were more likely to accept industry payments, particularly in higher amounts. These findings underscore the importance of conflict of interest review and management to support medical professionalism and patient trust.

PMID:40762911 | DOI:10.1001/jamanetworkopen.2025.26643

Mil Psychol. 2025 Aug 5:1-10. doi: 10.1080/08995605.2025.2525657. Online ahead of print.

ABSTRACT

The prevention of suicide mortality and suicidality (ideation, self-harm, and attempted suicide) is a key concern for the Australian Army. Currently, there are limitations to the scope of surveillance of these events, resulting in a restricted evidence base from which to design prevention and intervention strategies. This study aimed to examine opportunities to improve surveillance through analysis of the existing data landscape. A 10-year, mixed-methods, retrospective review of all events involving suicide or suicidality over the period Jan 2012 – Dec 2021 was conducted utilizing Army administrative records. Variables of interest related to demographics, event characteristics, and outcomes were summarized, and bivariate associations between variables were explored. Misclassification errors were common due to the inconsistent application of event definitions and the reliance on free-text narratives rather than structured data fields led to missing data and inconsistent data quality. Demographic data was the most reliable, while contextual and outcome data was scarce which limited statistical analysis. High-quality surveillance data contributes to many aspects of suicide and suicidality prevention. Our findings suggest the need for improved standardization and structured data fields, in addition to the expansion of data collection, particularly for event context and outcomes.

PMID:40762908 | DOI:10.1080/08995605.2025.2525657

Indian Pediatr. 2025 Aug 5. doi: 10.1007/s13312-025-00156-9. Online ahead of print.

ABSTRACT

OBJECTIVE: To develop and validate the Assamese version of the Rashtriya Bal Swasthya Karyakram (RBSK) screening tool for developmental delay (1-72 months) and autism (15-24 months) and to assess its diagnostic accuracy in comparison with the Developmental Profile-3 (DP-3) and the All India Institute of Medical Sciences (AIIMS)-Modified INCLEN Diagnostic Tool for autism spectrum disorder (INDT-ASD).

METHODS: A cross-sectional study was conducted from January to December 2024 at a tertiary care hospital in India. The RBSK screening tool for developmental delay and autism was translated into Assamese through a standardized process involving forward translation, back-translation, expert review, and pilot testing (n = 10). Children aged 1-72 months were recruited from the outpatient department. Developmental delay was assessed using the Developmental Profile-3 (DP-3) and ASD in children aged 15-24 months using the AIIMS-Modified INCLEN Diagnostic Tool for Autism Spectrum Disorder (INDT-ASD) tool. Diagnostic accuracy was assessed by calculating sensitivity, specificity, positive and negative predictive values, Cohen’s kappa statistic, and area under receiver operating characteristic (AUROC) curves.

RESULTS: A total of 139 children with mean (SD) age 30.5 (12.2 months) were enrolled. The Assamese version of the RBSK screening tool demonstrated a sensitivity and specificity of 94.1% and 84.9%, respectively, for developmental delay, and 89.5% and 93.8%, respectively, for ASD. Agreement with reference tools was high (Cohen’s kappa = 0.85 for DP-3, 0.83 for AIIMS-Modified INDT-ASD). The tool showed excellent discriminative performance with AUROC (95%CI) of 0.94 (0.89, 0.98) for developmental delay and 0.92 (0.85, 0.98) for ASD.

CONCLUSION: The validated Assamese version of the RBSK screening tool for developmental delay and autism is an accurate screening tool in Assamese-speaking population.

PMID:40762879 | DOI:10.1007/s13312-025-00156-9

Obes Surg. 2025 Aug 5. doi: 10.1007/s11695-025-08088-w. Online ahead of print.

ABSTRACT

BACKGROUND: To describe patterns and predictors of leisure-time physical activity (LTPA) in patients awaiting (PRE) and after (POST) metabolic and bariatric surgery (MBS).

METHODS: A cross-sectional study was conducted with 180 participants (PRE: n = 63, POST: n = 117). Data were collected through a structured questionnaire on demographic and clinical variables, LTPA patterns, and professional guidance. Descriptive statistics, chi-square and Fisher’s exact tests, and binomial logistic regression were used.

RESULTS: The sample was predominantly female (83.3%), with a mean age of 43.16 ± 11.13 years and BMI of 40.85 ± 10.79 kg/m². In the PRE group, 70% were classified as inactive, with 44.3% reporting no physical activity (PA). Walking or running outdoors was the most common activity. Most active participants (88.2%) exercised under professional supervision versus 27.8% of inactive ones [X²(1) = 13.05; p < 0.001]. In the POST group, 57% were inactive, although 43.1% engaged in at least one type of LTPA. Walking or running was most common overall (40.2%), while resistance training predominated among active individuals (60%). Indoor settings were preferred for LTPA (63.4%). Being accompanied by an exercise professional significantly increased the odds of being active (OR = 4.57, 95% CI: 1.31-15.88, p = 0.017).

CONCLUSIONS: LTPA participation and characteristics differ considerably between PRE and POST MBS groups. Receiving guidance from an exercise professional was significantly associated with higher PA levels. These findings highlight the importance of developing tailored LTPA programs that include professional support to encourage PA among MBS patients.

