Tag: pubmed

Sex Med Rev. 2026 Jun 30;14(3):qeag046. doi: 10.1093/sxmrev/qeag046.

ABSTRACT

BACKGROUND: Endothelial dysfunction and arterial stiffness are key underlying mechanisms that contribute to erectile dysfunction (ED), a common and often underdiagnosed condition among men with hypertension. Furthermore, certain classes of antihypertensive medications may adversely affect erectile function, adding to the burden of the disease. While the link between hypertension and ED is well-established globally, the epidemiology of this comorbidity in the African context is less clearly defined. Although several individual studies have investigated the prevalence of ED among hypertensive men within specific African countries, there is currently no continent-wide pooled estimate to inform regional healthcare policy and clinical practice. This review aimed to determine the pooled prevalence of ED and its associated factors among hypertensive men in Africa.

METHODS: A comprehensive literature search was conducted on PubMed, HINARI/Research4Life, and Google Scholar to find relevant studies. Data extraction and quality assessment were performed independently by two reviewers using a prepared standard Microsoft Excel 19 form and the Joanna Briggs Institute critical appraisal checklist. STATA version 17 was used to conduct the meta-analysis. Heterogeneity was assessed using the I2 and Cochran’s Q test. Meta-analysis was conducted using a random-effects model, Publication bias was assessed using the funnel plot and Egger’s test statistics. Moreover, subgroup analysis, and sensitivity analysis were also performed.

RESULTS: Eighteen studies involving 3648 male hypertensive patients from three African regions were included. The pooled prevalence of ED was 65.05% (95% CI: 54.23-75.87), with substantial heterogeneity across studies (I2 = 98.39%). The prevalence varied by African region, country, assessment tool, sampling method, and study population, with the highest estimates observed in Central Africa, in studies using the SHIM and those employing convenience sampling. A higher prevalence was also reported among hypertensive men with comorbidity. Older age was significantly associated with ED, with higher odds among men aged 61-80 years (OR = 3.70, 95% CI: 2.04-6.71) and those aged >80 years (OR = 5.34, 95% CI: 3.51-8.13). Additional significant factors included stage II hypertension (OR = 3.81, 95% CI: 2.25-6.44), hypertension duration >10 years (OR = 4.20, 95% CI: 1.83-9.62), antihypertensive polytherapy (OR = 2.87, 95% CI: 1.93-4.26), comorbid conditions (OR = 2.59, 95% CI: 1.16-5.79), and depression (OR = 2.67, 95% CI: 1.72-4.14).

CONCLUSION: In Africa, ED is highly prevalent in men with hypertension. Comorbid conditions, depression, antihypertensive polytherapy, advanced age, Stage II hypertension, and hypertension that has been present for more than 10 years are important factors linked to ED. Routine screening and integrated management strategies should be incorporated into hypertension care. In addition, further population-based studies using standardized methodologies are necessary to refine prevalence estimates and guide public health interventions.

PMID:42447425 | DOI:10.1093/sxmrev/qeag046

J Clin Oncol. 2026 Jul 14:JCO2600705. doi: 10.1200/JCO-26-00705. Online ahead of print.

ABSTRACT

The TRIANGLE trial established an ibrutinib-containing therapy without autologous stem-cell transplantation (ASCT) as the new standard for younger, treatment-naïve patients with mantle cell lymphoma (MCL). However, the benefit of rituximab maintenance (RM) within this novel standard is unclear. We investigated whether RM improves progression-free survival (PFS) and overall survival (OS) with acceptable toxicity when added to the experimental arms of TRIANGLE. This secondary analysis of TRIANGLE included patients randomly assigned to ibrutinib-containing therapy without (I) or with (A + I) ASCT who responded to induction/ASCT. RM was given per national and center practice. PFS and OS of patients with and without RM were compared with inverse probability of treatment weighted Kaplan-Meier curves and log-rank tests. Among responders after induction/ASCT (I: 274; A + I: 237), RM was given to 61% (I) and 64% (A + I). RM prolonged PFS in ibrutinib-containing treatment arms (I: log-rank test: P = .003, 4-year PFS probability RM v no RM, 85% v 73%; A + I: P < .001, 90% v 75%). There were trends toward prolonged OS in RM groups. RM groups were at higher risk of grade 3 to 5 infectious toxicity (I: 34% v 11%; A + I: 41% v 18%). Our findings support adding RM to BTK inhibitor treatments in younger, untreated patients with MCL to achieve prolonged remission.

