Tag: pubmed

Eur J Psychotraumatol. 2025 Dec;16(1):2590402. doi: 10.1080/20008066.2025.2590402. Epub 2025 Dec 22.

ABSTRACT

Background: The International Trauma Questionnaire – Child and Adolescent Version (ITQ-CA) is an assessment tool designed to evaluate ICD-11 defined post-traumatic stress disorder (PTSD) and Complex PTSD (CPTSD) symptoms in children and adolescents and is widely utilized on an international scale.Objective: In this study, the psychometric properties of the ITQ-CA in the Turkish cultural context were evaluated.Method: The research sample consisted of 204 children and adolescents aged 7-17 who experienced the earthquakes centred in Kahramanmaraş, Turkey, in February 6, 2023. To determine the construct validity of the scale, four different models were established based on ICD-11, and their structures were analysed through confirmatory factor analysis (CFA).Results: The CFA results indicated that among the models tested, only the first-order six-factor model demonstrated an acceptable fit. Although it was determined to exhibit better model fit compared to other models, high correlations between subscales and inappropriate factor loadings in items (Heywood cases) were observed. This indicates a potential issue of model misspecification, suggesting that the obtained results should be interpreted with caution.Conclusions: This study provides evidence of the validity and reliability of the ITQ-CA, a widely used international assessment tool, in the Turkish cultural context. However, consistent with the literature, Heywood cases were observed in the models tested. These results indicate that models used to examine trauma symptoms with the ITQ should be carefully evaluated.

PMID:41424344 | DOI:10.1080/20008066.2025.2590402

Int J STD AIDS. 2025 Dec 22:9564624251410773. doi: 10.1177/09564624251410773. Online ahead of print.

ABSTRACT

BackgroundThis study aimed to identify people living with HIV (PLWH) with tuberculosis (TB) co-infection, explore their demographic and clinical characteristics, and determine predictors of early mortality within 6 months of TB diagnosis.MethodsA cross-sectional study was conducted in a tertiary referral center in Türkiye of PLWH diagnosed with TB between 2004 and 2023. Demographic, clinical, and laboratory data were reviewed, and statistical analyses were performed to identify early mortality predictors.ResultsAmong 1541 PLWH, 62 (4%) had TB, and 23 (37%) died within 6 months. TB presentations were pulmonary (44%), extrapulmonary (27%), and both (29%). Predictors significantly associated with early mortality included lymphopenia (p = 0.009), a CD4 + T lymphocyte count ≤50 cells/mm³ (p = 0.015), anemia (p = 0.009), and thrombocytopenia (p = 0.034), particularly platelet counts below 150,000/mm³ (p = 0.001). Clinical predictors also included symptoms such as fever (p = 0.017), anorexia (p = 0.012), weight loss (p = 0.012), and altered mental status (p = 0.043). Additionally, receiver operating characteristic (ROC) analysis demonstrated that CD4 + T lymphocyte count ≤50 cells/mm³ (AUC = 0.76, p = 0.039) and platelet count <150,000/mm³ (AUC = 0.71, p = 0.034) were significant predictive cutoffs for early mortality. TB culture positivity was high (84%), while PCR positivity was low (15%). Opportunistic infections were seen in 11% of cases.ConclusionsHigh early mortality among people living with HIV/TB co-infection is associated with advanced immunosuppression and hematological abnormalities. These results highlight the importance of early HIV detection and close clinical monitoring to reduce mortality.

PMID:41424343 | DOI:10.1177/09564624251410773

J Appl Gerontol. 2025 Dec 22:7334648251408868. doi: 10.1177/07334648251408868. Online ahead of print.