PMID:40762865 | DOI:10.1007/s11695-025-08088-w

Radiology. 2025 Aug;316(2):e243788. doi: 10.1148/radiol.243788.

ABSTRACT

Background The optimal treatment of patients with oligometastatic breast cancer and the methods for selecting individuals who may benefit from metastasis-directed therapies are controversial. Purpose To determine the prevalence of oligometastatic disease (OMD; defined as five or fewer distant metastases) in patients with locally advanced breast cancer initially staged at fluorine 18 (¹⁸F) fluorodeoxyglucose (FDG) PET/CT or at CT and bone scintigraphy (CTBS), and to compare patterns of local-regional and distant metastatic disease. Materials and Methods This is a post hoc analysis of data from a prospective, multicenter randomized trial including participants with stage IIb (T3N0) or III invasive ductal carcinoma in the breast between December 2016 and April 2022. Participants were randomized for staging at ¹⁸F-FDG PET/CT or at conventional chest, abdomen, and pelvis CTBS. The prevalence of OMD, sites of distant metastases, and extent of local-regional disease were compared using the χ² test or Fisher exact test. Logistic regression was used to assess the association between imaging and disease extent, with P < .05 indicating a statistically significant difference. Results The study included 369 participants (mean age, 53 years ± 13 [SD]). OMD was more common on ¹⁸F-FDG PET/CT scans (19 of 180; 11%; 95% CI: 6.9, 15.9) than on CTBS scans (eight of 185; 4%; 95% CI: 2.2, 8.3; P = .03). Polymetastatic disease (more than five distant metastases) was also more common on ¹⁸F-FDG PET/CT scans (24 of 180; 13%) than on CTBS scans (13 of 185; 7%; P = .04). Patients with OMD that was depicted on ¹⁸F-FDG PET/CT and CTBS scans had axillary lymph node metastases, but ¹⁸F-FDG PET/CT helped to detect extra-axillary regional lymphadenopathy, extra-regional lymph node metastases, and liver metastases more frequently than did CTBS (six of 19 [32%] vs one of eight [13%], three of 19 [16%] vs 0 of eight [0%], and six of 19 [32%] vs one of eight [13%], respectively; P = .63, .53, and .63, respectively). Conclusion At patient presentation, ¹⁸F-FDG PET/CT helped to detect OMD in more than one in 10 participants with locally advanced breast cancer, which was more than 2.5 times more often than CTBS, and ¹⁸F-FDG PET/CT helped to detect more extensive local-regional metastatic disease. ClinicalTrials.gov Identifier: NCT02751710 © RSNA, 2025 Supplemental material is available for this article. See also the editorial by Ulaner in this issue.

PMID:40762843 | DOI:10.1148/radiol.243788

Dev Neurorehabil. 2025 Aug 5:1-7. doi: 10.1080/17518423.2025.2541823. Online ahead of print.

ABSTRACT

This study aimed to investigate the effect of Sensory Integration Therapy (SIT) in children with cerebral palsy (CP). Twenty children with CP were randomly assigned to intervention and control groups. Quality of Upper Extremity Skills Test (QUEST), Trunk Control Measurement Scale (TCMS), and Pediatric Balance Scale (PBS) were used in pre-and post-treatment. There was a statistically significant increase in the dissociated movements sub-scale of the QUEST, dynamic reaching sub-scale of the TCMS, and PBS scores in the intervention group. There was a statistically significant increase in both dissociated movements and grasps sub-scale of the QUEST and PBS scores in the control group. In conclusion, SIT applications can be integrated into rehabilitation programs to improve dissociated upper extremity movements, dynamic trunk control, and balance control in children with CP.

PMID:40762832 | DOI:10.1080/17518423.2025.2541823

Psychol Rep. 2025 Aug 5:332941251363891. doi: 10.1177/00332941251363891. Online ahead of print.

ABSTRACT

Grit is important to experiencing success and is shaped through several childhood experiences. However, the association of adverse childhood experiences (ACEs) and benevolent childhood experiences (BCEs) to grit is underexplored, especially through emotional regulation. Hence, this study examined the association between ACEs, BCEs, emotional regulation, and grit. Further, we investigated the mediating role of emotional regulation between (a) ACEs and grit and (b) BCEs and grit. Self-report measures of ACEs, BCEs, emotional regulation, and grit were used to collect data from 548 Gen Z young adults born in 1997 or later (Female = 344, Male = 202, Mean age = 20.39) in India. We applied descriptive statistics, linear regression, and structural equation modelling (SEM) to analyze the data. The analyses revealed a significant negative association of ACEs with emotional regulation and grit, whereas BCEs were associated positively. Emotional regulation fully mediated the relationships between (a) ACEs and grit (β = -.08; CI = -.13 to -.04) and (b) BCEs and grit (β = .16; CI = .10 to .23). The study findings confirm the negative relationship of ACEs on an important life outcome, grit. However, BCEs showed beneficial effects. Furthermore, emotional regulation explains the association between negative and positive childhood experiences and grit. These findings have implications for fostering emotional regulation and mitigating the negative outcomes of ACEs among emerging adults.

