Tag: pubmed

Swiss Med Wkly. 2026 Jan 31;156:4231. doi: 10.57187/4231.

ABSTRACT

STUDY AIMS: Robson’s Ten-Group Classification System (TGCS) was proposed to describe caesarean section rates by ten patient-centred risk-specific groups. The aim of the study was to describe Swiss caesarean section rates according to this classification, further stratifying it according to region and type of structure where delivery took place. We also aimed to compare our results to the standard caesarean section rates, recommended by the World Health Organization (WHO).

METHODS: An observational study including all women delivering in health facilities in Switzerland in the period 2014-2021. A total of 695,733 deliveries were included. Core variables used for classification were semi-automatically generated using routine data provided by the Swiss Federal Statistics Office. Caesarean section rates were reported according to the TGCS. Data were also stratified according to each of the 26 Swiss cantons, as well as to the typology of hospital where delivery took place.

RESULTS: The major relative contributors to the overall caesarean section rate were Group 2 (nulliparous, above 37 weeks, with induction) and Group 5 (women with previous caesarean section, above 37 weeks with a singleton pregnancy), respectively accounting for 20.7% and 30.1% of all caesarean sections. We also showed that the Swiss population was similar to the population considered in the WHO recommendation. Nonetheless, the caesarean section rate among our population exceeded that suggested by the WHO recommendations, being respectively of 44.4% vs 39.9% and 86.0% vs 74.4% for Groups 2 and 5. Large variations were detected in the caesarean section rate when looking at the different cantons, ranging from 29.8% to 59.6% for Group 2 and between 58.0% and 100.0% for Group 5.

CONCLUSION: Routine data collection allowed us to describe caesarean section rates throughout Switzerland according to the TGCS. The Swiss caesarean section rate was higher than the caesarean section rate recommended by the WHO, even though the population characteristics were comparable. Substantial differences were found when stratifying caesarean section rates according to the canton, as well as to the type of structure where delivery took place.

PMID:41962064 | DOI:10.57187/4231

JMIR Cancer. 2026 Apr 10;12:e84042. doi: 10.2196/84042.

ABSTRACT

BACKGROUND: Small cell lung cancer (SCLC) is a challenging disease to treat due to rapid progression, development of chemoresistance, and discrepancies in outcomes between real-world data and clinical trials. There is a lack of comprehensive analyses in other studies with regard to intermediate events and the treatment process, such as treatment decisions, progression of disease, and the occurrence of adverse events (AEs) over time.

OBJECTIVE: The aim of this study was to apply advanced statistical methods to a longitudinal SCLC dataset in order to identify factors of importance for the risk of AEs and for survival.

METHODS: Treatment pathways of 421 patients with SCLC collected from Karolinska University Hospital, located in Stockholm, Sweden, between 2016 and 2022, were analyzed with data-driven modeling. The analysis focused on the impact of dose adjustment on AEs, including neutropenia, by estimating odds ratios (ORs) using Bayesian mixed effects modeling. Covariates’ effects on Eastern Cooperative Oncology Group performance status (ECOG PS) deterioration and early discontinuation of chemotherapy with cause-specific hazard ratios (csHR) were explored using competitive risk models. This approach was applied to patient cohorts receiving combinatorial first-line platinum/etoposide and second-line platinum/etoposide or platinum/irinotecan.

RESULTS: At the end of the first-line treatment, most patients exhibited tumor regression (n=167). Patients with neutropenia had longer overall survival (hazard ratio 0.70, 95% CI 0.53-0.92). Higher etoposide dose levels were associated with subsequent occurrences of AEs (OR 5.97, 95% CI 1.41-30.5) and neutropenia (OR 3.55, 95% CI 1.03-13.3). Dose adjustment did not affect overall survival if the patient completed the 4-dose regimen treatment. With regard to second-line therapy, fewer patients completed 4 treatment cycles, and the most common reason for early discontinuation was tumor progression (n=72, 58%). Male patients (n=118) experienced fewer AEs and better first-line treatment response compared to females (csHR 0.51, 95% CI 0.25-0.90). High-risk patients (defined as ECOG PS 2-3 or age >75 years) with early discontinuation of therapy had survival outcomes similar to those who did not receive any therapy.

