Tag: pubmed

JMIR Med Educ. 2026 May 5;12:e85967. doi: 10.2196/85967.

ABSTRACT

BACKGROUND: Three-dimensional modalities are increasingly being used as adjuncts for medical trainees learning about complex anatomical concepts, such as congenital heart disease.

OBJECTIVE: This study aimed to evaluate the use of 2 such modalities, 3D-printed models, and augmented reality (AR), in improving medical students’ understanding and knowledge retention of congenital heart disease when compared to traditional teaching methods.

METHODS: A prospective cohort pilot study was performed with 26 first-year medical students. Students were randomly assigned to receive a 30-minute teaching session using traditional slide-based lecture, 3D-printed model, or AR. Participants completed a 16-question pretest consisting of 4 basic general cardiology questions and 6 questions each regarding the anatomy and physiology of tetralogy of Fallot and hypoplastic left heart syndrome. Participants completed a posttest immediately following the teaching session, as well as a delayed posttest 3 weeks later.

RESULTS: When comparing overall and subsection posttest scores, the AR group obtained perfect immediate posttest scores at a significantly increased rate compared to the lecture and 3D model groups (6/9, 67% vs 1/8, 13% and 1/9, 11%, respectively; large effect size Cramér V=0.57; P=.02). Participants in the lecture group reported difficulty understanding cardiac anatomy and physiology using only 2D diagrams, whereas those in the 3D-printed model and AR groups almost unanimously reported improved visualization of complex cardiac defects, which enhanced their understanding.

CONCLUSIONS: Due to the visuospatial benefits of 3D-printed models and AR, there is potential for use in medical education to improve students’ knowledge of complex anatomical and physiological concepts. Students who received teaching using 3D-printed models or AR overwhelmingly reported improved 3D visualization of congenital cardiac defects compared to those who were taught via lecture. Additionally, AR and 3D-printed models offer practical opportunities for implementation into medical education curricula as both adjunct and stand-alone teaching modalities.

PMID:42085666 | DOI:10.2196/85967

Health Promot Int. 2026 May 5;41(3):daag058. doi: 10.1093/heapro/daag058.

ABSTRACT

Healthcare costs not subsidized by the government and are covered by patients, are known as out-of-pocket healthcare expenditure (OOPHE). In Australia, OOPHE disproportionately impacts Aboriginal households, particularly in rural and remote regions. Currently no patient reported measures (PRM) to assess OOPHE exist, despite being an identified priority in Aboriginal communities. This study developed and psychometrically evaluated (validity and test-retest reliability) of an OOPHE PRM for Aboriginal households in outer regional to remote areas. This Aboriginal led study was governed by an Aboriginal Governance Group, which involved a 4-stage process: (i) identification of community-derived OOPHE themes; (ii) item development and expert judgment quantification; (iii) exploratory factor analysis (EFA) to determine factor structure through pilot testing with Aboriginal participants; and (iv) assessment of reliability and stability through test-retest methods. Stage 1 identified OOPHE themes (i.e. barriers, financial strain), informing development of a 15 item PRM in Stage 2. In Stage 3, 39 Aboriginal participants completed Test 1, with EFA revealing a two-factor model; Factor 1 (8 items, internal consistency = 0.91) and Factor 2 (6 items, internal consistency = 0.85). In Stage 4, 32 participants completed Test 2, with over 60% of items showing substantial to perfect agreement (κ = 0.61-0.87) and scale-level reliability as good to excellent (ICC = 0.75-0.92). Two items performed poorly and were removed, resulting in a final 13-item PRM. The OOPHE PRM demonstrates promising psychometric properties as a culturally grounded measure of OOPHE burden among Aboriginal families, supporting advocacy for equitable policy, funding, and health system reform.

PMID:42085664 | DOI:10.1093/heapro/daag058

JMIR Form Res. 2026 May 5;10:e90261. doi: 10.2196/90261.