PMID:42447409 | DOI:10.1200/JCO-26-00705

Qual Manag Health Care. 2026 Jul 14. doi: 10.1097/QMH.0000000000000572. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Despite widespread benefits of physicians engaging in organizational quality & safety (Q&S) activities, such engagement often remains infrequent, informal, and inconsistent. This work aimed to design and implement uniquely-tailored and concurrent interventions to increase the size and Q&S competency levels of UHN’s Physician Council on Q&S over a 2-year period.

METHODS: Ten Q&S competency dimensions were tracked as outcome measures: Q&S science & methods, engaging stakeholders for success, aligning local projects with organizational priorities, building local Q&S infrastructure, navigating organizational Q&S processes, obtaining funding for Q&S, scholarly approach to Q&S, academic promotion through Q&S, career development through Q&S, and teaching Q&S. Competency levels were reported on a 4-point scale (ie, novice, competent, proficient, and expert). Process measures centered around change concepts and included the number of attendees at Q&S events, the number of mentorship pairings, the number of QI projects awarded grant funding, and the number of visits to our Q&S intranet site.

RESULTS: Baseline results (n = 32) revealed participants were predominantly in the novice/competent categories for all dimensions. Competency levels were retested in 2023 (n = 41) and chi-square analyses revealed improvements in the expected direction on all dimensions. Statistically significant increases were observed for navigating UHN processes (P < .01) and building organizational Q&S infrastructure (P < .05). The Council grew over 5-fold in size from its 13 original members to 75 members with representation from all of our organization’s programs, departments, and divisions.

CONCLUSIONS: Results indicate that this approach to Educate and Connect (eg, rounds and summit), Promote and Support (eg, grants and awards), and provide Customized Resources (eg, playbook and intranet) was effective in growing a robust and competent physician Q&S community of practice.

PMID:42447405 | DOI:10.1097/QMH.0000000000000572

J Patient Saf. 2026 Jul 14. doi: 10.1097/PTS.0000000000001559. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the association of a templated interhospital transfer (IHT) note on transfer appropriateness and clinical outcomes.

METHODS: We conducted a retrospective, single-center study of 100 IHTs to the Department of Medicine services between May and June 2023. The exposure was the type of documentation at the time of transfer, categorized as templated note, nontemplated note, or no note. The primary outcome was appropriateness of transfer, determined by 2 independent adjudicators using a standardized framework developed as part of the POINT Study. Documentation type by clinical specialty and reason for transfer were assessed, with statistical analyses of clinical outcomes limited to those with an incidence >5% (ie, escalation/downgrade in level of care within 24 h of transfer and 30 d mortality).

RESULTS: Among 100 transfers, 81 (81%) were deemed appropriate and 19 (19%) were deemed inappropriate. Documentation was present in 59%, including templated (35%) and nontemplated notes (24%). IHTs without documentation had the highest appropriateness rate (87.8%, 36/41), compared with templated notes (29/35, 82.9%; P=0.15) and nontemplated notes (66.7%, 16/24; P=0.042). Downgrades were more common in inappropriate transfers with nontemplated notes (50.0%, 4/8) than in appropriate transfers with templated notes (10.3%, 3/29; P=0.012).

CONCLUSIONS: Structured IHT documentation was inconsistently used and did not predict the appropriateness of transfer. Transfers without documentation were most often appropriate, suggesting straightforward cases may not require formal notes. In contrast, nontemplated notes in inappropriate transfers showed high downgrade rates, implying that unstructured documentation may inflate perceived acuity. Further evaluation of documentation strategies is needed to support appropriate transfer decision-making.

