Tag: pubmed

JAMA Netw Open. 2026 Aug 3;9(8):e2628371. doi: 10.1001/jamanetworkopen.2026.28371.

ABSTRACT

IMPORTANCE: Immigrants without US citizenship, or noncitizens, disproportionately endure poverty, labor exclusions, and inadequate health care access-structural drivers of adverse cancer outcomes. While screening is critical for preventing cancer deaths, and cancer is the leading cause of death among noncitizens, little is known about citizenship status and its potential influence on cancer screening.

OBJECTIVES: To examine cancer screening inequities associated with citizenship status, evaluate whether these inequities vary across states, and determine whether structural factors mediate these inequities.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used nationally representative data from the National Health Interview Survey (2010-2023). Eligibility for cancer screening and the timing and types of tests considered appropriate were determined using US Preventive Services Task Force guidelines. Data were analyzed from May to August 2025.

EXPOSURE: Citizenship status: noncitizen (regardless of documentation), naturalized, or US-born.

MAIN OUTCOMES AND MEASURES: Outcomes included colorectal, cervical, or breast cancer screening. Potential mediators included socioeconomic and health care factors (eg, poverty-to-income ratio and insurance), whereas clinical factors (eg, cancer history) were considered confounders. Mediation analysis using nonlinear multiple additive regression tree models was performed to evaluate associations between citizenship status and cancer screening and to identify mediators.

RESULTS: The sample included 131 501 participants eligible for colorectal (3687 [5.1%] noncitizen, median [IQR] age, 61.1 [55.0 to 67.0] years, 39 040 [47.8%] male), cervical (6812 [10.2%] noncitizen, median [IQR] age 41.1 [30.0-52.0]), or breast (1815 [5.1%] noncitizen, median [IQR] age 60.8 [55.0-66.0]) cancer screening. In 2023, noncitizens had significantly lower colorectal (43.6%; 95% CI, 38.7%-48.4% vs 75.5%; 95% CI, 74.6%-76.5%), cervical (57.1%; 95% CI, 53.1%-61.0% vs 71.6%; 95% CI, 70.3%-72.8%), and breast (73.0%; 95% CI, 66.4%-78.7% vs 80.1%; 95% CI, 78.8%-81.3%) cancer screening rates than US-born citizens. These citizenship-based disparities were observed throughout the study period and were present in many states. Noncitizens had significantly lower odds of receiving colorectal (OR, 0.35; 95% CI, 0.32-0.38), cervical (OR, 0.41; 95% CI, 0.38-0.44), and breast (OR, 0.57; 95% CI, 0.52-0.62) cancer screenings than US-born citizens, with socioeconomic and health care factors jointly mediating these inequities (proportion mediated, colorectal cancer: 56.6%; 95% CI, 49.1%-64.2%; cervical cancer: 39.6%; 95% CI, 32.3%-47.0%; breast cancer: 97.1%; 95% CI, 87.1%-107.1%).

CONCLUSIONS AND RELEVANCE: In this nationally representative study, noncitizens had lower rates of cancer screenings, an inequity largely explained by socioeconomic barriers and inadequate health care access. Efforts to increase cancer screening and reduce preventable cancer mortality among noncitizens should focus on improving their health care access.

PMID:42574011 | DOI:10.1001/jamanetworkopen.2026.28371

JAMA Netw Open. 2026 Aug 3;9(8):e2628380. doi: 10.1001/jamanetworkopen.2026.28380.

ABSTRACT

IMPORTANCE: The cost-effectiveness of remote rehabilitation for survivors following critical illness after intensive care unit (ICU) care is unknown.

OBJECTIVE: To evaluate the cost-effectiveness of remote multicomponent rehabilitation compared with standard care following discharge from hospital after an ICU admission.

DESIGN, SETTING, AND PARTICIPANTS: This economic evaluation was conducted within a pragmatic, multicenter, assessor-blinded trial comparing remote rehabilitation delivered online with standard care after discharge from ICU from both National Health Service (NHS) and Personal Social Services (PSS) and societal perspectives over a 6-month time horizon. The trial was conducted from December 2022 to November 2025. The setting was 52 NHS hospitals in the United Kingdom. Participants were adults (aged ≥18 years) within 12 weeks of discharge from hospital that included an ICU admission for critical illness, requiring mechanical ventilation for 48 hours or longer.