ABSTRACT

IntroductionAgeism is an understudied issue in prisons, especially among people with intersecting vulnerabilities. This study examined the prevalence and determinants of age-based discrimination among incarcerated older adults in Mexico using nationally representative data.MethodsWe analyzed the 2021 National Survey of Incarcerated People, focusing on adults aged 50 and older (n = 8,116). Descriptive statistics assessed prevalence and reasons for discrimination, and multinomial logistic regression identified associated factors.ResultsOverall, 21.4% of older adults reported discrimination, with age as the main reason (11.6%). Older women were almost twice as likely as men to report ageism. Older age, hypertension, other illnesses, disability, perceived insecurity, and experiences of violence were strongly associated with discrimination.ConclusionAge-based discrimination represents a significant and intersectional vulnerability for older adults. Findings underscore the need for age-responsive prison policies that promote safety, equity, and dignified aging.

PMID:41424333 | DOI:10.1177/07334648251408868

Am J Hum Biol. 2025 Dec;37(12):e70186. doi: 10.1002/ajhb.70186.

ABSTRACT

BACKGROUND: Obesity is a critical public health challenge in South Asia, yet region-specific data remain limited. This study examines the prevalence and sex-specific sociodemographic, economic, and behavioral determinants of obesity in rural Punjab, India.

METHODS: A population-based cross-sectional study of 2349 adults in Mansa district, Punjab, assessed general obesity using BMI and central obesity by WC, WHR, and WHtR. Structured interviews captured sociodemographic, economic, and behavioral data. Sex-stratified logistic regression models estimated AORs for obesity.

RESULTS: General obesity was high (69.6%), with central obesity more pronounced (WC: 76%; WHtR: 85.8%; WHR: 93.4%). Females had significantly higher obesity risk (WC and WHR) than males. In males, obesity risk peaked at ages 40-49 (BMI, WC, and WHtR) and 50-59 (WHR), while females’ risk increased from 50 years (WC) and ≥ 60 years (WHR and WHtR). Education and income showed sex-specific associations: primary education increased females’ risk (WC), and senior secondary and higher increased males’ risk (BMI) compared with those with no formal education but decreased at higher education levels in females. Higher income increased obesity risk in males (BMI, WC, and WHtR). Belonging to the Jatt Sikh community and sedentary behavior increased obesity risk in both sexes.

CONCLUSION: The higher central obesity among women reflects gendered vulnerabilities shaped by socioeconomic and educational disparities. The coexistence of high central obesity and sedentary behavior in a transitioning rural context highlights the shifting sociocultural landscape of obesity in LMICs. Age-related decrease in general but persistent central obesity warrants longitudinal biocultural investigations.

PMID:41424332 | DOI:10.1002/ajhb.70186

Clin Nephrol. 2025 Dec 22. doi: 10.5414/CN111884. Online ahead of print.

ABSTRACT

BACKGROUND: It is recognized that topiramate use may affect risk of stone disease, but large population-based and weighted evaluations are absent. Furthermore, the suspected increased odds of stone disease have remained unquantified. We leveraged the nationally representative National Health and Nutrition Examination Survey (NHANES) to perform a population-based assessment of the association of current topiramate use on occurrence of stones presenting within the year immediately preceding survey participation.

MATERIALS AND METHODS: We utilized the 2017 – 2020 (Pre-COVID-19) NHANES data to assess association between current topiramate use and incidence of kidney stones. Weights and strata provided by NHANES were employed, and analyses were performed using survey package for STATA v14.

RESULTS: 843 participants met analysis criteria, weighted to represent a nationally representative population of 23,064,066 noninstitutionalized U.S. adults. Logistic regression was used to analyze the relationship between the incidence of kidney stone passage in the last 12 months and current topiramate use. It was found that current topiramate use was associated with a statistically significant 810% increase in the odds of stone passage in the last 12 months (OR: 8.1, 95% CI (1.04 – 63.06), p = 0.046). None of the investigated demographic or pharmaceutical covariates (age, diabetes status, body mass index, or concomitant use of diuretics, proton pump inhibitors, or H2-blockers) demonstrated statistically significant association with topiramate use and thus were not included as covariates.