PMID:42447403 | DOI:10.1097/PTS.0000000000001559

J Sex Med. 2026 Jul 3;23(8):qdag214. doi: 10.1093/jsxmed/qdag214.

ABSTRACT

BACKGROUND: Human papillomavirus (HPV) is a prevalent sexually transmitted infection that negatively affects women’s psychological, social, and sexual well-being worldwide.

AIM: This study aimed to evaluate the effect of group Acceptance and Commitment Therapy (ACT) counseling on sexual function in women diagnosed with HPV infection.

METHODS: This single-blind randomized clinical trial was conducted on 56 women with HPV infection. Participants were randomly assigned to an intervention group (n = 28) receiving 8 sessions of ACT counseling or a control group (n = 28) receiving routine care. The Female Sexual Function Index (FSFI) questionnaire was administered at baseline, immediately after, and 1 month following the intervention. Descriptive statistics were calculated, and chi-square and independent t-tests were used to examine baseline differences. Longitudinal changes and between-group comparisons were analyzed using Generalized Estimating Equations with an appropriate correlation structure. A P-value of <.05 was considered statistically significant.

OUTCOMES: The primary outcome was the change in overall sexual function score, as measured by the FSFI, across the 3 assessment points.

RESULTS: Participants in the intervention and control groups had mean ages of 35.96 ± 8.53 and 32.48 ± 6.40 years, respectively. The baseline mean FSFI scores were similar between groups (16.06 ± 7.69 vs. 15.86 ± 8.08). Following ACT counseling, the intervention group’s mean FSFI score significantly increased to 20.68 ± 4.58 immediately post-intervention and 20.64 ± 4.29 1 month later, while the control group’s scores decreased slightly to 15.36 ± 8.68 and 14.20 ± 8.83, respectively. Between-group differences were statistically significant both immediately (B = 5.120, P = .002) and 1 month (B = 6.244, P < .001) after the intervention. Improvements were observed in the desire, arousal, satisfaction, and orgasm domains (P < .001), but changes in lubrication and pain were not significant (P < .05).

CLINICAL IMPLICATIONS: Group ACT counseling offers a promising psychotherapeutic approach to improve sexual health and emotional well-being among women affected by HPV infection.

STRENGTHS & LIMITATIONS: Strengths include the randomized design and the use of validated assessment tools, while limitations involve the small sample size, short follow-up period, and restriction to a single geographic location, limiting generalizability.

CONCLUSION: Group Acceptance and Commitment Therapy effectively enhances sexual function and overall quality of life in women with HPV, suggesting its integration into supportive healthcare interventions.

PMID:42447398 | DOI:10.1093/jsxmed/qdag214

J Pediatr Orthop. 2026 Jul 14. doi: 10.1097/BPO.0000000000003407. Online ahead of print.

ABSTRACT

BACKGROUND: In general, the onset of Legg-Calvé-Perthes disease (LCPD) before age 6 is thought to be associated with a good radiographic outcome. Many of these patients, however, still develop a poor outcome with ovoid-to-flat femoral head deformity. Currently, no early-stage prognosticator of outcome exists for patients younger than 6 years at onset. This study investigated whether perfusion MRI (pMRI) obtained in early stages of LCPD correlates with deformity index (DI), epiphyseal index (EI), and sphericity deviation score (SDS). We hypothesized that early-stage femoral head hypoperfusion would correlate significantly with these radiographic outcomes and serve as an early prognosticator.

METHODS: This multicenter study reviewed demographic, pMRI, and radiographic data from patients with LCPD who had disease onset before age 6. Inclusion criteria were pMRI at Waldenström stage I to IIa. DI and EI were evaluated at 2-year follow-up, and SDS at the healed stage. Statistical analyses included Pearson correlation and ROC analysis, with a threshold predictive of SDS >20.