INTERVENTIONS: A remotely delivered rehabilitation program or standard care.

MAIN OUTCOMES AND MEASURES: Costs including using questionnaires and microcosting approach (in 2024 UK pounds sterling) and quality-adjusted life-years (QALYs), derived directly from trial data, were calculated per group and reported in terms of incremental cost per QALY gained.

RESULTS: A total of 429 participants (245 men [57%]; mean [SD] age, 55.4 [13.9] years) were enrolled, including 231 (54%) in the intervention group and 198 (46%) in the standard group. From a UK NHS-PSS perspective, the rehabilitation intervention was associated with increased mean costs (£1250; 95% CI, £562-£1938) and QALYs (0.023; 95% CI, 0.007-0.040) per participant, compared with the standard care group. Incremental cost-effectiveness ratio (ICER) was £54 034 per QALY. The probability of rehabilitation intervention being cost-effective was 3% and 11% at UK willingness-to-pay thresholds of £20 000 and £30 000 per QALY, respectively. The intervention was cost-effective for patients with mechanical ventilation for 7 days or less (ICER, £21 476 per QALY) or if a societal perspective was adopted (ICER, £6341 per QALY).

CONCLUSIONS AND RELEVANCE: In this economic analysis, among ICU survivors overall, a remotely delivered multicomponent rehabilitation program was not cost-effective from a UK NHS-PSS perspective. Cost-effectiveness was more favorable from a societal perspective and for patients receiving mechanical ventilation for 7 days or less. For rehabilitation interventions to be both clinically and cost-effective a precision medicine approach to medical and psychosocial health care interventions is needed once patients are home from hospital.

PMID:42574010 | DOI:10.1001/jamanetworkopen.2026.28380

Biometrics. 2026 Jul 1;82(3):ujag140. doi: 10.1093/biomtc/ujag140.

ABSTRACT

For the analysis of interval-censored data, we propose a deep generalized accelerated hazards model. This model is designed to facilitate a detailed exploration of the relationship between various risk factors and the hazard associated with failure time. We develop a sieve maximum likelihood estimation procedure that combines deep neural networks and monotonic splines. By employing deep neural networks, we can effectively capture nonparametric effects, enabling a flexible and adaptive modeling approach for complex relationships. Under certain regularity conditions, we derive a nonasymptotic error bound for the resulting estimator and show that the finite-dimensional estimator is asymptotically normal and achieves the semiparametric efficiency. We conduct simulation studies to evaluate the finite-sample performance of the proposed approach. Furthermore, the proposed method is applied to the Atherosclerosis Risk in Communities study for practical illustration.

PMID:42574000 | DOI:10.1093/biomtc/ujag140

Biometrics. 2026 Jul 1;82(3):ujag138. doi: 10.1093/biomtc/ujag138.

ABSTRACT

Neyman-Pearson (NP) classifiers, which aim to maximize the clinical benefit while adhering to risk constraints, are crucial in many practical fields, including early cancer detection. However, applying these classifiers can be challenging due to discrepancies between the data distributions of the source and target populations. The potential impact can be disproportionately severe for under-represented groups. We propose a semi-parametric model-based approach for adapting NP classifier decision rules to different populations while equitably controlling classification errors specific to clinical applications. Our method involves a shift-adjustment strategy that leverages a small unlabeled sample from the target population, along with minimal auxiliary information and the labeled source data. This approach enhances the applicability of the learned decision rules and ensures they are consistently tailored for the target population. We demonstrate the performance through theoretical studies and simulations and illustrate the approach with an example of a prostate cancer study.

PMID:42573999 | DOI:10.1093/biomtc/ujag138

JAMA Intern Med. 2026 Aug 10. doi: 10.1001/jamainternmed.2026.3332. Online ahead of print.

ABSTRACT

IMPORTANCE: Medicare Advantage (MA) costs 22% more than original Medicare (OM) for a given individual ($83 billion in annual excess public costs). However, MA may improve type 2 diabetes (T2D) outcomes compared with OM by providing financial protections (eg, annual out-of-pocket spending caps) and supplemental benefits (eg, healthy food assistance) that OM cannot.

OBJECTIVE: To determine whether MA coverage is associated with better T2D outcomes than OM.