CONCLUSION: Our results demonstrate that odds of a stone within the last 12 months is increased significantly with topiramate use. Additionally, we provide the initial quantification of the strength of this association, with an estimated 8-fold increase in odds of stone formation. These findings can allow improved risk counseling for patients considering topiramate use for providers.

PMID:41424319 | DOI:10.5414/CN111884

Perfusion. 2025 Dec 22:2676591251409381. doi: 10.1177/02676591251409381. Online ahead of print.

ABSTRACT

BackgroundExtracorporeal membrane oxygenation (ECMO) is a life-saving intervention for neonates with severe respiratory or circulatory failure. Due to its complexity, ECMO is often performed in specialized centers, necessitating the transport of eligible patients from non-ECMO centers. While ECMO transport has been deemed safe, limited data exist comparing outcomes between in-house and transported neonates. This study aimed to evaluate the survival and long-term outcomes of neonates requiring ECMO support based on the cannulation location.MethodsA single-center study was conducted at the largest tertiary center in Israel (2009-2025). Patients were categorized based on cannulation site: in-house ECMO (performed at the tertiary center) or on-site ECMO (cannulated at the referring center and transported on ECMO support). Primary endpoints were in-hospital and long-term survival. Secondary outcomes included ECMO-related complications and long-term sequelae.ResultsA total of 53 neonates received ECMO support, with 26 (49.1%) in the in-house group and 27 (50.9%) in the on-site group. Despite pre-cannulation differences, including higher vasoactive-inotropic scores in the in-house group, lower pH and higher pCO2 in the on-site group, there were no statistically significant differences between the groups (53.8% vs 77.8%, p = 0.12). ECMO-related adverse events and long-term sequelae showed no statistically significant differences between groups, though the study was underpowered to detect clinically meaningful differences.ConclusionAlthough survival rates of critically ill neonates requiring on-site ECMO initiation and transport and those connected to ECMO in the in-house setting, did not differ significantly, the study was underpowered to detect potentially meaningful differences. Nonetheless, the findings reinforce the viability of neonatal ECMO transport.

PMID:41424306 | DOI:10.1177/02676591251409381

Health Technol Assess. 2025 Dec;29(67):1-29. doi: 10.3310/RBGD4741.

ABSTRACT

BACKGROUND: Proximal femoral (hip) fracture is common, serious and costly. An enhanced community rehabilitation intervention (Fracture in the Elderly Multidisciplinary Rehabilitation) was codeveloped with patients, carers and therapists. Trial methods have been tested previously in a feasibility study.

OBJECTIVE: To determine the effectiveness and cost-effectiveness of the Fracture in the Elderly Multidisciplinary Rehabilitation intervention compared with usual NHS rehabilitation care. To determine the mechanisms and processes that explain the implementation and impacts of the Fracture in the Elderly Multidisciplinary Rehabilitation intervention.

DESIGN AND METHODS: Definitive, pragmatic, multisite, parallel-group, two-armed, superiority randomised controlled trial with 1 : 1 allocation ratio. Concurrent economic and process evaluations.

SETTING: Participant recruitment in 13 hospitals across England and Wales, with the Fracture in the Elderly Multidisciplinary Rehabilitation intervention delivered in the community.

PARTICIPANTS: Patients aged over 60 years, with mental capacity, recovering from surgical treatment for proximal femoral fracture, and living in their own home prior to fracture.

INTERVENTIONS: Usual rehabilitation care (control) was compared with usual rehabilitation care plus the Fracture in the Elderly Multidisciplinary Rehabilitation intervention, which comprised a patient-held workbook and goal-setting diary aimed at improving self-efficacy, and six additional therapy sessions delivered in the community (intervention), to increase the practice of exercise and activities of daily living.

PRIMARY AND SECONDARY OUTCOME MEASURES: Primary effectiveness outcome was the Nottingham Extended Activities of Daily Living scale at 12 months. Secondary outcomes included: Hospital Anxiety and Depression Scale, Falls Self-Efficacy – International scale, hip pain intensity, fear of falling, grip strength and Short Physical Performance Battery. Economic outcomes were EuroQol EQ-5D-3L and Client Service Receipt Inventory.