CONCLUSIONS: Our results indicate that first-line therapies may benefit from more individualized dosing strategies. It would also be beneficial to assess the risk-benefit of treating specific subgroups, including patients receiving second-line therapy. Real-world data proved beneficial for studying therapy response and risk-benefit of treating patient groups that are underrepresented in clinical trials.

PMID:41962051 | DOI:10.2196/84042

Swiss Med Wkly. 2026 Mar 31;156:4539. doi: 10.57187/4539.

ABSTRACT

BACKGROUND: Initiatives like “Choosing Wisely” promote efficient and high-quality healthcare by reducing overuse. The interdisciplinary copAIN project aims to reduce resource utilisation in medical ward patients by providing specific guidelines to internal medicine residents.

METHODS: This study was conducted in the Cantonal Hospital Aarau, a 500-bed tertiary care and academic facility.After implementing the copAIN project for medical inpatients on 1 June 2023, we conducted an interrupted time-series (ITS) cohort study and analysed it using a mixed-effects regression model for comparison. Neurological patients not involved in copAIN served as the control group. The primary outcome was resource utilisation defined by the measurement frequency of five vital signs and laboratory orders. The secondary, safety outcome was in-hospital mortality.

RESULTS: Of 51,396 admissions between 1 September 2022 and 31 May 2024, 8344 cases were eligible for analysis. While there were no differences in measurement frequencies in the control group, we found a significant reduction in the intervention group for the frequency of measurements of blood pressure (0.28 measures per day per length of stay [dLOS]), heart rate (0.26 measures per dLOS), oxygen saturation (0.28 measures per dLOS) and temperature (0.27 measures per dLOS). However, this effect was temporary, and adjusted analyses showed no significant difference between pre- and post-intervention periods. There was no change in mortality between study periods in both groups.

CONCLUSION: An intervention focusing on the reduction of routine parameters within the hospital settingresulted in a temporary decrease in resource use without increasing in-hospital mortality. This data supports recent initiatives aimed at improving resource efficiency in medicine without compromising quality. The absence of a sustained impact highlights the need for ongoing strategies to maintain and reinforce improvements.

PMID:41962046 | DOI:10.57187/4539

JMIR Form Res. 2026 Apr 10;10:e85484. doi: 10.2196/85484.

ABSTRACT

BACKGROUND: Physical inactivity remains a public health concern, with 42% (around 1 in 2) of women and 34% (around 1 in 3) of men in the United Kingdom, for example, failing to meet moderate-to-vigorous physical activity guidelines. To promote physical activity (PA) at scale, smartphone-based mHealth (mobile health) software apps offer a promising solution.

OBJECTIVE: This study aims to evaluate the feasibility of implementing an mHealth app offering very small (“micro”) financial incentives for PA in Leeds, United Kingdom.

METHODS: A 5-week single-arm proof-of-concept study was conducted with rolling recruitment among Caterpillar Health app users between September 12 and December 12, 2022 (Obesity-Related Behavioral Intervention Trial model, phase IIa). Users earned microincentives in the form of “points,” redeemable for consumer rewards (eg, movie tickets and gym passes), for meeting personalized daily step goals (US $0.13 per goal achieved; set using data from a 5-day baseline) and completing educational quizzes (US $0.33 per quiz). Descriptive statistics assessed feasibility outcomes (ie, reach, recruitment, retention, engagement, and acceptability) and preliminary effectiveness. Paired-samples t tests (P<.05) examined changes in weekly mean daily step count (from baseline) and step goal achievement over 5 weeks.

RESULTS: Of 285 app downloads, 46 users consented to participate (recruitment rate: 16.1%). Participants (mean age: 39.9, SD 11.1 y; 71.1%, 33/46 woman) had a baseline step count of 5598 (SD 2664) steps/day. A total of 25 participants remained engaged (ie, completed at least 1 quiz) at study week 5 (retention rate: 54.3%). Acceptability was high, with 75% of respondents (12/16) indicating they would recommend the app. Weekly mean daily step count did not significantly increase from baseline (mean difference 317, SD 2273, P=.53). Weekly daily step goal achievement rate (%) decreased from study week 1 to 5 (-23.23, SD 22.85, P=.02).