DESIGN, SETTING, AND PARTICIPANTS: A longitudinal cohort study using target trial emulation principles for design and analysis in adults aged 18 years or older receiving OM or MA with T2D, followed up before and after Medicare coverage in community-based health centers (January 2021 to June 2024) across 44 states. Analyses were conducted from September 2025 to May 2026.

EXPOSURES: MA or OM coverage.

MAIN OUTCOMES AND MEASURES: Hemoglobin A1c (HbA1c) (primary outcome), systolic blood pressure (SBP) and diastolic blood pressure (DBP), low-density lipoprotein (LDL) cholesterol, food insecurity, housing instability, and transportation barriers at 12 months after Medicare coverage (primary time point) and at 6, 18, and 24 months. Statistical analysis accounted for pre-Medicare coverage factors that may influence selection of MA vs OM using targeted minimum loss estimation. Covariates were age, sex, race and ethnicity, comorbidities, income, Social Vulnerability Index, pre-Medicare insurance, Medicaid coverage, and pre-Medicare coverage values for HbA1c, SBP, DBP, LDL cholesterol, body mass index, food insecurity, housing instability, and transportation barriers.

RESULTS: In this study in 34 648 adults (19 054 in OM, 15 594 in MA) with T2D, followed up before and after Medicare coverage, the mean (SD) age was 65.24 (9.73) years and 53.42% were women. Twelve months after Medicare coverage, MA was not associated with better HbA1c (mean difference, 0.01; 95% CI, -0.04 to 0.05, P = .74), SBP (-0.15; 95% CI, -0.54 to 0.24; P = .44), DBP (0.06; 95% CI, -0.15 to 0.27; P = .58), or LDL cholesterol (-0.41; 95% CI, -1.24 to 0.42; P = .33), with similar results at other time points. MA was also not associated with a lower risk of food insecurity (relative risk [RR], 1.00; 95% CI, 0.94-1.05), housing instability (RR, 1.00; 95% CI, 0.91-1.09), or transportation barriers (RR, 1.00; 95% CI, 0.93-1.07) at 12 months or any other time point.

CONCLUSIONS AND RELEVANCE: In this study, when accounting for factors that may drive MA selection, MA was not associated with better T2D outcomes or fewer health-related social needs than OM. Given substantially higher spending for MA, it is important to ensure this spending is being used effectively to improve health.

PMID:42573997 | DOI:10.1001/jamainternmed.2026.3332

Obes Surg. 2026 Aug 10. doi: 10.1007/s11695-026-08895-9. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate whether metabolic bariatric surgery (MBS) influences the risk of alcohol-related liver disease (ARLD), particularly alcoholic cirrhosis, and assess its long-term hepatic implications.

METHODS: This study followed PRISMA guidelines and was prospectively registered in PROSPERO. PubMed, Embase, Web of Science, Scopus, Cochrane Library, and ClinicalTrials.gov were systematically searched from inception to 26 December 2025 for observational cohort studies comparing the incidence of alcoholic cirrhosis between MBS patients and matched non-surgical controls. Data extraction and quality assessment were independently performed, and pooled effect sizes were calculated using random-effects models. Subgroup, sensitivity, and publication bias analyses were conducted. Statistical analyses were performed using Stata 17.0.

RESULTS: Five studies were included. The overall association between MBS and alcohol-related cirrhosis was not statistically significant (OR 1.18, 95% CI 0.91-1.53; p = 0.214), with substantial heterogeneity (I² = 97.5%). However, significantly increased odds were observed in studies with sample sizes ≥ 1,000,000 and in those with follow-up durations ≥ 10 years. Leave-one-out analysis showed that no single study substantially altered the pooled estimate, and Begg’s and Egger’s tests detected no significant publication bias.

CONCLUSIONS: Current evidence does not show a significant overall association between MBS and alcohol-related cirrhosis. However, substantial heterogeneity and increased odds in large-sample and long-term studies preclude firm conclusions regarding long-term hepatic safety.

PMID:42573970 | DOI:10.1007/s11695-026-08895-9

Dermatol Ther (Heidelb). 2026 Aug 10. doi: 10.1007/s13555-026-01884-x. Online ahead of print.

