Tag: pubmed

BMC Geriatr. 2026 May 15. doi: 10.1186/s12877-026-07616-2. Online ahead of print.

ABSTRACT

BACKGROUND: Caregivers of individuals with vascular dementia (VaD) face various physical and psychological burdens in their daily caregiving responsibilities. This role is challenging, demanding, and often stressful due to the symptoms characteristic of this condition. The aim of this study was to assess the level of burden experienced by caregivers of individuals diagnosed with vascular dementia.

METHODS: The study included a total of 351 participants. The research was conducted anonymously and voluntarily among informal caregivers of individuals with dementia. A survey questionnaire and the Caregiver Burden Scale (CB Scale) were employed. Statistical analysis was conducted using the χ² independence test, t-test for independent samples, Mann-Whitney test, Kruskal-Wallis test, Spearman’s rank correlation coefficient, Wilcoxon signed-rank test, and Kolmogorov-Smirnov test.

RESULTS: High caregiving burden was most commonly observed in the domains of General Burden (63.2%), Disappointment (59.8%), and Social Isolation (58.1%). A significantly lower percentage of caregivers reported high burden levels in the domains of Environmental Factors (36.8%) and Emotional Engagement (34.2%).

CONCLUSIONS: Our study demonstrates that caregivers of individuals with VaD experience particularly high levels of overall burden, social isolation, and a sense of disappointment. The findings highlight the need for early interventions focused on psychosocial support, as well as preventive programs aimed at reducing caregiver strain. In the broader perspective, these results may serve as a starting point for developing comprehensive models of home care and public health targeted at caregivers of individuals with VaD.

PMID:42141395 | DOI:10.1186/s12877-026-07616-2

BMC Infect Dis. 2026 May 15. doi: 10.1186/s12879-026-13582-2. Online ahead of print.

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19), first identified in Wuhan, China, in December 2019, rapidly evolved into a global pandemic with substantial morbidity and mortality. Severe COVID-19 cases, particularly those with pneumonia requiring intensive care unit (ICU) admission, posed significant challenges for healthcare systems. This study aimed to evaluate and compare healthcare-associated infections (HAIs) developing in the ICU during the pre-pandemic and pandemic periods.

METHODS: This retrospective observational study was conducted at Sakarya Yenikent State Hospital, a secondary-care hospital with 50 ICU beds. Active surveillance data collected by the infection control team were analyzed for two periods: pre-pandemic (May 2018-February 2020) and pandemic (March 2020-December 2021). The number of ICU patients, patient-days, HAI rates, causative microorganisms, antimicrobial resistance patterns, and mortality rates were compared between periods. Statistical analyses were performed using Epi Info™ version 7.2.5.0, with p < 0.05 considered statistically significant.

RESULTS: A total of 1,840 patients (16,572 patient-days) in the pre-pandemic period and 2,119 patients (12,460 patient-days) in the pandemic period were followed. Mortality significantly increased during the pandemic period compared to the pre-pandemic period (40.96% vs. 24.94%, p = 0.00001). Although the overall HAI rate did not differ significantly between periods (3.26% vs. 2.73%, p = 0.333), Although the overall HAI rate did not differ significantly between periods (3.26% vs. 2.73%, p = 0.333), HAI density was higher during the pandemic. Notably, Acinetobacter baumannii-related HAIs increased significantly during the pandemic period (58.89% vs. 35.00%, p = 0.016), while distributions of other pathogens remained similar. Antimicrobial resistance patterns were more pronounced during the pandemic period.

CONCLUSION: Despite similar HAIs rates, in-hospital mortality increased during the pandemic. This was accompanied by higher disease severity, reflected by increased cardiopulmonary resuscitation rates, and a shift toward Acinetobacter baumannii infections. Although mortality was high among COVID-19-positive patients, COVID-19 status was not an independent predictor. Overall, worse outcomes during the pandemic were associated with increased disease severity and pathogen distribution rather than changes in HAI incidence.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:42141392 | DOI:10.1186/s12879-026-13582-2

BMC Med Imaging. 2026 May 15. doi: 10.1186/s12880-026-02413-0. Online ahead of print.