ABSTRACT

BACKGROUND: Outdoor secondhand smoke (SHS) remains a public health concern, particularly around designated outdoor smoking areas where nonsmokers may pass through or remain nearby. Although prior studies have quantified outdoor SHS concentrations, fewer have examined how many people may be present within a plausible exposure setting. Estimating the exposure-opportunity level requires methods that are feasible, scalable, and minimally intrusive.

OBJECTIVE: This study aimed to evaluate the feasibility of using passive Wi-Fi packet sensing, calibrated with brief on-site observation, to estimate the number of smokers and passersby within a plausible SHS exposure range at a public outdoor smoking area in Japan.

METHODS: We conducted a formative field study at a designated outdoor smoking area at the Asia Pacific Trade Center in Osaka, Japan. A passive Wi-Fi packet sensor collected timestamps, anonymized device identifiers, organizationally unique identifiers, and received signal strength indicator (RSSI) values from October 13 to 29, 2023. The main analysis focused on October 28, 2023, a high-footfall event day selected for direct calibration. Episodes were classified using empirically derived RSSI thresholds, and class-specific calibration ratios were applied to estimate day-level counts.

RESULTS: Of 128,313 anonymized detections recorded on October 28, 90.3% (115,950/128,313) occurred during business hours. Among these, 8.6% (n=11,068) identifiers were detected more than once. Dwell time could be calculated for 1.4% (n=1817) of the identifiers, and 0.5% (n=659) eligible presence episodes remained after preprocessing. During a 30-minute validation window, smokers and passersby were counted manually within a 25-m radius. During the validation window, 6230 signal records formed 104 stays, with a mean stay duration of 9.89 (SD 7.89) minutes. During the validation window, direct observation recorded 14 smokers and 207 passersby within the 25-m radius. Applying the rule-based classification and calibration ratios to business hours data yielded estimated day totals of 262 smokers and 3907 passersby within the plausible SHS exposure range. Estimated smoker counts showed 2 peaks, around noon and 4 PM, whereas passerby volume peaked around midday. In an exploratory analysis, a random forest model using stay duration, mean RSSI, and RSSI variability achieved an accuracy of 0.95, sensitivity of 0.75, specificity of 0.97, and area under the receiver operating characteristic curve of 0.99.

CONCLUSIONS: This formative field study suggests that passive Wi-Fi packet sensing, combined with brief on-site observation, can be used to estimate population-level exposure opportunity around an outdoor smoking area. The method identified substantial numbers of potentially exposed passersby in a high-footfall public setting. Although the findings are site specific and preliminary, they indicate that exposure-count metrics may complement concentration-based and survey-based SHS research. Further studies incorporating repeated validation, direct pollutant monitoring, and multiple sites are needed to refine the method and strengthen its usefulness for tobacco control and public health decision-making.

PMID:42085663 | DOI:10.2196/90261

JMIR Hum Factors. 2026 May 5;13:e86152. doi: 10.2196/86152.

ABSTRACT

BACKGROUND: Digital remote monitoring using smartphones and wearable devices is a promising solution for psychosis management, where precise, time-sensitive intervention is crucial. Combining active symptom monitoring (ASM) and passive sensing (PS) can support self-management by allowing remote, low-burden mental health monitoring.

OBJECTIVE: This study aimed to explore (1) views on collecting data using ASM and PS methods and comfort levels with different types of data gathered via these methods, (2) views on using smartphones and wearable devices in the context of mental health care, and (3) the ownership and usage of smartphones and wearable devices.

METHODS: We conducted a cross-sectional survey study with service users with psychosis in the United Kingdom between March 2023 and March 2024.

RESULTS: A total of 309 participants completed the survey. They reported mixed views on using ASM and PS technologies for monitoring mental health, with more participants endorsing the concept than opposing it (ASM: n=145, 46.9% and PS: n=132, 42.7%). However, the type of data gathered using these methods was an important factor. Collecting personal information was deemed less acceptable (P<.001) than other data types (physical health, mental health, environment, and nonpersonal device information).