RESULTS: Forty-one femoral heads (37 patients; mean age at onset 5.0±0.9 years) were analyzed with a mean follow-up of 4.1±1.3 years. Mean hypoperfusion was 49±28%. Mean DI was 0.38±0.18, EI was 0.26±0.10, and SDS was 18.2±12.9. Increasing hypoperfusion (%) correlated significantly with greater femoral head deformity, including higher DI (r=0.76), lower EI (r=-0.62), and higher SDS (r=0.64) (all P<0.001). ROC analysis identified 62% hypoperfusion as optimal for predicting SDS >20 (AUC: 0.80; sensitivity 75%; specificity 87%). Using a 60% cutoff point, outcomes were worse above the threshold: DI (0.31±0.16 vs. 0.52±0.14, P=0.002), EI (0.30±0.09 vs. 0.19±0.07, P<0.001), and SDS (11.7±6.1 vs. 26.8±14.6, P=0.001).

CONCLUSIONS: Early-stage femoral head hypoperfusion correlated significantly with radiographic outcomes at 2-year follow-up and at the healed stage in patients with LCPD onset before age 6. A pMRI hypoperfusion threshold of 60% identified femoral heads at a higher risk for femoral head deformity, supporting pMRI as a potential early prognostic marker.

LEVEL OF EVIDENCE: Level III.

PMID:42447391 | DOI:10.1097/BPO.0000000000003407

J Pediatr Orthop. 2026 Jul 14. doi: 10.1097/BPO.0000000000003411. Online ahead of print.

ABSTRACT

BACKGROUND: Surgical procedures that improve motion for slipped capital femoral epiphysis (SCFE) deformity are typically guided by radiographic imaging. However, the specific aspects of the deformity that have the greatest impact on hip functional biomechanics remain unclear. This study investigated the relationship between radiographic parameters and clinical ROM measurements in patients with SCFE to better elucidate which elements of SCFE pathoanatomy have the greatest effect on joint mobility.

METHODS: Patients who underwent in situ pinning for stable SCFE at a single institution between 2013 and 2025 were retrospectively reviewed. Patients were excluded if they had unstable SCFE or underwent a modified Dunn osteotomy or simultaneous bilateral SCFE procedures. Demographics and clinical ROM measurements were obtained from the electronic health record. Radiographic parameters, including the Southwick slip angle (SSA), posterior sloping angle (PSA), percent epiphyseal displacement of Wilson (PED), and alpha angle, were measured on immediate postoperative radiographs. ROM deficits were calculated as the difference between affected and unaffected hips. The relationships between radiographic and clinical ROM variables were quantified using linear regressions.

RESULTS: Seventy-four hips in 69 patients (mean age 12.3±1.5 y, 50.7% male) were included. In 5 patients, ROM data were available for the contralateral, unaffected hip just before a subsequent slip and were used as control measurements for that hip. Overall, PED had the largest effect on ROM. For every 1% increase in displacement, patients lost an average of 2.18 degrees of flexion (P<0.001) and 2.13 degrees of abduction (P=0.001). SSA, PSA, and AP alpha angle had statistically significant effects on internal rotation in flexion (IRF)-a 1-degree increase in each led to a 0.78, 0.81, and 0.74-degree decrease in IRF, respectively (P<0.001 for all). The lateral alpha angle had the smallest impact.

CONCLUSIONS: In children with SCFE, radiographic deformity predicts clinical ROM. PED has the strongest negative association with flexion and abduction, while PSA, SSA, and AP alpha angle have negative associations with IRF. Reconstructive strategies should prioritize correction of these aspects of the SCFE deformity to maximize joint mobility.

LEVEL OF EVIDENCE: Level III-retrospective comparative study.

PMID:42447386 | DOI:10.1097/BPO.0000000000003411

J Cardiovasc Nurs. 2026 Jul 14. doi: 10.1097/JCN.0000000000001363. Online ahead of print.