ABSTRACT

OBJECTIVE: The cartilaginous endplate (CEP) exhibits an intrinsically short [Formula: see text] model based on ultrashort echo time (UTE) sequence, and to explore the diagnostic utility of bi-exponential [Formula: see text]-derived parameters and monoexponential UTE-[Formula: see text] mapping values in grading CEP damage. METHODS: This study retrospectively collected 46 patients who underwent lumber UTE MRI, of whom 43 met the inclusion criteria. CEP was graded into three groups according to morphological features on multiple MRI sequences: healthy (structurally intact), mild damage (localized thinning or concavity with preserved continuity), and moderately damage (defects < 50% with disrupted continuity). Multiple quantities were evaluated using the UTE sequence on the CEP manually drawn by an experienced radiologist. One-way Kruskal-Wallis test was used to inspect the distribution differences among groups. Logistic regression and support vector machine models were applied to predict the level of degeneration with a considerably good precision, and receiver operating characteristic curves suggests a distinguishable performance among those models.

RESULTS: [Formula: see text] values showed significant differences among the groups (p < 0.05), with Tukey’s test indicating the most significant difference between the moderately damaged group and the healthy controls. [Formula: see text] values were non-normally distributed but statistically different between the moderate and mild damage groups (p < 0.05), a trend also observed in monoexponential UTE-[Formula: see text] mapping values (p < 0.05). The logistic regression and SVM models performed well in identifying moderate damage (AUC of 0.878 and 0.858, respectively), but had limited ability to detect mild damage (AUC of 0.718 and 0.729). CONCLUSION: The UTE bi-exponential [Formula: see text] model enable effective separation and quantification of distinct water components within the CEP. Both [Formula: see text] and UTE-[Formula: see text] mapping show promise as imaging biomarkers for grading CEP degeneration even in the early stage of CEP degeneration.

PMID:42141391 | DOI:10.1186/s12880-026-02413-0

BMC Musculoskelet Disord. 2026 May 16. doi: 10.1186/s12891-026-09965-w. Online ahead of print.

ABSTRACT

BACKGROUND: Charcot neuroarthropathy (CN) is a debilitating joint disorder that predominantly affects patients with neuropathy, particularly those with diabetic peripheral neuropathy (DPN). CN causes painless, rapid joint destruction and often leads to foot deformity, ulceration, osteomyelitis, and, in severe cases, amputation. Its pathogenesis involves repetitive microtrauma due to loss of protective sensation, triggering an inflammatory cascade that activates osteoclasts (OCs) disproportionately relative to osteoblasts (OBs) via the RANKL-RANK-OPG pathway, resulting in progressive bone loss and joint destruction. This systematic review and meta-analysis evaluated the efficacy of anti-resorptive agents in promoting bone remodeling and alleviating clinical symptoms in patients with active or stable CN.

METHODS: Following Cochrane Collaboration guidelines, we searched MEDLINE, EMBASE, and the Cochrane Library for randomized controlled trials (RCTs) comparing anti-resorptive agents, such as bisphosphonates, denosumab, calcitonin, and parathyroid hormone analogues, with placebo or no treatment in patients with Charcot neuroarthropathy. Two independent reviewers performed data extraction and risk-of-bias assessment using the Cochrane RoB 2 tool. Primary outcomes were bone mineral density (BMD), bone turnover markers (BTMs), time to remission, change in foot temperature, and adverse events. Statistical analyses were conducted using Stata 18, with random-effects models used to pool results.

RESULTS: We identified 936 records and nine reports describing seven RCTs met the inclusion criteria. The meta-analysis showed no significant difference in BMD between anti-resorptive agents and control groups. However, anti-resorptive therapy significantly reduced bone resorption markers. Clinical outcomes, including foot temperature change and time to remission, did not differ significantly between groups. Adverse events were similar between the intervention and control groups.

CONCLUSIONS: Although anti-resorptive agents reduce bone resorption markers in patients with Charcot neuroarthropathy, current evidence does not support their efficacy in improving BMD or providing clinically meaningful symptom relief beyond standard offloading. High-quality clinical trials and mechanistic studies are needed to define the role of these agents in CN management.

PMID:42141385 | DOI:10.1186/s12891-026-09965-w

J Racial Ethn Health Disparities. 2026 May 15. doi: 10.1007/s40615-026-03005-y. Online ahead of print.

ABSTRACT

INTRODUCTION: Social Determinants of Health (SDoH) profoundly influence cancer outcomes, yet their distribution among racially diverse gastrointestinal (GI) cancer patients remains understudied. This study examines racial differences in SDoH between non-Hispanic White (NHW) and Non-White (including Asian, African American, and Hispanic) patients with gastrointestinal (GI) cancers using data from the All of Us Research Program.

