Tag: pubmed

JMIR Res Protoc. 2026 Apr 1;15:e83377. doi: 10.2196/83377.

ABSTRACT

BACKGROUND: Retention of specialists is critical for sustaining health system performance. In Malaysia, the Ministry of Health (MOH) has implemented multiple workforce retention strategies (WRSs) to enhance job satisfaction and reduce turnover among specialists. However, evidence on specialists’ awareness, participation, and perceived effectiveness of these strategies remains limited. To address this gap, we plan to administer a standardized survey among specialists in MOH health care facilities to guide evidence-based strategic planning toward specialist retention.

OBJECTIVE: This protocol describes a national-level online survey to assess MOH specialists’ perceptions of WRS and examine their associations with job satisfaction and turnover intention, using REDCap (Research Electronic Data Capture) to ensure real-time data collection within a robust and secure digital platform.

METHODS: A cross-sectional mixed methods study will be conducted among 1325 MOH specialists selected through systematic random sampling from the Human Resource Management Information System. Data collection will be implemented using a REDCap-based workflow to support secure and efficient survey administration. REDCap functionalities will be used, including automated survey invitations with nontransferable links to prevent duplicate responses, branching logic to tailor item relevance, auto-reminder scheduling, and real-time data validation to minimize entry errors. The self-administered questionnaire comprises measures of specialists’ awareness, participation, and perceived effectiveness of 12 MOH-implemented WRSs, job satisfaction assessed using the Job Satisfaction Survey, and turnover intention measured with the Turnover Intention Scale-6, as well as 2 optional open-ended questions for qualitative input to strengthen the quantitative results. A pilot study will be conducted to assess instrument reliability and REDCap platform usability. Quantitative data will be exported from REDCap for descriptive and inferential analyses, while qualitative responses will undergo thematic analysis using NVivo and be integrated with quantitative findings during interpretation.

RESULTS: This study will generate vital evidence of MOH specialists’ engagement with WRSs and how perceptions of these strategies related to their job satisfaction and turnover intention. Participant recruitment and data collection have been completed, and the study is in the data analysis phase. It is expected that the data analysis will be completed in March 2026 and that the results will be published in June 2026.

CONCLUSIONS: This protocol establishes a REDCap-based survey for conducting large-scale research focused on MOH specialists. Findings are expected to guide data-driven improvements to WRS implementation within the MOH Malaysia and may serve as a useful methodological model for similar research in public sector workforce studies.

PMID:41921120 | DOI:10.2196/83377

JCO Oncol Pract. 2026 Apr 1:OP2501270. doi: 10.1200/OP-25-01270. Online ahead of print.

ABSTRACT

PURPOSE: The objective of priority review is to expedite the review duration for drugs that provide significant improvements. We analyzed the duration of regulatory review of cancer drugs granted priority versus nonpriority review and differences in the proportion of cancer drugs with high therapeutic value granted priority versus nonpriority review in the United States, European Union, and Switzerland.

METHODS: In this cross-sectional study, we used US Food and Drug Administration’s (FDA), European Medicines Agency’s (EMA), and Swissmedic’s databases to identify all new cancer drugs approved in 2010-2024, their submission and approval dates, and approval pathways. European Society for Medical Oncology-Magnitude of Clinical Benefit Scale (ESMO-MCBS) and ESMO-Magnitude of Clinical Benefit Scale for Haematological Malignancies scores were calculated to assess their therapeutic value. We applied summary statistics (medians and IQR) to describe differences in review duration for priority versus nonpriority review. Review duration was calculated from submission to approval date. For estimated differences in proportions of high therapeutic value scores for drugs granted priority versus nonpriority review, we calculated classical normal 95% CIs.

RESULTS: In all, 144 (86%) of 168 cancer drugs were granted priority review by the FDA, 37 (25%) of 147 by EMA, and 37 (28%) of 132 by Swissmedic. Of those, the FDA reviewed 30%, EMA 5%, and Swissmedic 49% within the required time period; review duration was similar for drugs with high and low therapeutic value. The difference in the proportion of high value scores between priority and nonpriority review was -4% (95% CI, -20 to 13) for the FDA, 22% (95% CI, 6 to 38) for EMA, and 17% (95% CI, <1 to 33]) for Swissmedic.

