Tag: pubmed

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2026 Apr;38(4):317-324. doi: 10.3760/cma.j.cn121430-20251126-00564.

ABSTRACT

OBJECTIVE: To analyze the occurrence and clinical characteristics of poor inguinal incision healing after weaning in patients undergoing peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO), and to explore its risk factors and clinical management strategies.

METHODS: A retrospective case-control study was conducted to select VA-ECMO patients admitted to the intensive care unit (ICU) of the First Affiliated Hospital of Wannan Medical College (Yijishan Hospital) from February 2022 to February 2025 as the study objects. All patients were weaned from ECMO under open surgery and were divided into normal incision healing group and poor incision healing group according to the healing of the inguinal incision on the side of ECMO catheterization after weaning. The basic data, clinical parameters and laboratory indicators between the two groups were compared, and the risk factors of poor inguinal incision healing after weaning in patients undergoing VA-ECMO were analyzed by univariate and multivariate Logistic regression analyses.

RESULTS: Finally, 41 patients undergoing VA-ECMO were enrolled, including 23 males and 18 females. Among the 41 patients, 27 patients had normal inguinal incision healing, 14 patients had poor inguinal incision healing, and the incidence of poor incision healing was 34%. There were statistically significant differences between the two groups of patients in terms of ECMO catheterization location and ECMO catheterization protocol (both P<0.05). The patients in the poor incision healing group often completed ECMO intubation in the operating room, and most of them chose the unilateral semi-incision catheterization protocol. Compared with the normal incision healing group, the length of ICU stay, the duration of mechanical ventilation and the duration of continuous application of vasoactive drugs in the poor incision healing group were longer [length of ICU stay (days): 29.0 (21.0, 39.0) vs. 15.0 (10.0, 19.0), duration of mechanical ventilation (hours): 454.0 (170.0, 789.0) vs. 134.0 (45.0, 269.0), duration of continuous application of vasoactive drugs (days): 18.5 (6.5, 24.3) vs. 5.0 (2.0, 12.0), all P<0.05], 3-day accumulated fluid balance overload after ECMO weaning [mL: 616.5 (-249.3, 2 148.0) vs. -878.0 (-1 603.0, -387.0), P<0.05], suggesting that the poor healing of inguinal incision after VA-ECMO weaning was related to the above factors. The results of univariate Logistic regression analysis showed that unilateral semi-incision catheterization [odds ratio (OR)=21.000, 95% confidence interval (95%CI) was 2.868-153.754, P=0.003], length of ICU stay>10 days (OR=5.571, 95%CI was 1.042-29.790, P=0.045) and positive 3-day accumulated fluid balance after ECMO weaning (OR=16.133, 95%CI was 3.244-80.224, P=0.001) were the risk factors for poor inguinal incision healing after weaning in patients undergoing VA-ECMO. The variables with statistical significance in univariate Logistic regression analysis were incorporated into the binary multivariate Logistic regression model. The analysis results showed that unilateral semi-incision catheterization (OR=13.203, 95%CI was 1.295-134.632, P=0.029) and positive 3-day accumulated fluid balance after ECMO weaning (OR=14.178, 95%CI was 1.985-101.245, P=0.008) were independent risk factors for poor inguinal incision healing after weaning in patients undergoing VA-ECMO. Fourteen patients with poor healing of inguinal incisions presented with massive exudate from the incision (12 cases), delayed incision healing (7 cases), non-healing of the incision (7 cases), incision infection (4 cases), lymphatic leakage (4 cases), and incision dehiscence (3 cases). In addition to routine dressing change, 12 cases underwent negative pressure sealed drainage (VSD), 7 cases underwent reoperation for debridement, and 2 cases underwent flap repair. Four patients died in the ICU with unhealed incisions, 2 patients had unhealed incisions at the time of discharge referral, and the remaining patients’ groin incisions eventually healed.

CONCLUSIONS: The incidence of poor healing of inguinal incisions after weaning from VA-ECMO is relatively high, mainly manifested as excessive exudate from the incision, delayed incision healing, non-healing of the incision, incision infection, lymphatic leakage, and incision dehiscence. Unilateral semi-incision catheterization and positive 3-day accumulated fluid balance after ECMO weaning are independent risk factors for poor inguinal incision healing in patients undergoing VA-ECMO. Early application of VSD is an effective solution for treating poor incision healing accompanied by a large amount of exudate.

PMID:42200240 | DOI:10.3760/cma.j.cn121430-20251126-00564

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2026 Apr;38(4):309-316. doi: 10.3760/cma.j.cn121430-20250801-00417.