ABSTRACT

INTRODUCTION: Scalp psoriasis is often associated with poor adherence to topical therapy. A novel formulation of calcipotriol and betamethasone dipropionate based on polyaphron dispersion (CAL/BDP PAD-cream) showed improved outcomes and satisfaction in the PRO-SCALP study, particularly in patients with high adherence. We evaluated how adherence to CAL/BDP PAD-cream influences patients- and clinicians-reported outcomes and treatment preferences in mild-to-moderate scalp psoriasis under real-life conditions in Europe.

METHODS: PRO-SCALP patients reported their adherence level using a visual analogue scale (VAS). Outcomes were compared between low- and high-adherence subgroups.

RESULTS: Among 252 patients, 59.9% reported high adherence (VAS 80-100). Older patients and those with moderate disease reported high adherence (both p < 0.05). High-adherent patients reported higher scores in the Treatment Satisfaction Questionnaire for Medication Version 9, for Convenience of use (p = 0.0019) and Global Satisfaction (p = 0.0166) domains, and in the Psychosocial Effects of Scalp Psoriasis Questionnaire (p = 0.0004) at week 8. Both adherence subgroups showed significant reductions in the scalp Worst Itch Numeric Rating Scale (WI-NRS), scalp-modified Psoriasis Area and Severity Index (S-mPASI), and Scalpdex scores (all p < 0.0001 vs. baseline), although high-adherent patients achieved greater improvements in WI-NRS (p < 0.0001), S-mPASI (p = 0.0153), and the Scalpdex Symptoms domain (p = 0.001) than low-adherent. Each 10% increase in adherence corresponded to a 0.10- and 0.35-point reduction in S-mPASI and WI-NRS (both p < 0.05) at week 8. Scalp-Physician Global Assessment success rates were comparable in low- vs. high-adherence subgroups (65.0% vs. 70.5%; p = 0.3633). Sleep quality improved significantly in both subgroups (p < 0.0001). High adherence was associated with higher Patient Preference Questionnaire scores (p = 0.0012), better Cream Usability Scalp Psoriasis Questionnaire ratings (p = 0.0455) and greater product consumption (p < 0.0001), despite similar once-a-day usage.

CONCLUSION: High adherence to CAL/BDP PAD-cream was associated with greater effectiveness, satisfaction, preference, and QoL. While patients with low adherence still benefited, maximizing adherence is key for optimal real-world outcomes in scalp psoriasis.

TRIAL REGISTRATION NUMBER: ClinicalTrials.gov identifier NCT05811234.

PMID:42573965 | DOI:10.1007/s13555-026-01884-x

Esophagus. 2026 Aug 10. doi: 10.1007/s10388-026-01238-8. Online ahead of print.

ABSTRACT

BACKGROUND: Upper gastrointestinal endoscopy traverses the full upper aerodigestive tract, unlike radiography, potentially enabling incidental detection of non-gastric malignancies. However, its population-level incidental detection rate for non-gastric upper aerodigestive tract cancers has not been systematically quantified. The aim of this study was to compare endoscopic screening with radiography and quantify detection of non-gastric upper aerodigestive tract cancers in a population-based setting.

METHODS: This population-based cohort study was conducted by linking the Okayama City municipal gastric cancer screening registry with the Kokuho Database (KDB) for fiscal years 2016-2021. Among 36,326 participants contributing 64,822 screening examinations (40,832 radiography; 23,990 endoscopy), diagnoses of oral cavity, pharyngeal, laryngeal, and esophageal cancer occurring within 2 months of screening were ascertained from the KDB. Generalized estimating equations with modified Poisson regression were used to estimate adjusted risk ratios (aRRs) comparing endoscopy with radiography.

RESULTS: Endoscopic screening was significantly associated with higher composite incidental detection rates for non-gastric upper aerodigestive tract cancers (95.9 vs. 34.3 per 100,000 examinations; aRR 2.94, 95% confidence interval [CI] 1.50-5.76; p = 0.002). Specifically, esophageal cancer detection was markedly higher with endoscopy (83.4 vs. 17.1 per 100,000; aRR 5.16, 95% CI 2.16-12.32; p < 0.001). No statistically significant differences were observed for oral cavity, pharyngeal, or laryngeal cancers.

CONCLUSIONS: Endoscopic gastric cancer screening is associated with substantially higher incidental detection of non-gastric upper aerodigestive tract cancers, particularly esophageal cancer. These findings suggest an additional detection value for endoscopy that extends beyond its primary gastric cancer target in organized screening programs.