CONCLUSIONS: We found that participants were comfortable with using apps and wearables for digital remote monitoring, though personal information was less acceptable than other data types due to privacy and surveillance concerns. This highlights the importance of further exploring trust issues related to digital monitoring and ensuring that end users have choices regarding the types of data that digital systems gather and share with mental health services.

PMID:42085662 | DOI:10.2196/86152

Turk Arch Pediatr. 2026 Mar 23;61(5):438-443. doi: 10.65717/TurkArchPediatr.2026.25309.

ABSTRACT

OBJECTIVE: Serum Krebs von den Lungen-6 (KL-6) level increases in interstitial lung disease and lung cancer. The present study investigated whether there was an increase in serum KL-6 levels in patients with bone sarcoma who were considered positive for lung metastasis.

MATERIALS AND METHODS: Serum samples were collected from patients diagnosed with Ewing sarcoma and osteosarcoma before starting chemotherapy. The samples were frozen and stored at -80°C, and serum KL-6 level was measured using enzyme-linked immunosorbent assay.

RESULTS: Serum samples of 47 patients and 42 healthy volunteers were evaluated. At the time of diagnosis, 10 patients had pulmonary tumor metastasis. Patients were followed up for a median of 43 months (1-125 months). At the time of diagnosis, the median KL-6 level of patients with lung metastases was 38.15 U/mL (10.6-155.6 U/mL), while the KL-6 level of patients without lung metastases was 15.2 U/mL (10.7-188.3 U/mL). The difference between these 2 groups was borderline significant (P = .051). The median KL-6 value of the control group was 14.85 U/mL (10.3-188.6 U/mL). When the patients with lung metastasis at the time of diagnosis were compared with the healthy control group, the KL-6 level of the patients was statistically significantly higher than the control group (P = .017).

CONCLUSION: In this pilot study, it was found that serum KL-6 levels were elevated in patients with lung metastasis at the time of diagnosis compared to healthy controls. Serum KL-6 level may be used as an additional parameter to detect pulmonary metastasis, and further studies are needed to confirm this observation.

PMID:42084889 | DOI:10.65717/TurkArchPediatr.2026.25309

Turk Arch Pediatr. 2026 May 4;61(5):406-413. doi: 10.65717/TurkArchPediatr.2026.25344.

ABSTRACT

OBJECTIVE: “Nutrition Friendly School Initiative” (NFSI) project intends to improve school health by increasing sensitivity about healthy feeding and active life and supporting good practices on this topic. The study aimed to evaluate the effect of this project on eating habits and anthropometric values in school-aged children.

MATERIALS AND METHODS: A total of 516 children from 2 nutrition friendly schools and 4 nonnutrition friendly schools are included. Eating habits and behaviors are evaluated by questionnaires. Weight and height z scores, weight for height and body mass index percentages were calculated. Eating habits and anthropometric values were compared between schools that are and are not nutrition friendly.

RESULTS: Students from nutrition-friendly schools were consuming fruits more frequently. Their families also preferred homemade foods. Most of the children had a tendency to consume vegetables, vegetable meals, and fruits. Malnutrition was present in 102 (19.8%) of the children, whereas 328 (63.5%) were normal and 86 (16.7%) were overweight and obese. Overweight and obesity were higher in control group (n=48, 19.0% vs. n=38, 14.4%, P=.342), but this was not statistically significant.

CONCLUSION: The “Nutrition Friendly School” project had a positive effect on eating behaviors, but no relation was present with obesity. Besides supporting the NFSI, the importance of the family and environment should be remembered, and the education of the people responsible for feeding the child should be taken in consideration.

PMID:42084885 | DOI:10.65717/TurkArchPediatr.2026.25344

JAMA Netw Open. 2026 May 1;9(5):e2610789. doi: 10.1001/jamanetworkopen.2026.10789.

ABSTRACT

IMPORTANCE: The 988 Suicide & Crisis Lifeline (998 Lifeline) receives millions of contacts annually. Adequate staffing of 988 Lifeline centers may be important for timely, high-quality service, but little information exists on current staffing levels or difficulties.