CONCLUSION: It could be beneficial for patients if agencies applied more scrutiny in the selection of which cancer drugs to grant priority review. Such drugs should have a high therapeutic value, and their review should be completed in a timely manner to enable quicker access to important cancer drugs for patients. Although the FDA would need to take the most substantial steps, EMA and Swissmedic could also improve their systems.

PMID:41921119 | DOI:10.1200/OP-25-01270

JCO Oncol Pract. 2026 Apr 1:OP2501182. doi: 10.1200/OP-25-01182. Online ahead of print.

ABSTRACT

PURPOSE: Contact days exceeding trial protocol-mandated care may represent adverse clinical events and portend worse outcomes. Identifying patients at risk of poor outcomes could enable clinical teams to intervene early and support patients’ needs.

MATERIALS AND METHODS: We linked data from 6 SWOG trials to Medicare claims. We calculated contact days (days with ambulatory, emergency department, inpatient, or facility-based care) and their composition using protocol calendars. Total contact days were delineated as protocol-mandated (planned) ambulatory or unplanned (including unplanned ambulatory v unplanned inpatient). Cox frailty landmark regression analysis was used in a random 60% training set to identify the optimal threshold (percentile) and landmark (months) for contact-day measures as the predictor based on the chi-square statistic. Candidate predictors were tested in the remaining 40% sample.

RESULTS: We included 1,429 patients (median age, 71 years, 7.6% Black, 21.4% female). In the first 3 months, among 15,301 contact days in the training set (6.4 contact days per person per month; 21.2% of total days), 4,102 (26.8%) were protocol-mandated ambulatory, and 11,199 (73.2%) were unplanned (including 7,328 [47.9%] ambulatory and 3,871 [25.3%] inpatient). The 2-month follow-up time at the 75th percentile threshold was the optimal model in the training set. In the test set, unplanned contact days, especially unplanned inpatient contact days, were associated with subsequent survival (≥1 unplanned inpatient contact days, adjusted hazard ratio, 1.25 [1.02-1.52], P = .014).

CONCLUSION: One in five trial follow-up days was a health care contact day, of which the majority were unplanned ambulatory contact days. Meaningfully decreasing contact-day burdens will require addressing uncoordinated unplanned ambulatory contact days. The low threshold (≥1 in the first 2 months) of unplanned inpatient days in predicting mortality highlights the adverse impact of any acute care use on survival.

PMID:41921118 | DOI:10.1200/OP-25-01182

JMIR Public Health Surveill. 2026 Apr 1;12:e85875. doi: 10.2196/85875.

ABSTRACT

BACKGROUND: Utilization of the maternal continuum of care (CoC)-comprising adequate antenatal care (ANC), skilled birth attendance, and postnatal care (PNC)-is critical for improving maternal and child health outcomes. However, dropout from the CoC remains substantial in Bangladesh, with women discontinuing services at different stages of pregnancy, delivery, and postpartum care.

OBJECTIVE: This study aimed to quantify maternal dropout at each stage of the CoC and identify socioeconomic and demographic factors associated with discontinuity, comparing two nationally representative survey rounds.

METHODS: Data were drawn from the Bangladesh Demographic and Health Surveys (BDHS) 2017-2018 and 2022. Women aged 15 to 49 years with a live birth in the preceding 2 to 3 years were included. Completion of full CoC was defined as receiving at least 4 ANC visits, delivering with a skilled birth attendant, and obtaining at least 1 PNC contact within 48 hours of delivery. Predisposing (age, education, parity, religion, and division), enabling (wealth index, media exposure, health care access, and residence), and need factors (terminated pregnancy and desired pregnancy status) were identified using the Andersen Behavioral Model. Survey-weighted multivariable logistic regression models were fitted for each CoC component and overall CoC completion, with interaction terms to assess whether associations differed between survey rounds.