METHODS: A total of 6,620 participants with GI cancer were identified using ICD-10 and SNOMED codes, of whom 1,831 completed the SDoH survey and were included in the analysis. Descriptive statistics summarized SDoH constructs such as social cohesion, support, and neighborhood disorder. Variables were categorized using validated scoring tools or grouped into tertiles. Group comparisons used chi-square, t-tests, or Wilcoxon rank-sum tests.

RESULTS: Among the 1,831 participants included in the overall cohort, 80.7% (n = 1,478) identified as non-Hispanic White and 13.9% (n = 255) as Non-White, including Black or African American (6.2%), Hispanic or Latino (6.4%), and Asian (1.4%). NHW participants were older (71.0 vs. 64.2 years) and reported greater social cohesion (3.9 vs. 3.6, p < 0.001) and support (3.9 vs. 3.7, p < 0.001). Non-White patients reported higher perceived discrimination (1.7 vs. 1.5, p = 0.016), daily spiritual experience (4.5 vs. 3.7, p < 0.001), neighborhood disorder (2.2 vs. 2.1, p < 0.001), food insecurity (23.6% vs. 5.8%, p < 0.001), and housing issues (41.8% vs. 21.8%, p < 0.001). Delayed care (47.1% vs. 26.8%, p < 0.001) and unaffordability of care (9.9% vs. 3.4%, p < 0.001) were also more common.

CONCLUSION: Significant racial disparities in SDoH were observed among GI cancer patients. Non-White individuals faced greater economic hardship, environmental disadvantage, and barriers to healthcare access.

KEY MESSAGES: WHAT IS KNOWN ON THIS TOPIC: Racial disparities in gastrointestinal cancer outcomes persist, but the social and structural factors underlying these differences are not routinely captured in oncology research. Many cancer datasets emphasize clinical characteristics while underrepresenting patient-reported social, economic, and neighborhood conditions. Addressing social determinants of health is increasingly recognized as necessary to advance equity in cancer care delivery.

WHAT THIS STUDY ADDS: This study provides a comprehensive, patient-reported assessment of social determinants of health among GI cancer patients in the All of Us Research Program. Non-White patients experience a higher burden of economic instability, neighborhood disadvantage, perceived stress,and barriers to accessing healthcare services. These findings identify concrete social risk domains that can inform equity-focused screening, care navigation, and policy interventions within oncology practice.

PMID:42141357 | DOI:10.1007/s40615-026-03005-y

Environ Int. 2026 May 9;212:110286. doi: 10.1016/j.envint.2026.110286. Online ahead of print.

ABSTRACT

BACKGROUND: Climate change threatens global health, particularly among vulnerable populations such as pregnant individuals and their newborns. Evidence linking heat to premature birth is largely based on single-location studies or heterogeneous meta-analyses, leaving important gaps regarding underrepresented regions, preterm subgroups, and the role of maternal and infant characteristics.

OBJECTIVES: To quantify the association between heat and preterm birth (PTB) across multiple countries, assess gestational-age-specific effects, and identify maternal vulnerability factors.

METHODS: We analysed 36.6 million births occurring during the warm season from 250 locations in 13 countries to assess heat effects on PTB. Distributed lag non-linear models (DLNM) with quasi-Poisson regression estimated heat-PTB associations and the fraction of PTB attributable to heat. Gestational-age subcategories (extreme, very, late, and at-term) and socio-economic vulnerability profiles were also examined.

RESULTS: Overall, 1.4% (95% CI: 1.3-1.5) of PTB were attributable to heat (855 PTB per million births), with national burdens from 628 to 1,347 PTB per million. Higher susceptibility was suggested for younger, single, non-primiparous, less-educated, and socio-economically deprived mothers, and among female fetuses. Late PTB showed the largest risk; at-term births also displayed a small but consistent heat-related increase.

CONCLUSIONS: This large analysis of heat-related PTB using harmonized individual-level data indicates that heat increases PTB risk, with variations across countries and climates. It also shows that heat can trigger labour beyond the typical PTB window, affecting pregnancies not usually considered clinically vulnerable. Overall, these findings underscore the need for strategies to mitigate heat-related risks during pregnancy, particularly among socio-economically vulnerable populations.