OBJECTIVES: To describe 988 Lifeline center staffing and assess staffing-related difficulties.

DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, a survey was fielded between May 6 and July 25, 2025, to all 206 centers in the 988 Lifeline network in the US and territories. Eligible respondents were individuals in leadership positions (eg, executive directors, vice presidents).

MAIN OUTCOMES AND MEASURES: The survey measured staffing levels, shift coverage, modalities (telephone, text, and/or chat), operation of non-988 lines (eg, 211, local lines), proportions of paid and volunteer staff, remote and/or in-person work arrangements, and 4 domains of staffing difficulty: adequate staffing for the volume of contacts, acquiring funding to hire, recruiting staff, and retaining staff. Responses were linked with administrative data on location, presence of state 988 telecommunications fees, and subnetwork services (eg, national backup, Spanish language).

RESULTS: Leaders at 159 of the 206 centers completed the survey (77% response rate), 71% (102 of 144) reported that their center was understaffed, and 89% (141 of 159) indicated difficulty acquiring resources to hire. Leaders at centers offering remote work reported greater difficulty in obtaining these resources compared with centers without remote work (94% [89 of 95] vs 81% [50 of 62]; odds ratio [OR], 3.40; 95% CI, 1.21-9.68; P = .02) but less difficulty recruiting staff (76% [72 of 95] vs 89% [55 of 62]; OR, 0.39; 95% CI, 0.14-0.98; P = .04). Respondents from centers with all paid staff reported greater difficulty recruiting compared with centers using at least some volunteers (86% [102 of 118] vs 66% [27 of 41]; OR, 3.28; 95% CI, 1.42-7.60; P = .006). Leaders at centers handling only 988 contacts reported less difficulty retaining staff than those also handling non-988 lines (63% [17 of 27] vs 83% [109 of 132]; OR, 0.36; 95% CI, 0.14-0.92; P = .03). Wide 95% CIs indicate uncertainty in the magnitude of these results.

CONCLUSIONS AND RELEVANCE: In this cross-sectional survey study of 988 Lifeline leaders, results suggested that most centers struggled to find resources to keep the center fully staffed. If staffing challenges persist, centers could face risks to staff well-being and service quality. Financing and operational strategies that support recruitment and retention will be critical to sustaining the quality and accessibility of 988 Lifeline centers.

PMID:42084871 | DOI:10.1001/jamanetworkopen.2026.10789

JAMA Netw Open. 2026 May 1;9(5):e2610810. doi: 10.1001/jamanetworkopen.2026.10810.

ABSTRACT

IMPORTANCE: Inpatient care is costly, and an aging population, hospital bed shortages, and practitioner shortages stretch inpatient capacity. Alternative modalities of acute care delivery may support growing demands.

OBJECTIVE: To compare outcomes of hospital at home (HaH) vs traditional inpatient hospital admissions and to assess facility-level variability in HaH utilization.

DESIGN, SETTING, AND PARTICIPANTS: This propensity score-matched, retrospective, comparative effectiveness research study used data for age-qualifying (≥65 years) fee-for-service Medicare beneficiaries admitted from January 1, 2021, through December 1, 2022, within HaH-waivered US hospitals that had 12 or more HaH admissions. Analyses were completed from November 2024 to March 2026.

EXPOSURE: HaH vs traditional inpatient hospitalization.

MAIN OUTCOMES AND MEASURES: Primary clinical outcomes were in-hospital mortality and hospital readmissions and emergency department (ED) visits within 30 days of index admission discharge. Facility-level characteristics were assessed for facilities that had HaH admissions above and below the median (≥149 admissions). Conditional logistic regression was used for dichotomous outcomes, with adjusted odds ratios (aORs) and 95% CIs reported. Log-transformed linear regression was used for skewed continuous outcomes within matched pairs, with adjusted percentage changes and 95% CIs reported.