RESULTS: Among 8424 mothers, 27.9% (n=2350) failed to complete all components of the maternal CoC. Dropout was highest at the ANC stage (n=4962, 55.7%), followed by PNC (n=3976, 47.2%) and skilled birth attendant-assisted delivery (n=3378, 40.1%). Between survey rounds, overall CoC dropout decreased significantly from 31.9% (BDHS 2017-2018) to 22.4% (BDHS 2022), reflecting modest improvements in service continuity. Factors significantly associated with higher odds of CoC dropout included lower maternal education (adjusted odds ratio [AOR] 2.70, 95% CI 1.94-3.77; P<.001), higher parity (AOR 2.73, 95% CI 2.12-3.50; P<.001), lower wealth quintiles (AOR 4.04, 95% CI 3.02-5.41; P<.001), and rural residence (AOR 1.40, 95% CI 1.18-1.67; P<.001). Protective factors included older maternal age at delivery (AOR 0.56, 95% CI 0.42-0.74; P<.001) and history of ever-terminated pregnancy (AOR 0.74, 95% CI 0.63-0.86; P<.001). Significant temporal interactions (all P<.05) indicated that the strength of associations for education, parity, religion, wealth, media exposure, health care access barriers, residence, and pregnancy desire differed between survey rounds, reflecting changing determinants of CoC engagement amid policy reforms and pandemic disruptions.

CONCLUSIONS: Maternal, socioeconomic, and geographic factors are strongly associated with discontinuity along the maternal health care continuum in Bangladesh. Statistically significant temporal variations underscore the impact of evolving health policies and system disruptions on maternal service utilization patterns. Targeted, area-specific interventions addressing these determinants across all CoC components are essential to improve maternal health care retention and achieve better maternal and child health outcomes.

PMID:41921113 | DOI:10.2196/85875

Acta Orthop. 2026 Apr 1;97:225-231. doi: 10.2340/17453674.2026.45693.

ABSTRACT

BACKGROUND AND PURPOSE: In elastic stable intramedullary nailing (ESIN) for forearm fractures, nail protrusion may cause irritation-related implant removal. The primary aim was to evaluate implant retention after nail impaction, and secondarily to assess secondary procedures, complications, and protrusion as a predictor of removal.

METHODS: We analyzed a retrospective cohort of children with diaphyseal forearm fractures treated with impacted ESIN between 2017 and 2024. Implant retention was defined as no nail removal at record review. Secondary procedures were unplanned operations, while complications were adverse events managed conservatively. Radiographic nail protrusion was measured as extraosseous nail length and evaluated using receiver operating characteristic analysis to predict irritation-related implant removal.

RESULTS: 160 children with diaphyseal forearm fractures were included. At a mean observation time of 5 years, 132/160 children retained their implants (83%, 95% confidence interval [CI] 76-88). Secondary procedures occurred in 30/160 patients (19%, CI 13-26), most commonly irritation-related implant removal (10%, CI 6-16) and refracture (6%, CI 3-10). Complications occurred in 19/160 patients (12%, CI 7-18), including superficial radial nerve symptoms (7/160; 4.4%) and irritation without implant removal (6/160; 3.8%). A protrusion threshold of 3.3 mm predicted irritation-related implant removal (AUC 0.79, CI 0.71-0.86; sensitivity 100%, CI 83-100; specificity 55%, CI 49-61). No irritation-related removals occurred below this threshold.

CONCLUSION: Impacted ESIN was associated with high long-term implant retention, although secondary procedures and complications occurred in about one-third of the patients. A protrusion threshold of 3 mm was linked to irritation-related removal and may guide implant retention.

PMID:41921102 | DOI:10.2340/17453674.2026.45693

Acta Orthop. 2026 Apr 1;97:217-224. doi: 10.2340/17453674.2026.45695.

ABSTRACT

BACKGROUND AND PURPOSE: Denosumab may preserve periprosthetic bone mineral density (pBMD) around uncemented total hip arthroplasty (THA) components. This exploratory analysis of a previously published randomized controlled trial (RCT) aimed to assess the effects of denosumab on BMD 5 years after treatment cessation.

METHODS: 64 non-osteoporotic patients undergoing uncemented THA were enrolled in a randomized, double-blind, placebo-controlled phase-2 trial and received either 2 doses of denosumab or placebo. The primary outcome was pBMD at 12 months, measured by dual-energy X-ray absorptiometry (DEXA). At a mean follow-up of 5.6 years (range 4.3-7.3), 54 patients remained for clinical assessment, DEXA, and plain radiography. The study was registered on ClinicalTrials.gov (NCT01630941).