PMID:42139755 | DOI:10.1016/j.envint.2026.110286

J Neurosurg Pediatr. 2026 May 15:1-9. doi: 10.3171/2025.12.PEDS25317. Online ahead of print.

ABSTRACT

OBJECTIVE: Fetal myelomeningocele repair (FMMR) has shown significant promise in decreasing the incidence of myelomeningocele (MMC)-associated hydrocephalus. In this study, the authors report on the reversal of hindbrain herniation via FMMR. They also describe biometric changes in third ventricle anatomy, which influences the outcome of endoscopic third ventriculostomy and choroid plexus cauterization (ETV/CPC).

METHODS: At the Arnold Palmer Hospital for Children and Winnie Palmer Hospital for Women & Babies, the maternal and fetal inclusion and exclusion criteria developed by the Management of Myelomeningocele Study (MOMS) were applied to determine eligibility for prenatal MMC repair. Patient charts, prenatal fetal MRI, ultrasonography studies, and postnatal brain MRI for the first 50 FMMRs performed between 2019 and 2024 were retrospectively reviewed for this study. Ventricle size was measured prior to fetal surgery, as was the clivus-supraocciput angle (CSO) on fetal and postnatal images. Neonates were stratified into hydrocephalic and nonhydrocephalic groups for comparative analysis. The hydrocephalic group included patients who had undergone ETV/CPC or insertion of a ventriculoperitoneal shunt (VPS).

RESULTS: A total of 50 women underwent FMMR. One woman did not consent to inclusion in the study, 8 patients remained in utero at the time of analysis, and 3 patients died. Of the 38 patients included in the analysis, 21 (55%) underwent treatment for their symptomatic hydrocephalus; 4 received a VPS, and 17 underwent ETV/CPC. Four ETV/CPC cases did not respond to the treatment and were scheduled for VPS insertion, resulting in an overall ETV/CPC success rate of 70.6% (12/17) in the study. A statistically significant difference in the mean prenatal ventricle size was observed between the nonhydrocephalic (9.61 mm) and hydrocephalic (12.1 mm, p = 0.023) groups. Additionally, a significant difference in the CSO angle in the first month after birth was noted between the groups (67.2° vs 76.7°, p = 0.01).

CONCLUSIONS: There is strong evidence that FMMR decreases MMC-related hydrocephalus by reversing hindbrain herniation and altering the developmental anatomy of the third ventricle. This makes ETV/CPC a safe alternative to CSF shunting because of the newly altered anatomy of the third ventricle and posterior fossa. Larger studies are recommended to further evaluate fetal brain development after FMMR.

PMID:42139738 | DOI:10.3171/2025.12.PEDS25317

J Neurosurg. 2026 May 15:1-7. doi: 10.3171/2026.1.JNS252444. Online ahead of print.

ABSTRACT

OBJECTIVE: Predicting language lateralization using functional MRI (fMRI) in patients with cerebral vascular malformations close to language areas is essential for treatment decision-making and patient outcomes. Functional MRI-based prediction is challenged because of potential remodeling processes and hemodynamic phenomena. However, there is a lack of possible factors influencing laterality prediction. The authors hypothesized that there might be an impact of lesion type and location on language lateralization.

METHODS: This retrospective study included 24 patients with arteriovenous malformations (AVMs), 11 patients with cavernomas, and 15 healthy controls. Participants performed a subvocal verb-generation task during fMRI. Data analysis in Statistical Parametric Mapping (SPM) 12 involved realignment, coregistration, and smoothing for preprocessing. The authors conducted a whole brain analysis using the general linear model approach at the individual level and calculated the lateralization indices (LIs) using the LI toolbox implemented in SPM independently based on the frontal, temporal, and parietal lobes.

RESULTS: The mean absolute LIs were above 0.2 in all groups. Distribution between groups varied significantly (p = 0.032, f = 0.34). A significant difference was found between patients with AVMs and healthy controls (p = 0.038, r = 0.628). Specifically, patients with frontal AVMs showed significantly lower frontal LIs than did healthy controls (p = 0.032, r = 0.435). In contrast, LIs in cavernoma patients did not differ significantly from controls (p = 0.313). No significant difference was observed between language-adjacent and language-distant lesions (p = 0.14).

CONCLUSIONS: The results of this study suggest that lesion type and location influence language lateralization prediction. Frontal AVMs exhibit significantly lower LIs, requiring caution and experience in interpreting results to ensure patient safety. Cavernomas did not influence LI. Further research with larger cohorts is necessary to understand the underlying causality and neuroplastic changes involved.