RESULTS: Among 15 871 Medicare beneficiaries (4174 HaH and 11 697 traditional inpatient admissions), the overall mean (SD) age was 77.4 (8.0) years, and 8396 beneficiaries (56.2%) were female. Of 313 HaH-waivered hospitals, 68 were eligible for inclusion, and 11 hospitals accounted for approximately 50% of all HaH admissions. Compared with traditional inpatient admissions, HaH admissions were associated with lower in-hospital mortality (16 of 4174 admissions [0.4%] vs 423 of 11 697 admissions [3.6%]; aOR, 0.09; 95% CI, 0.06-0.16) and lower ED use within 30 days of discharge (366 of 4174 admissions [8.8%] vs 1164 of 11 697 admissions [10.0%]; aOR, 0.86; 95% CI, 0.76-0.97), with no significant difference in readmissions within 30 days of discharge (490 of 4174 admissions [11.7%] vs 1282 of 11 697 admissions [11.0%]; aOR, 1.07; 95% CI, 0.96-1.20).

CONCLUSIONS AND RELEVANCE: In this retrospective comparative effectiveness research study of Medicare beneficiaries, HaH was associated with lower in-hospital mortality and ED use within 30 days of discharge, but not hospital readmissions within 30 days, compared with traditional inpatient care. These findings support HaH as an approach that may maintain similar or better short-term outcomes among appropriately selected patients; future studies should evaluate implementation and equity.

PMID:42084870 | DOI:10.1001/jamanetworkopen.2026.10810

JAMA Netw Open. 2026 May 1;9(5):e2610831. doi: 10.1001/jamanetworkopen.2026.10831.

ABSTRACT

IMPORTANCE: Drug overdose is a leading cause of death among US veterans with homeless experience. Medications for opioid use disorder (MOUD) reduce overdose and all-cause mortality, yet receipt remains low among veterans with homeless experience. Identifying factors associated with MOUD receipt in Department of Veterans Affairs (VA) permanent supportive housing (PSH) can inform strategies to support MOUD implementation and advance health equity.

OBJECTIVE: To identify demographic, clinical, and service-related factors associated with MOUD receipt among veterans with homeless experience with opioid use disorder (OUD) in the Housing and Urban Development-VA Supportive Housing (HUD-VASH) program.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used linked national VA administrative and electronic health record data. US veterans with OUD entering HUD-VASH between October 1, 2017, and September 30, 2021, were followed up for 12 months after move-in. Eligible participants were diagnosed with OUD as defined by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision criteria within 5 years before or 1 year after move-in. Sequential logistic regression models examined associations between demographic, clinical, and service utilization factors and MOUD receipt. Statistical analyses were conducted between May 2025 and February 2026.

EXPOSURE: Demographic, clinical, and service-related factors.

MAIN OUTCOMES AND MEASURES: Receipt of MOUD (buprenorphine, methadone, or extended-release naltrexone) within 12 months after HUD VASH move-in.

RESULTS: Among 10 110 veterans with OUD, the mean (SD) age was 53.2 (12.0) years (9297 male [92%]; 3211 Black [32%], 606 Hispanic [6%], 5537 White [55%]); 1685 veterans (17%) received MOUD. Older age (age 55 to 64 years: adjusted odds ratio [AOR], 0.52 [0.42-0.64]) and non-Hispanic Black race (AOR, 0.47 [95% CI, 0.40-0.55]) were associated with lower odds of MOUD receipt, while depression (AOR, 1.24 [95% CI, 1.05-1.46]) and greater behavioral health engagement was associated with higher odds of receipt. Having 1 or more instances of inpatient hospitalization was associated with lower odds of MOUD receipt (AOR, 0.74 [95% CI, 0.64-0.87]).

CONCLUSIONS AND RELEVANCE: In this cohort study of veterans with homeless experience with OUD, 1 in 6 veterans received MOUD within a year of entering PSH. Lower rates of MOUD receipt among older veterans and veterans from racial minority groups highlighted persistent inequities, regardless of housing status.

PMID:42084867 | DOI:10.1001/jamanetworkopen.2026.10831

JAMA Netw Open. 2026 May 1;9(5):e2610839. doi: 10.1001/jamanetworkopen.2026.10839.