RESULTS: No differences in pBMD in the acetabular Digas zones or femoral Gruen zones were found between the groups at 5 years. The estimated mean difference in the sum of all zones around the cup was 0.042 g/cm² (95% confidence interval [CI] -0.31 to 0.35; P = 0.8), and for the sum of all Gruen zones -0.06 g/cm² (CI -0.55 to 0.43; P = 0.8). No statistically significant differences were observed in patient-reported outcome measures or the incidence of heterotopic ossification. A gradual decline in pBMD was evident.

CONCLUSION: At 5 years, the adjusted between-group difference and its 95% confidence interval showed no statistically or clinically relevant effect of denosumab. Whether longer treatment duration or a sequential post-denosumab regimen could influence long-term periprosthetic bone preservation is unknown.

PMID:41921101 | DOI:10.2340/17453674.2026.45695

Opt Lett. 2026 Apr 1;51(7):1800-1803. doi: 10.1364/OL.589508.

ABSTRACT

In this Letter, we propose a resilient non-line-of-sight (NLOS) optical camera communication (OCC) system addressing the critical challenges of stochastic data loss and spatial division multiplexing (SDM). It integrates two core innovations: a unified byte-level RaptorQ coding scheme that reconstructs source blocks from fragmented data, obviating the need for repetitive transmissions and increasing throughput by 49% for a data reception ratio (DRR) of 0.82 and a 4-byte payload; and the normalized variance ratio (NVR), a novel, to the best of our knowledge, statistical metric that enables NLOS SDM by adaptively identifying distinct data streams within partially superimposed light patterns. Experimental validation demonstrates the system’s resilience: at 0.8 m, our NVR-enabled NLOS SDM 2-LED system delivers 4.4 kbps throughput while maintaining a bit error rate (BER) below 10^-5. This result offers a substantial reliability advantage over other OCC systems such as ReflexCode, showcasing the system’s potential for practical applications.

PMID:41920627 | DOI:10.1364/OL.589508

JMIR Cancer. 2026 Apr 1;12:e72647. doi: 10.2196/72647.

ABSTRACT

BACKGROUND: People with cancer often experience unmet needs during treatment and survivorship, which can impact their ability to carry out daily tasks, reduce their quality of life, and limit their participation in work and social activities. Cancer Coach by CancerAid (now known as Osara Health) is a digital health intervention designed to address these needs through a combination of synchronous telehealth coaching and an asynchronous mobile app that supports behavior change and emotional well-being.

OBJECTIVE: This study aimed to evaluate the impact of Cancer Coach by CancerAid on the mental and physical health of people with cancer using patient-reported outcomes.

METHODS: Participants were referred to the program via insurers and hospital clinics. Health coaches administered the Patient-Reported Outcomes Measurement Information System 10-item Global Health Short Form via telephone at both the beginning and end of the intervention. This tool measures global physical health (GPH) and global mental health (GMH). Pre- and postintervention scores were analyzed using Wilcoxon signed rank tests. Independent 2-tailed t tests assessed whether changes in GPH and GMH scores were associated with the use of health coaching alone or in combination with the mobile app.

RESULTS: Statistically significant improvements were observed in both GPH (z=-4.97; P<.001; r=0.37) and GMH (z=-4.53; P<.001; r=0.34), indicating moderate effect sizes in the 89 participants. The average T score point changes of 4.43 for GPH and 4.58 for GMH represented a minimal important change for participants. The improvement in the group GMH T score was reflected in the move from “good” to “very good” mental health status. Participants who engaged with both health coaching and the mobile app showed greater improvements in physical health, whereas those who received health coaching alone exhibited higher gains in mental health. This suggests that the mode of support may influence specific health outcomes.

CONCLUSIONS: The use of the Patient-Reported Outcomes Measurement Information System 10-item Global Health Short Form showed that participants had significant improvements in physical and mental health after participating in the Cancer Coach by CancerAid️ intervention. The integration of telehealth coaching with app-based support may enhance overall well-being and address holistic needs during cancer treatment and survivorship.

PMID:41920589 | DOI:10.2196/72647

JMIR Form Res. 2026 Apr 1;10:e87094. doi: 10.2196/87094.

ABSTRACT

BACKGROUND: Artificial intelligence (AI)-enabled digital health kiosks are increasingly used in workplaces and communities to promote health awareness, especially in low- and middle-income countries. However, evidence on their real-world use, user acceptability, and immediate behavioral responses remains limited, especially outside formal clinical care.