CONCLUSIONS: Despite lower-than-expected recruitment and no statistically significant PA increase, relatively high engagement and acceptability suggest future pilot testing (Obesity-Related Behavioral Intervention Trial model, phase IIb) of a refined intervention (eg, wider selection of loyalty reward partners) and modified study protocol (eg, simplified consent process) is warranted.

PMID:41962040 | DOI:10.2196/85484

Traffic Inj Prev. 2026 Apr 10:1-22. doi: 10.1080/15389588.2026.2636773. Online ahead of print.

ABSTRACT

OBJECTIVE: Since 1979, traffic fatalities dropped 16.0% in the U.S. compared to 77.4 ± 5.9% for 14 other countries. The gap to other countries has grown and has been statistically significant since 1996. This study describes reasons for the gap in traffic fatality reductions in the U.S.

METHODS: NHTSA’s research, programs and activities were analyzed to identify causes for the lack of traffic fatality reductions in the U.S. This includes policy decisions, selection of research projects, meaningfulness of NCAP and other tests, and errors in field accident data on serious injury and death.

RESULTS: There were three primary and nine secondary reasons identified. NHTSA has: 1) not set targets focusing activities on fatality reductions, 2) not pursued research with measurable reductions in fatalities, 3) no meaningful engagement with industry, IIHS and others on research, NCAP, and safety priorities, 4) not conducted critical analysis of projects, programs and research, 5) inherent problems managing research, regulations, investigations, and enforcement under one leadership, 6) not verified assumptions for field accident data collection, 7) not used correct sampling frequencies or case weights in NASS-CDS and CISS, 8) not terminated testing that does not measurably reduce fatalities, 9) not followed-up on useful research, 10) not pursued crash tests with relevance to traffic fatalities and wrongheaded focus on MAIS 2 injuries, 11) not required timely engineering reports on internal and external projects, and 12) inaccessible archives of many reports and findings.

Fatalities in the U.S. would have increased the past 25 years if safety technologies had not been voluntarily introduced by automotive manufacturers, including ESC (electronic stability control), AEB (automatic emergency braking) and high retention seats. NHTSA’s budget has increased 459% over 25 years, a 14.4% increase each year. NHTSA has little to show for the extremely large budget, except “we could do better with more money.”

CONCLUSION: NHTSA must set priorities and targets for research, programs, and activities that reduce traffic deaths. They must change their leadership, because the Agency has failed its core mission to reduce traffic deaths the past 25+ years. NHTSA focuses on new car technologies in crash tests with no relevance to fatal accidents. Most fatalities are in 10+ year old vehicles, where risky driver behavior is the main cause with no seatbelt use, alcohol-drug use, and aggressive, risk-taking speeding. NHTSA must prioritize risky driver behavior and align State activities to reduce traffic fatalities.

PMID:41962029 | DOI:10.1080/15389588.2026.2636773

Microb Genom. 2026 Apr;12(4). doi: 10.1099/mgen.0.001690.

ABSTRACT

Whole-genome sequencing provides a vast amount of genetic information, but its use in clinical and epidemiological studies often depends on the accurate inference of genomic variants. Comparative genomic studies in Mycobacterium tuberculosis typically involve mapping short reads from a diverse population to the same reference genome. This approach can lead to the incorrect characterization of many genomic regions that are susceptible to mapping bias when the reference is too distantly related to the sample. We analysed the consequences of mapping reads from different lineages of M. tuberculosis to the commonly used reference H37Rv and showed that the mapping bias varied depending on both the lineage and the gene mapped. To resolve these issues, we propose a new hybrid workflow which involves three steps: first, building a de novo assembly from short reads; second, aligning this assembly to a reference genome; and finally, mapping the reads to this aligned assembly. We show that many of the lineage and gene biases were corrected using this approach, which leads to a better characterization of lineages and hypervariable regions in comparative analysis. Our proposed approach will enable researchers to elucidate more genetic variations in M. tuberculosis and other bacterial pathogens.

PMID:41961532 | DOI:10.1099/mgen.0.001690

JAMA Netw Open. 2026 Apr 1;9(4):e264892. doi: 10.1001/jamanetworkopen.2026.4892.

ABSTRACT

IMPORTANCE: Exposure to parental depression is a risk factor for offspring mental illness.

OBJECTIVE: To examine the association between the timing of exposure to parental depression, from pregnancy to young adulthood, and adult offspring mental health.