ABSTRACT

IMPORTANCE: Allogeneic hematopoietic cell transplant (HCT) is curative for hematologic cancers, yet access remains inequitable for racially and ethnically underrepresented and socioeconomically disadvantaged populations, making the goal of having a suitable donor for every patient who needs a transplant challenging. The ACCESS trial broadened access by enrolling patients without matched donors, who instead received an HCT from a mismatched unrelated donor.

OBJECTIVE: To compare baseline characteristics of ACCESS trial participants with participants enrolled in a similar clinical trial and a patient-reported outcome (PRO) protocol cohort.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included adult participants (aged ≥18 years) from 3 cohorts-the ACCESS trial (2021-2024), BMT CTN 1703 trial (2019-2021), and Center for International Blood and Marrow Transplant Research (CIBMTR) PRO Protocol observational study (2020-2025)-who completed a baseline PRO survey. The ACCESS and PRO Protocol cohorts were stratified by conditioning intensity (myeloablative [MAC] vs reduced-intensity and nonmyeloablative [RIC/NMA]); all BMT CTN 1703 participants received RIC/NMA.

EXPOSURE: Hematopoietic cell transplant.

MAIN OUTCOMES AND MEASURES: Racial and ethnic diversity, insurance type, education, and income were compared among cohorts using counts and percentages, and socioeconomic and structural disadvantage were measured using the Social Vulnerability Index and Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy.

RESULTS: Baseline surveys were completed by 208 participants in the ACCESS trial (median [range] age at transplant, 62.3 [20.4-78.9] years; 108 male [51.9%]), 122 participants in the PRO Protocol study (median [range] age at transplant, 63.9 [21.1-78.0] years; 67 male [54.9%]), and 342 participants in the BMT CTN 1703 trial (median [range] age at transplant, 66.9 [20.7-78.6] years; 218 male [63.7%]). Participants in ACCESS were more racially and ethnically diverse, with 15 (7.2%), 25 (12.1%), 46 (22.2%), 110 (53.1%), and 11 (5.3%) of Asian, Black or African American, Hispanic or Latino, White, and other race and ethnicity, respectively, compared with 4 (3.3%), 2 (1.6%), 8 (6.6%) 104 (85.2%), and 4 (3.3%), respectively, in the PRO Protocol and 10 (3.0%), 0, 16 (4.8%), 302 (91.0%), and 4 (1.2%), respectively, in the BMT CTN 1703 trial. Participants in ACCESS were more likely to have Medicaid (36 [18.1%]) vs PRO Protocol (8 [6.7%]) and BMT CTN 1703 (16 [5.1%]) participants and reported lower education (some college or an associate’s degree: 103 [49.5%] vs 73 [59.8%] in the PRO Protocol; postcollege education: 34 [17.3%] vs 35 [29.2%] in the PRO Protocol) and household income (<$40 000 annually: 25 [24.0%] vs 8 [11.6%] in the PRO Protocol and 7 [38.9%] in the BMT CTN 1703 trial). Median Social Vulnerability Index scores were highest among participants in the ACCESS MAC group (median [range], 0.72 [0.01-0.97] vs 0.61 [0.16-0.78] in the PRO Protocol MAC group), and 16 participants [27.6%] in the ACCESS MAC group reported moderate to severe financial toxicity. The ACCESS participants lived closer to transplant centers, especially in the RIC/NMA group (median [IQR], 28 [14-75] miles vs 47 [16-96] miles for BMT CTN 1703 participants and 49 [21-104] miles for PRO Protocol participants).

CONCLUSIONS AND RELEVANCE: This cross-sectional study of clinical trial participants and a clinical cohort found that the ACCESS trial enrolled a more racially and ethnically diverse and socioeconomically disadvantaged population. Trial designs that broaden eligibility could expand access to HCT, highlighting the need for systemic interventions to ensure equity.

PMID:42084866 | DOI:10.1001/jamanetworkopen.2026.10839