ABSTRACT

BACKGROUND: Cardiometabolic syndrome is a major global driver of poor outcomes. Behavioral and socioeconomic factors influence outcomes of cardiometabolic syndrome. Conventional risk models often neglect to capture the role of behavioral and socioeconomic characteristics in cardiometabolic syndrome mortality.

OBJECTIVE: We aimed to identify behavioral-socioeconomic phenotypes among adults with cardiometabolic syndrome using a clustering approach and to examine their associations with cardiovascular and all-cause mortality.

METHODS: We analyzed data from 7839 U.S. adults with cardiometabolic syndrome (2005-2018), followed for a median of 87 months. To explore behavioral-socioeconomic patterns, we used hierarchical clustering on factor analysis of mixed data. Survival analyses were performed using Kaplan-Meier curves with log-rank tests to evaluate mortality differences among clusters. Cluster profile differences were assessed to characterize the demographic, behavioral, socioeconomic, and clinical heterogeneity among the identified subgroups.

RESULTS: Three distinct clusters were identified, differing significantly across demographic, socioeconomic, and behavioral characteristics (P < .001 for most comparisons). Cluster 1 comprised younger, socioeconomically deprived, physically active individuals with higher alcohol use and depression prevalence. Cluster 2 included predominantly older women with lower socioeconomic status, multiple comorbidities, and the poorest cardiometabolic profile, showing the highest cardiovascular and all-cause mortality rates (all log-rank P < .001). Cluster 3 represented socioeconomically advantaged, middle-aged men with the most favorable behavioral patterns and the lowest depression prevalence.

CONCLUSION: Behavioral-socioeconomic clustering identified phenotypes with distinct prognoses in cardiometabolic syndrome. The high-risk cluster 2 reflects the cumulative physiological consequences of long-standing adverse behaviors, socioeconomic deprivation, and comorbid disease progression.

PMID:42447384 | DOI:10.1097/JCN.0000000000001363

JMIR Res Protoc. 2026 Jul 14;15:e94797. doi: 10.2196/94797.

ABSTRACT

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental condition affecting approximately 7% to 8% of children and adolescents, characterized by persistent inattention, hyperactivity, and impulsivity. Adolescence represents a period of heightened vulnerability, during which pharmacological treatments are frequently limited by adverse effects, suboptimal adherence, and partial response. Physical exercise, particularly high-intensity interval training (HIIT), has demonstrated superior effects on inhibitory control and inattention compared with moderate-intensity continuous exercise. However, the repetitive nature and high perceived exertion of traditional HIIT protocols result in poor adherence, especially in individuals with ADHD. Virtual reality (VR)-based exergames have been proposed as a strategy to sustain vigorous physiological demands while maintaining intrinsic motivation. Despite this potential, the existing literature is predominantly limited by passive control conditions, which prevent adequate control for the effects of VR immersion and cognitive engagement, limiting causal inference regarding the specific contribution of physiological exertion.

OBJECTIVE: This paper presents the protocol for a randomized clinical trial designed to evaluate whether an HIIT-based VR exergame produces greater improvements in inhibitory control and inattention symptoms compared with an active, nonexercise VR control condition in adolescents with ADHD.

METHODS: This multisite, parallel-group, single-blind randomized clinical trial will recruit 98 adolescents aged 12 to 17 years with a confirmed diagnosis of ADHD according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, from 2 outpatient centers in Brazil. Participants will be allocated 1:1 to an HIIT-based VR exergame intervention (Move Sapiens) or an active control condition using the same VR platform without vigorous physical exertion. The intervention comprises 20 sessions over 4 weeks delivered in a home-based format following supervised laboratory familiarization. Primary outcomes are Swanson, Nolan, and Pelham Rating Scale version IV inattention subscale scores and go/no-go commission errors. Secondary outcomes include working memory, cognitive flexibility, processing speed, impulsivity, sleep quality, and anxiety symptoms. Analyses will follow an intention-to-treat approach using linear mixed-effects models.