DESIGN, SETTING, AND PARTICIPANTS: This prospective longitudinal cohort study of adult offspring aged 22 to 27 years in the Avon Longitudinal Study of Parents and Children, a British birth cohort, was conducted from September 1990 to July 2020. Data were analyzed from March 2024 to January 2026.

EXPOSURES: Parental depressive symptoms were assessed repeatedly using the Edinburgh Postnatal Depression Scale (score range, 0 to 30, with higher scores indicating more severe depressive symptoms) beginning in pregnancy through offspring age of 21 years.

MAIN OUTCOMES AND MEASURES: The main outcomes were offspring symptoms of depression at age 27 years, anxiety at age 25 years, psychotic disorders at age 24 years, and alcohol use disorder (AUD) at age 22 years. Covariates included socioeconomic status and maternal-offspring polygenic risk for multiple psychiatric disorders.

RESULTS: A total of 5329 adult offspring (3276 females [61.5%]) provided at least 1 outcome measure, which included 3795 participants providing symptoms of depression (mean [SD] age, 27.8 [0.5] years), 3505 participants providing symptoms of anxiety (mean [SD] age, 25.3 [0.6] years), 3342 participants with assessments for psychotic disorders (mean [SD] age, 24.5 [0.8] years), and 3392 participants reporting on symptoms of AUD (mean [SD] age, 22.9 [0.5] years). Cumulative exposure to parental depression across all time points was associated with increased odds of offspring depression (maternal: AOR, 2.36 [95% CI, 1.91-2.92]; paternal: AOR, 2.13 [95% CI, 1.60-2.83]) and anxiety (maternal: AOR, 2.58 [95% CI, 2.06-3.23]; paternal: AOR, 1.98 [95% CI, 1.49-2.63]). Only maternal depression was associated with increased odds of psychosis symptoms (maternal: AOR, 1.90 [95% CI, 1.27-2.82]; paternal: AOR, 1.63 [95% CI, 0.95-2.80]). There were no statistically significant associations with AUD. Significant associations between maternal depression and adult offspring depression were observed from 32 weeks’ gestation (AOR, 1.08 [95% CI, 1.01-1.15]) to age 18 years (AOR, 1.08 [95% CI, 1.01-1.16]). Maternal depression from the 8-month postnatal period (AOR, 1.06 [95% CI, 1.01-1.11]) onward (aged 21 years: AOR, 1.13 [95% CI, 1.02-1.24]) was associated with offspring anxiety symptoms. Paternal depression was significantly associated with offspring depression from mid-childhood (AOR, 1.08 [95% CI, 1.01-1.15]) onward (aged 21 years: AOR, 1.22 [95% CI, 1.04-1.43]), with similar associations between paternal depression and offspring anxiety from mid-childhood (aged 5 years: AOR, 1.11 [95% CI, 1.03-1.18]) onward (aged 21 years: AOR, 1.22 [95% CI, 1.04-1.43]). Only maternal prenatal depression at 32 weeks’ gestation was associated with offspring psychotic symptoms (AOR, 1.20 [95% CI, 1.03-1.41]).

CONCLUSIONS AND RELEVANCE: In this cohort study, analyses of 2 decades of data found distinct temporal associations between maternal and paternal depression and offspring psychiatric symptoms, and pregnancy was found to be a sensitive period in the association between maternal depression and offspring psychotic experiences. The findings suggest a substantial role of timing for specifying the association between parental depression and psychiatric outcomes in young adults and emphasize the need to support parental mental health from pregnancy onward.

PMID:41961501 | DOI:10.1001/jamanetworkopen.2026.4892

JAMA Netw Open. 2026 Apr 1;9(4):e264901. doi: 10.1001/jamanetworkopen.2026.4901.

ABSTRACT

IMPORTANCE: Taxane-induced peripheral neuropathy (TIPN) affects quality of life and ability to complete cancer treatment and has limited effective interventions for prevention and treatment.

OBJECTIVE: To develop and validate a TIPN risk prediction model.