RESULTS: In total, 205 participants were randomised (n = 104 experimental; n = 101 control). Trial processes were adversely affected by the coronavirus disease discovered in 2019 pandemic and the target sample of 446 was not met. By 52 weeks, the intervention group had worse Nottingham Extended Activities of Daily Living scores than the control group (mean difference: -1.9; 95% confidence interval: -3.7 to -0.1), which was not clinically important. Joint modelling analysis testing for difference in longitudinal outcome adjusted for missing values, removed the apparent inferiority of the Fracture in the Elderly Multidisciplinary Rehabilitation intervention with a mean difference of 0.1 (95% confidence interval: -1.1 to 1.3). There was no statistical or clinically significant difference in secondary outcomes between groups. A median of 4.5 extra rehabilitation sessions were delivered to the intervention group, with a median of two sessions delivered in-person. Instrumental variable regression did not find any effect of the amount of rehabilitation on the main outcome. There were 53 unrelated serious adverse events including 11 deaths in the control group: 41 serious adverse events including nine deaths in the intervention group. The mean cost of delivering the Fracture in the Elderly Multidisciplinary Rehabilitation intervention was £444 per participant. The intervention group gained 0.02 (95% confidence interval: -0.036 to 0.076) more quality-adjusted life-years than the control group. This was not clinically or statistically significant. Mean health service use costs were higher in the intervention group.

LIMITATIONS: The trial was severely impacted by coronavirus disease discovered in 2019. Possible reasons for lack of detected effect included limited intervention fidelity (number and remote mode of delivery), lack of usual levels of support from health professionals and families, and change in recovery beliefs and behaviours during the pandemic.

CONCLUSION: The Fracture in the Elderly Multidisciplinary Rehabilitation intervention was not more effective and had higher costs than usual rehabilitation care.

FUNDING: This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 16/167/09.

PMID:41424298 | DOI:10.3310/RBGD4741

Stroke. 2025 Dec 22. doi: 10.1161/STROKEAHA.125.052763. Online ahead of print.

ABSTRACT

BACKGROUND: Robot-assisted gait training (RAGT) with wearable exoskeletons has the potential to enhance walking in patients with stroke; however, large-scale evidence is inconclusive. The aim of this study was to determine the effect of overground gait training using a torque-assisted exoskeleton in patients with subacute stroke on the recovery of ambulatory function.

METHODS: This international, multicenter, randomized controlled trial enrolled 151 patients with subacute stroke who presented with severe gait impairment but relatively preserved trunk control. Participants were randomized to the RAGT group (30 minutes of conventional gait training plus 30 minutes of exoskeleton) or the control group (60 minutes of conventional gait training), 5 times per week for 4 weeks. The primary outcome was the change in ambulatory function, assessed by the Functional Ambulation Category (FAC) before and immediately after the 4-week intervention. Secondary outcomes included the lower limb strength, balance function. Independent ambulation was reassessed 3 months after the intervention.

RESULTS: A total of 127 participants (56 female (44.1%), mean age, 60.1±13.6 years) completed the 4-week intervention. There were no serious adverse events related to the interventions, and dropout rates tended to be higher in the RAGT group without statistical significance. Both groups showed significant improvement in FAC after the intervention; however, no significant difference between groups (mean change (range), 3.0 (1-5) and 2.5 (1-4) in the RAGT and control group). Both groups exhibited significant gains in lower limb motor function; however, the RAGT group demonstrated a significantly greater improvement in lower limb strength (mean change, 15.9±14.2 and 11.1±11.2 in the RAGT and control group, P=0.034).

CONCLUSIONS: Overground gait training using an exoskeleton was not superior to conventional rehabilitation for improving ambulatory function in subacute stroke patients; however, it could provide additional lower extremity motor improvement. These findings suggest that the overground gait training with an exoskeleton might be a potential intervention for patients with subacute stroke.

REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05157347.

PMID:41424275 | DOI:10.1161/STROKEAHA.125.052763

Ann Afr Med. 2025 Dec 15. doi: 10.4103/aam.aam_575_25. Online ahead of print.

ABSTRACT

CONTEXT: Type 2 diabetes mellitus (T2DM) and hypertension are major chronic conditions affecting elderly populations globally, often combined with socioeconomic hardship and comorbidities, which can impair quality of life (QoL).

AIMS: The aim of this study was to assess the health-related QoL among elderly persons with type 2 diabetes and hypertension living in urban slums of Bengaluru and to identify socio-demographic, clinical, lifestyle, and comorbidity factors associated with QoL.

SETTINGS AND DESIGN: A community-based cross-sectional study was conducted among 255 elderly persons (age ≥60 years) with T2DM and hypertension using probability proportional to size sampling from 12 slums in the field practice area of a tertiary care hospital in Bengaluru, India. Methods and Materials: Data were collected on sociodemographic profile, clinical status, disease duration, comorbidities, lifestyle behaviors, and health-related QoL using domain-specific assessments.

STATISTICAL ANALYSIS USED: Statistical analysis included descriptive statistics, ANOVA/Chi-square tests, and Pearson correlation.

RESULTS: Of 255 participants, the mean age was 67.7 years. Almost half (47.1%) the participants reported poor QoL, predominantly in the social and psychological domains. The mean QoL score among the study subjects is 44.92 ± 7.6, which is below average. The highest score was 47.19 ± 14.6, seen in the physical domain, and the lowest mean scores were observed in social (42.96 ± 16.30) and psychological domains (43.92 ± 10.4).

CONCLUSIONS: The elderly with type 2 diabetes and hypertension in urban slums experience poor QOL influenced by sociodemographic, clinical, and lifestyle factors. Interventions emphasizing physical activity, diet adherence, comorbidity management, and social support are needed.

PMID:41424274 | DOI:10.4103/aam.aam_575_25

Glob Health Action. 2025 Dec;18(1):2599567. doi: 10.1080/16549716.2025.2599567. Epub 2025 Dec 22.

ABSTRACT

BACKGROUND: Hypertension is a major risk factor for cardiovascular diseasemorbidity and mortality, affecting 25% of adults in Ghana. Access to adequate care is critical for effective hypertension management.

OBJECTIVE: Evaluate healthcare utilisation among patients with hypertension and identify determinants.

METHODS: Guided by the Andersen and Newman model, we examined predisposing, enabling, and need factors affecting HCU. Data were collected from 600 patients with hypertension, 19 in-depth interviews with health workers, and six focus group discussions with patients. Logistic regression was used for quantitative analysis, while qualitative data were analyzed thematically.

RESULTS: In all, 73% of patients with hypertension used health care. Key predisposing factors included age 70+ years (adjusted odds ratio [aOR]: 1.97, 95% CI: 1.06-3.69) and being female (aOR: 2.32, 95% CI: 1.53-3.54). Enabling factors included health insurance (aOR: 4.07, 95% CI: 2.04-8.20), closer proximity to referral facilities (aOR: 2.28, 95% CI: 1.44-3.65), and care at district hospitals (aOR: 3.37, 95% CI: 1.94-6.03). Need factors were not associated with HCU. Barriers included financial difficulties, reliance on alternative medicines, poor health-seeking behavior, delays, erratic medication supplies, and health insurance limitations.

CONCLUSIONS: This study finds high healthcare use (73%) among rural Ghanaian hypertension patients, mainly driven by demographic and structural factors. It highlights ongoing inequalities, especially among men. Interventions should focus on addressing gender issues, enhancing access to insurance, and strengthening district hospital services. Future research should evaluate the quality and consistency of hypertension care to improve health outcomes.

PMID:41424267 | DOI:10.1080/16549716.2025.2599567