OBJECTIVE: This study evaluated the implementation experience, user acceptability, and immediate self-reported actions associated with the use of an AI-enabled workplace health kiosk among public school teachers in an urban, low-resource setting in the Philippines.

METHODS: We conducted a study involving 384 teachers who used an AI health kiosk during wellness activities. The kiosk provided informational health indicators. Postuse surveys assessed usability; trust; privacy concerns; and self-reported actions, such as health consultations and sharing results. Analyses were descriptive and exploratory. The study did not evaluate diagnostic accuracy, clinical validity, disease prevalence, or health outcomes.

RESULTS: Most participants (162/189, 85.7%) rated the kiosk experience as good or excellent, and 93.1% (176/189) found it easy to use. Overall, trust in kiosk results was high, although 31.7% (60/189) of the participants expressed privacy concerns. After using the kiosk, 70.9% (134/189) of the participants consulted a health care professional, and 66.7% (126/189) made lifestyle changes. A small percentage (32/189, 16.9%) reported no follow-up actions, mainly due to uncertainty about the next steps. User feedback highlighted convenience and accessibility but also noted operational issues such as queuing and connectivity problems.

CONCLUSIONS: In this workplace setting, an AI health kiosk was feasible, acceptable, and linked to immediate self-reported health actions. Findings are preliminary and context specific. Formal validation, follow-up studies, and further evaluation are needed before use in diagnostic, population health, or policy contexts.

PMID:41920576 | DOI:10.2196/87094

JAMA Netw Open. 2026 Apr 1;9(4):e263419. doi: 10.1001/jamanetworkopen.2026.3419.

ABSTRACT

IMPORTANCE: While numerous states have enacted laws to reduce access to firearms among high-risk individuals, the evidence regarding the associated outcome of reducing firearm suicide has been mixed, in part due to methodological limitations.

OBJECTIVE: To examine the association between state firearm laws and firearm-related suicide deaths across all 50 US states during the period from 1976 to 2024.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study, conducted in December 2025, used a difference-in-differences fixed-effects panel regression with Prais-Winsten correction applied to annual state-level data on firearm-related suicides from all 50 US states from January 1976 through December 2024. Sample data were obtained from the Centers for Disease Control and Prevention-maintained Web-based Injury Statistics Query and Reporting System.

EXPOSURES: Six firearm laws with prior evidence or theoretical plausibility of affecting risk of suicide: (1) required permits to purchase handguns; (2) waiting periods for firearm purchases; (3) laws requiring permits for concealed carry; (4) minimum age requirements; (5) extreme risk protection order laws; and (6) state permit requirements for gun dealers. Laws were modeled with a 2-year lag.

MAIN OUTCOMES AND MEASURES: The primary outcome was annual, age-adjusted, state-specific firearm suicide rate, and the negative control outcome was nonfirearm suicide rate. Models accounted for serial autocorrelation and heteroskedasticity in the data and adjusted for a range of sociodemographic covariates.

RESULTS: Across the study period, 2450 observations were collected. The mean overall suicide rate was 13.7 deaths per 100 000 with 7.9 deaths per 100 000 for firearm-related suicide and 5.8 deaths per 100 000 for non-firearm-related suicide. Firearm suicide rates varied 8-fold across states in 2024 (1.8 deaths per 100 000 in New York vs 15.1 deaths per 100 000 in Wyoming). Handgun permit laws (-6.7%; 95% CI, -9.7% to -3.7%), waiting periods (-12.5%; 95% CI, -22.1% to -1.7%), and requirements for a license for concealed carry (-8.9%; 95% CI, -13.1% to -4.8%) were significantly associated with decreases in firearm suicide rates but not with nonfirearm suicide rates. States with 1 (-8.1%; 95% CI, -11.4% to -4.7%), 2 (-12.5%; 95% CI, -16.3% to -8.5%), or all 3 (-25.3%; 95% CI, -34.2% to -15.2%) of these laws (handgun permit requirements, waiting periods, and concealed carry permits) had progressively lower firearm suicide rates.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study analyzing data from 49 years and 50 states, permit-to-purchase requirements for handguns, waiting periods, and the requirement for a license for concealed carry were each independently and cumulatively associated with significantly lower firearm suicide rates.

PMID:41920544 | DOI:10.1001/jamanetworkopen.2026.3419