DESIGN, SETTING, AND PARTICIPANTS: SWOG S1714 was a prospective observational cohort study conducted at sites in the National Cancer Institute National Community Oncology Research Program between March 1, 2019, and November 15, 2021, with 3 years of follow-up. The study included evaluable participants 18 years or older with stage I to III lung, breast, or ovarian, fallopian tube, or primary peritoneal cancer who were starting taxane-based treatment. Statistical analysis was conducted from December 2023 to June 2024.

EXPOSURES: Taxane-based regimens including paclitaxel or docetaxel.

MAIN OUTCOMES AND MEASURES: The primary end point was occurrence of TIPN by 24 weeks. TIPN was assessed using the patient-reported European Organization of Research and Treatment of Cancer Quality of Life Questionnaire-Chemotherapy-Induced Peripheral Neuropathy 20-item scale (CIPN-20) at baseline and weeks 4, 8, 12, and 24. Occurrence of TIPN was defined as an increase of 8 points or more over baseline in the CIPN-20 sensory subscale score. With a 60% random sample of evaluable participants, best-subset selection using logistic regression and k-fold cross-validation identified a best model based on demographic factors, baseline comorbid conditions, and treatment factors. Adverse risk factors were summed, generating a score, split at the median and tested in the remaining 40% of evaluable participants. The target difference was 12% between high-risk vs low-risk groups.

RESULTS: A total of 1336 participants enrolled in S1714. Of 1278 evaluable participants (median age, 55.0 years [range, 23.0-84.0 years]; 1264 women [98.9%]; 1164 with breast cancer [91.1%]), 804 (62.9%) experienced TIPN by week 24. Using the training set of 768 participants, a risk prediction model for TIPN was developed that included 5 adverse risk factors: receipt of paclitaxel; stage II or III disease; planned taxane duration of more than 12 weeks; diabetes, autoimmune disease, moderate kidney disease, or a neurologic condition; and self-identified race and ethnicity (Black, Hispanic, Native American, Pacific Islander, multiple races, or unknown race or ethnicity). In the test set of 510 participants, TIPN was more common in high-risk (235 of 345 [68.1%]) vs low-risk (84 of 165 [50.9%]) groups (absolute difference, 17.2%), exceeding the 12% target.

CONCLUSIONS AND RELEVANCE: In this cohort study of participants with early-stage cancer receiving a taxane regimen, a set of baseline risk factors stratified TIPN risk. A risk prediction model may guide treatment decision-making, symptom monitoring, and enrollment in interventional trials for TIPN prevention and treatment.

PMID:41961500 | DOI:10.1001/jamanetworkopen.2026.4901

JAMA Netw Open. 2026 Apr 1;9(4):e266042. doi: 10.1001/jamanetworkopen.2026.6042.

ABSTRACT

IMPORTANCE: Nirsevimab is highly effective in preventing respiratory syncytial virus (RSV) infection in healthy infants. Evidence among infants at higher risk of severe RSV disease, such as those born preterm or with congenital heart disease (CHD), remains limited to clinical settings.

OBJECTIVE: To evaluate the association of nirsevimab with the prevention of RSV-related hospitalizations among at-risk infants after implementation of a universal immunization strategy in Chile.

DESIGN, SETTING, AND PARTICIPANTS: This case-control study used nationwide health registries of all public and private hospitals in Chile during the 2024 RSV season following the launch of a universal RSV immunization program with nirsevimab. The case group included at-risk infants born preterm (gestational age <36 weeks) or with congenital heart disease (CHD) hospitalized for RSV-related lower respiratory tract infection (LRTI), while the control group included infants not hospitalized for RSV-related LRTI. Each case infant was matched to 4 control infants by age, prematurity or CHD status, and geographic region.

EXPOSURE: A single intramuscular dose of nirsevimab administered to all infants born up to 6 months before April 1, 2024, and those born between April 1 and September 30, 2024.

MAIN OUTCOME AND MEASURES: The main outcome was RSV-related LRTI hospitalization. Associations were assessed for at-risk infants and high-risk infants (born extremely preterm at gestational age <32 weeks or with CHD), with nirsevimab outcomes associated with RSV-related LRTI hospitalization estimated as (1 – adjusted odds ratio) × 100, with 95% CIs.