PMID:40762830 | DOI:10.1177/00332941251363891

J Math Biol. 2025 Aug 5;91(3):24. doi: 10.1007/s00285-025-02255-4.

ABSTRACT

In order to be useful in assessing the effects of climate change on biological populations, mathematical models have to adequately represent the life cycle of the species in question, the dynamics of and interactions with its resource(s), and the effect of changing environmental conditions on their vital rates. Due to this complexity, such models are often analytically intractable. We present here a consumer-resource model that captures seasonality (summer and winter), with synchronously reproducing consumers (birth pulse), structured into non-reproductive juveniles and reproductive adults, and that remains analytically tractable. Our model is motivated by hibernating mammals, such as marmots, ground squirrels, or bats, some of which live in high altitude regions where the effects of climate change are stronger than elsewhere. One stage-specific impact of climate change in those species is that juveniles may benefit from warmer winters while adults may suffer. We explore various aspects of how this differential response to climate change shapes population dynamics from stable populations to cycles and chaos. We show that the qualitative relationship between winter temperature and winter mortality has a significant effect on the model dynamics, hence informing empiricists of required data to assess the effect of climate change on these species. Our results question the long-standing expectation that species with slower life histories are necessarily more strongly affected by climate change than species with faster life histories.

PMID:40762823 | DOI:10.1007/s00285-025-02255-4

Int Urogynecol J. 2025 Aug 5. doi: 10.1007/s00192-025-06210-1. Online ahead of print.

ABSTRACT

INTRODUCTION AND HYPOTHESIS: Midurethral sling (MUS) success may depend on sling positioning along the urethra, which may be affected by concurrent apical prolapse repair. Our prospective cohort study evaluated differences in MUS positioning using translabial ultrasound in women who had MUS only versus those with concurrent apical prolapse repair.

METHODS: Women undergoing MUS with or without concurrent prolapse repair were enrolled. MUS was placed after the apical suspension. Ultrasound images were obtained at the beginning of the case, after suspension (if applicable), and following sling placement. Two experts reviewed the images and measured the urethral length, sling positioning along the urethra, and the angle between the urethra and the pubic symphysis. Measurements were averaged for statistical analysis.

RESULTS: Fifty-one women participated: 27 in the MUS alone group and 24 in the concurrent group. There were no differences in urethral length (27.4 vs 27.2 mm, p = 0.728), MUS position (0.24 vs 0.26 mm; p = 0.71), or angle (24° vs 23°, p = 0.574). Both groups demonstrated a significant improvement in Urinary Distress Inventory6 scores.

CONCLUSIONS: There have been conflicting reports of MUS success when placed on its own versus at the time of prolapse repair. One hypothesis has been that positioning of the MUS may be affected by the prolapse repair. Our study did not observe any difference in the MUS positioning along the urethra, nor sling angle when placed with or without a concurrent prolapse repair.

PMID:40762821 | DOI:10.1007/s00192-025-06210-1

Int Urogynecol J. 2025 Aug 5. doi: 10.1007/s00192-025-06198-8. Online ahead of print.

ABSTRACT

OBJECTIVE: Pelvic organ prolapse (POP) is a common health problem that significantly impairs quality of life, particularly in terms of sex. Our study aimed to assess the quality of sexual life of women after successful POP repair with laparoscopic sacrocolpopexy (LSC).

METHODS: This prospective cohort study was aimed at assessing the influence of successful laparoscopic sacrocolpopexy on the quality of sexual life after the surgery. Pre- and postoperative examinations included the Pelvic Organ Prolapse Quantification (POPQ) scale and validated quality-of-life questionnaires. PFDI-20 and PFIQ were used to choose patients who were satisfied with the results of the surgery. The quality of sexual life of sexually active and nonactive patients was subsequently evaluated via the PISQ-IR questionnaire. Post-surgery evaluation was planned 8-12 months after the procedure.

RESULTS: A total of 181 patients were included in the study. The mean age of the patients was 58.2±9.6 years. Patients in the sexually active group were significantly younger (55.5±9.5) than were those in the nonactive group (63.4±7.7). Follow-up visits took place 10±2.34 months after surgery. We achieved statistically significant improvements in the PFDI-20 questionnaire, particularly in the POPDI-6 section, the PFIQ-7 questionnaire, and the POPQ scale. Among sexually active women, improvements in sexual function were observed across most domains, including global quality (p = 0.003), arousal and orgasm (p < 0.001), condition impact (CI, feelings of sexual inferiority, embarrassment, or anger during sexual activity, p < 0.001), and condition-specific (CS, feelings of fear or shame during sexual activity, p < 0.001). A notable finding was the significant reduction in dyspareunia, which decreased from 12.7% to 3.3%. The study also revealed that sexual inactivity was correlated with negative self-perception, which improved significantly following surgery (CS, p = 0.04; CI, p < 0.001).

CONCLUSION: These findings suggest that laparoscopic sacrocolpopexy improves the quality of sexual life and leads to a reduction in dyspareunia and distress related to POP symptoms.

PMID:40762819 | DOI:10.1007/s00192-025-06198-8