RESULTS: The trial is ongoing. Funding was granted in October 2024. As of April 2026, 58 participants have been enrolled across 2 sites, of whom 46 (79.3%) have completed the full intervention protocol. Data collection is expected to be completed by October 2026, with results anticipated by December 2026.

CONCLUSIONS: This trial will provide controlled evidence on the efficacy of an HIIT-based VR exergame for adolescents with ADHD using an active control condition matched for technological immersion. The design will enable examination of whether vigorous physical exertion beyond VR immersion and digital engagement constitutes an essential active component for improvements in inhibitory control and inattention in this population. If effective, the intervention may offer an engaging, home-based adjunctive treatment option for adolescents with ADHD.

TRIAL REGISTRATION: ClinicalTrials.gov NCT06632249; https://clinicaltrials.gov/study/NCT06632249.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/94797.

PMID:42446902 | DOI:10.2196/94797

JAMA Netw Open. 2026 Jul 1;9(7):e2623057. doi: 10.1001/jamanetworkopen.2026.23057.

ABSTRACT

IMPORTANCE: Timely treatment in colorectal cancer (CRC) may influence the disease course and, thus, outcomes, but optimal delay thresholds remain uncertain. Identifying pathway-specific time-to-treatment initiation (TTI) effects can guide benchmarks and policies for coordinated, timely care.

OBJECTIVE: To evaluate the association between TTI and 3-year metastasis risk in patients with newly diagnosed nonmetastatic CRC undergoing curative-intent surgery, with attention to variation by treatment pathway.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study of insured US patients with nonmetastatic CRC used deidentified administrative claims from Optum’s Clinformatics Data Mart. Eligible individuals were adults aged 40 years or older with incident nonmetastatic CRC diagnosed during January 1, 2017, to December 31, 2021, who underwent curative-intent surgery within 1 year of diagnosis and had continuous coverage 1 year before and after. Data were analyzed June 2025.

EXPOSURES: TTI was defined as days from CRC diagnosis to the first receipt of cancer-directed therapy (surgery, chemotherapy, or radiation). Patients were categorized into 4 treatment pathways: surgery with or without radiation, surgery followed by adjuvant therapy with or without radiation, neoadjuvant therapy followed by surgery with or without radiation, and trimodality therapy (neoadjuvant therapy, followed by surgery, followed by adjuvant therapy with or without radiation).

MAIN OUTCOMES AND MEASURES: The outcome was 3-year cumulative incidence of metastasis. XGBoost identified optimal TTI thresholds, and Fine-Gray models with death as a competing risk evaluated these thresholds and estimated their associations with metastasis.

RESULTS: Among 11 927 patients (mean [SD] age, 70.7 [10.8] years; 6007 women [50.4%]; 1251 Black [10.5%], 7948 White [66.6%]), 4539 (38.0%) had moderate or severe comorbidity. Over 3 years, 1438 patients (12.1%) developed metastasis. Longer TTIs were associated with higher metastasis risk, varying by treatment pathway. For surgery plus adjuvant therapy, TTIs of 4 to 46 days (subdistribution hazard ratio [sHR], 1.27; 95% CI, 1.04-1.55) and 47 days or longer (sHR, 1.55; 95% CI, 1.08-2.23) were significantly associated with increased risk vs zero to 3 days. For surgery followed by radiation, delays of 223 days or longer showed higher risk (sHR, 2.00; 95% CI, 0.95-4.25) than TTI up to 222 days, although these results were not significant. For neoadjuvant therapy plus surgery, TTI of 68 days or longer were associated with higher risk (sHR, 2.66; 95% CI, 1.02-6.94) than TTI up to 67 days. For patients receiving trimodality therapy, there was no association between TTI and risk of metastasis.

CONCLUSIONS AND RELEVANCE: In this cohort study, treatment delays were associated with higher, pathway-specific metastasis risk. These findings support pathway-tailored benchmarks for treatment initiation and highlight the importance of integrated care in reducing delays and improving timely, equitable, cost-effective CRC care.

PMID:42446881 | DOI:10.1001/jamanetworkopen.2026.23057