PMID:42573963 | DOI:10.1007/s10388-026-01238-8

Environ Sci Pollut Res Int. 2026 Aug 10. doi: 10.1007/s11356-026-38124-w. Online ahead of print.

ABSTRACT

The transfer of pesticides to Aiguillon Bay, a major coastal ecosystem on the Atlantic coast of France, was investigated in relation to watershed characteristics, agricultural pressure, and hydrological dynamics. The bay receives inputs from three main rivers (Sèvre Niortaise, Lay, and Curé) as well as from the Vieux channel, a downstream branch of the Lay watershed characterized by distinct land-use and drainage features. This study combined spatial land-use analysis with contamination indicators to clarify pesticide transfer pathways and associated ecological risks in intensively cultivated sub-basins. Monthly surface water samples were analyzed using LC-MS/MS and GC-MS/MS. A Proximity Indicator was developed to identify high-pressure agricultural zones adjacent to watercourses. Individual Risk Quotients (RQs) were also calculated by comparing measured environmental concentrations with Predicted No-Effect Concentrations (PNECs) to evaluate the ecological risk associated with selected pesticide compounds, and the Cumulative Toxic Pressure Index (CTPI) was applied to assess mixture toxicity. CTPI analysis revealed recurrent exceedances of the toxicity threshold (CTPI > 1) across all monitored systems, with strong seasonal variability linked to hydrological conditions. The Sèvre Niortaise and Vieux channel exhibited sustained mixture pressure, whereas the Lay showed pronounced event-driven peaks associated with rainfall episodes. Despite its smaller size, the Curé watershed displayed disproportionately high toxic pressure, reflecting strong hydrological connectivity and cereal-dominated land use. Herbicides and their metabolites were the primary contributors to mixture toxicity, including the persistent metabolite chlorothalonil R471811, frequently detected despite its regulatory ban in 2020, suggesting legacy contamination and progressive remobilization. Although individual Risk Quotients indicated negligible ecological risk for the selected compounds, CTPI revealed repeated mixture toxicity exceedances, demonstrating that cumulative effects represent the primary ecological pressure within the watershed. By integrating land-use characterization, hydrological analysis, statistical comparison, mixture toxicity assessment, and ecological risk evaluation, this study provides a comprehensive framework for understanding pesticide transfer to protected coastal ecosystems and supports the development of more effective watershed management and monitoring strategies.

PMID:42573961 | DOI:10.1007/s11356-026-38124-w

Sleep Breath. 2026 Aug 10;30(4):236. doi: 10.1007/s11325-026-03781-1.

ABSTRACT

INTRODUCTION: Obstructive sleep apnea (OSA) commonly coexists with Restless Legs Syndrome (RLS). Positive Airway Pressure (PAP) treatment for coexisting OSA may alleviate RLS symptoms. However, RLS often contributes to insomnia, leading to difficulties with sleep initiation and maintenance that may compromise PAP adherence. Objective long-term adherence data in patients with comorbid RLS and OSA remains limited. This study evaluated PAP therapy adherence and its determinants in patients with comorbid RLS and OSA.

METHODS: This retrospective cohort study included patients with RLS who reported snoring and underwent overnight polysomnography (PSG) from Jan 2022 to July 2024, at the Division of Sleep Medicine in the Peking University People’s Hospital. Clinical features and objective PAP adherence were collected. And factors influencing adherence were assessed through semi-structured interviews. Patients were followed up 1 year after PAP initiation. Good adherence was defined as device use for ≥ 4 h/night on ≥ 70% of nights.

RESULTS: Among 114 patients with RLS, 84 (73.7%) had comorbid OSA. Of these, 70 initiated PAP therapy, 37 acquired devices and only 25 provided objective adherence data. The proportion of adherent users declined progressively: 76% at 1 week, 36% at 1 month, 20% at 3 months, 16% at 6 months and 12% at 1 year. Main influencing factors included a perceived lack of need or unwillingness to continue PAP treatment, device intolerance and socioeconomic burden.

CONCLUSIONS: Long-term PAP adherence appears suboptimal in this cohort of patients with comorbid RLS and OSA. Interventions targeting sleep symptom relief, device tolerability and socioeconomic factors may improve treatment adherence.

PMID:42573935 | DOI:10.1007/s11325-026-03781-1