RESULTS: Of 179 RSV-related LRTI hospitalizations among at-risk infants (including 58 [32.4%] with extreme prematurity, 41 [22.9%] with CHD, and 87 [48.6%] without extreme prematurity and CHD [non-high risk]; categories not mutually exclusive), 177 (median [IQR] age, 210.0 [148.0-266.0] days; 109 male [61.3%]) were successfully matched to 708 control infants (including 55 of 58 [94.8%] with extreme prematurity, 39 of 41 [95.1%] with CHD, and 87 [100%] non-high risk; median [IQR] age, 210.5 [147.8-268.5] days; 393 male [55.5%]). A total of 156 case infants (88.1%) and 689 control infants (97.3%) received nirsevimab. In subgroup analyses, nirsevimab receipt in case vs control infants was 79 of 90 (87.8%) vs 351 of 360 (97.5%) among high-risk infants, 50 of 55 (90.9%) vs 213 of 220 (96.8%) among extremely preterm infants, 33 of 39 (84.6%) vs 153 of 156 (98.1%) among infants with CHD, and 77 of 87 (88.5%) vs 339 of 348 (97.4%) in non-high-risk infants. Nirsevimab was associated with a reduced risk of RSV-related LRTI hospitalization of 84.3% (95% CI, 67.0%-92.5%) among all at-risk infants, 85.1% (95% CI, 60.2%-94.4%) among infants with extreme prematurity and CHD combined, and 96.3% (95% CI, 65.5%-99.6%) among infants with CHD but was not associated with a reduced risk for hospitalization among infants with extreme prematurity alone (65.9%; 95% CI, -10.8% to 89.5%).

CONCLUSIONS AND RELEVANCE: This case-control study of Chile’s nationwide nirsevimab immunization program found that RSV-related LRTI hospitalizations among infants at higher risk of severe disease were substantially reduced. These findings support replacing targeted palivizumab prophylaxis with a broader, universal nirsevimab strategy as part of RSV prevention policy.

PMID:41961498 | DOI:10.1001/jamanetworkopen.2026.6042

JAMA Netw Open. 2026 Apr 1;9(4):e266303. doi: 10.1001/jamanetworkopen.2026.6303.

ABSTRACT

IMPORTANCE: Colorectal cancer (CRC) is the third most common cancer in the US, accounting for 9% of all cancer deaths. People in persistent poverty areas-where at least 20% have lived in poverty for at least 30 years-face higher colorectal cancer mortality than those in other areas.

OBJECTIVE: To investigate which risk factors mediated the association between living in persistent poverty areas and mortality, specifically disease severity and aggressiveness, type of CRC treatment, quality of treatment, access to medical care, and complications.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used linked data from the Central Cancer Registry, Death Certificates, and the All-Payer Claims Database (APCD) from January 2013 to June 2023. The population included patients from urban census tracts in Arkansas who were newly diagnosed with colorectal cancer. Analyses were conducted between May and September 2025.

EXPOSURE: Residence in a persistent poverty census tract.

MAIN OUTCOME AND MEASURES: The main outcome was overall survival. Potential confounders (including demographics and comorbidities) and potential mediators (including disease severity and aggressiveness, type and quality of treatment, health care access, and complications) were also examined.

RESULTS: Among 5028 patients newly diagnosed with CRC in 382 urban census tracts, 2587 (51.5%) were male; 705 (14.0%) were Black, 4142 (82.4%) were White, and 181 (3.6%) were of other race or ethnicity; and 2371 (47.2%) were married, with a mean (SD) age of 64.6 (13.7) years. Among 617 patients living in persistent poverty tracts, 329 (53.3%) died, vs 1927 of 4411 (43.7%) in other tracts (hazard ratio, 1.17; 95% CI, 1.03-1.33). There was significant evidence of mediation by stage at diagnosis (33.7% mediation; 95% CI, 7.4%-89.5%; P = .01), not having surgery (29.3% mediation; 95% CI, 5.5%-87.2%; P = .02), and type of health insurance (13.8% mediation); 95% CI, 2.2%-55.3%; P = .03).

CONCLUSION AND RELEVANCE: In this retrospective cohort study of patients with CRC in urban persistent poverty areas, more advanced stage, not receiving surgery, and type of health insurance were key mediators of their increased risk of mortality. Improved awareness of these mediators may help inform targeted interventions to reduce the risk of mortality in this population.

PMID:41961497 | DOI:10.1001/jamanetworkopen.2026.6303