PMID:42139736 | DOI:10.3171/2026.1.JNS252444

JMIR Mhealth Uhealth. 2026 May 15;14:e66002. doi: 10.2196/66002.

ABSTRACT

BACKGROUND: Mobile health (mHealth) uses mobile technology as a tool for prevention and health promotion. Research indicates that user engagement is crucial for effective mHealth interventions and improved health outcomes. However, many studies report low adoption rates, rapid decline after initial use, and a lack of acknowledgment of user implications in achieving outcomes. Thus, conceptualizing participation in mHealth is essential to identify key determinants for engaging users.

OBJECTIVE: This scoping review aims to identify and characterize the attributes and definitions of user engagement in mHealth, examine engagement methods, and analyze barriers and facilitators influencing participation.

METHODS: Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, Scopus, Web of Science, and PubMed databases were searched for publications between 2000 and 2025 with a 2-stage selection process.

RESULTS: Out of 2489 articles identified, 1416 were screened, and 52 met the inclusion criteria. Half were recently published in the last 5 years (2020-2025). Existing literature focused on digital interventions for specific populations and health topics. Analysis revealed four main perspectives on engagement in mHealth: (1) usage metrics, (2) subjective user experiences, (3) a hybrid approach that combines both, and (4) a goal-oriented perspective (behavior change or health outcomes).

CONCLUSIONS: To understand the complexity and multifactorial nature of participation, it is relevant to conceptualize it as a dynamic mechanism enabling users to achieve their objectives. Both quantitative use and subjective user experience should be integrated to reach the optimal intervention dose. Recognizing users’ evolving needs, uniqueness, and their socioenvironmental context interdependence, it is essential to involve users in all stages (design, implementation, and iterative evaluation of mHealth). Findings will inform an e-Delphi study to establish consensus on engagement criteria.

PMID:42139698 | DOI:10.2196/66002

JMIR Form Res. 2026 May 15;10:e83199. doi: 10.2196/83199.

ABSTRACT

BACKGROUND: Cardiac auscultation is an essential component of clinical examination but is often challenging to achieve proficiency in. Self-contained, multisensory learning resources that incorporate simultaneous visual and haptic stimuli offer a unique approach to supporting learners in acquiring this core skill.

OBJECTIVE: This pilot study of both medical students and clinical educators evaluated the utility of a novel iPhone app, Haptic Heart, which generates haptic vibrations to simulate heart sounds and murmurs. We aimed to explore the perceptions of students and educators when using haptics as a learning resource and the underlying reasons behind these perceptions and to gather lessons that would inform future development of the resource.

METHODS: Clinical-year medical students from the Lincoln Medical School with access to an iPhone were invited to trial Haptic Heart between October 2023 and December 2024. Cardiology specialists involved in clinical education were also invited to take part. After using the app, participants were asked to complete a modified version of the 12-item Evaluation of Technology-Enhanced Learning Materials: Learner Perceptions questionnaire that included additional free-text items. Educators were also asked to comment on the resource’s authenticity and perceived usefulness. Quantitative responses were analyzed using descriptive statistics; free-text responses were analyzed for common themes.

RESULTS: A total of 21 students and 18 educators completed the evaluation. Both cohorts returned positive responses across nearly all questionnaire items, with students showing near universal agreement that the app was of excellent quality (21/21, 100%), supported their learning needs (21/21, 100%), and would change their clinical practice (20/21, 95.2%). Educators similarly rated the resource highly for learning utility (16/18, 88.9%) and authenticity (13/18, 72.2%). Reported technical difficulties were minimal for students (1/21, 4.8%) and educators (2/18, 11.1%). Analysis of free-text responses suggested that learners valued the ability to “feel” murmurs and to vary heart rate. Educators highlighted the resource’s novelty and innovation, although some noted concerns about audio quality when using a stethoscope to auscultate haptic vibrations directly.

CONCLUSIONS: This pilot evaluation demonstrates the potential of smartphone-based haptic technology as a tool for medical education. Haptic Heart was perceived by both students and educators as an innovative educational tool for cardiac auscultation. Further work should focus on expanding the range of haptic patterns provided and exploring the effectiveness of these resources on learning.

PMID:42139690 | DOI:10.2196/83199