ABSTRACT

OBJECTIVE: To observe the generation of low-density neutrophil (LDN) induced by lipopolysaccharide (LPS) stimulation in vitro to simulate a septic environment, and to analyze their generation mechanism, phenotype, and functional characteristics.

METHODS: 1) Analysis of LDN proportion in septic patients: A case-control study was conducted. Peripheral blood samples were collected from 45 septic patients admitted to the intensive care unit (ICU) of Suzhou Municipal Hospital from June 2022 to January 2024, and from 32 age- and sex-matched healthy volunteers as the control group. The proportion of LDN in the peripheral blood mononuclear cell (PBMC) layer and among total neutrophils was analyzed. The expression of CD10, a marker of mature neutrophils, was detected by flow cytometry to analyze the proportion of immature LDN. 2) LPS-induced LDN generation and mechanism analysis: Neutrophils were isolated from the peripheral blood of healthy volunteers. They were stimulated with different concentrations of LPS (10, 100, 1 000 μg/L) for 4 hours. High-density neutrophil (HDN) and LDN were separated by Percoll density gradient centrifugation, and the proportion of LDN was calculated. Neutrophil extracellular trap (NET) levels in the culture supernatant were detected by enzyme-linked immunosorbent assay (ELISA). Neutrophils from healthy volunteers were divided into HDN control, LDN control, LPS-stimulated HDN, and LPS-stimulated LDN groups. The LPS-stimulated groups were treated with LPS (1 000 μg/L) for 4 hours, while the control groups received an equal volume of culture medium. Morphological changes were observed under transmission electron microscope. Additionally, neutrophils from healthy volunteers were divided into control group (an equal volume of culture medium), LPS group (stimulated with 1 000 μg/L LPS for 4 hours), and phorbol 12-myristate 13-acetate (PMA) group (stimulated with 100 nmol/L PMA for 4 hours). NET formation was observed under scanning electron microscope. In another experiment, neutrophils from healthy volunteers were divided into LPS group (stimulated with 1 000 μg/L LPS for 4 hours) and GSK484 pretreatment group (pretreated with 50 nmol/L GSK484, a NET release inhibitor, for 30 minutes before LPS stimulation). LDN generation was detected by flow cytometry, and NET levels in the supernatant were detected by ELISA. 3) Phenotypic and functional analysis of neutrophils: Neutrophils from healthy volunteers were divided into the same four groups as described above (HDN control, LDN control, LPS-stimulated HDN, LPS-stimulated LDN groups). The expression of granulocyte maturation markers (CD66b, CD15, CD16), chemokine receptors (CXCR2, CXCR4), and cell activation markers (CD11b, CD62L) was detected by flow cytometry. Chemotactic function was assessed using an agarose chemotaxis model, and the chemotactic distance (CD), chemotactic cell ratio (CCR), and chemotactic index (CI) were analyzed.

RESULTS: 1) Analysis results of LDN proportion in septic patients: The proportion of neutrophils in the PBMC layer (0.362±0.125), the proportion of LDN among total neutrophils (0.439±0.162), and the proportion of CD10^– LDN (0.222±0.093) in septic patients were higher than those in healthy controls (0.040±0.013, 0.014±0.004, and 0.005±0.002, respectively, all P<0.05). 2) LPS-induced LDN generation and mechanism analysis results: Transmission electron microscope showed increased surface protrusions and intracellular vacuoles in both HDN and LDN after LPS stimulation, particularly in the LPS-stimulated LDN group. After LPS stimulation, both the proportion of LDN and NET levels in the supernatant increased in a concentration-dependent manner (all P<0.05). Scanning electron microscope revealed that LPS stimulation induced NET formation in neutrophils, but to a lesser extent than PMA stimulation. GSK484 intervention inhibited LPS-induced LDN generation and NET release, with statistically significant differences compared with the LPS group [LDN count (×10⁵): 3.75±0.52 vs. 7.07±1.14, NET (A value): 0.96±0.14 vs. 1.36±0.27, both P<0.05]. 3) Results of phenotypic and functional analysis of neutrophils: Cell phenotype analysis revealed that compared with the control groups, after LPS stimulation, both HDN and LDN showed increased expression of CD66b and CD11b, and decreased expression of CD16, CXCR2, and CD62L. Compared with the LPS-stimulated HDN group, the LPS-stimulated LDN group exhibited higher expression of CD66b [mean fluorescence intensity (MFI): 16 424±2 074 vs. 9 470±1 201, P<0.05] and lower expression of CD16 (MFI: 3 647±1 458 vs. 7 815±1 143, P<0.05), while CD15 expression showed no significant change. Regarding cell chemokine receptors, compared with the LPS-stimulated HDN group, the LPS-stimulated LDN group showed decreased CXCR2 expression and increased CXCR4 expression. Regarding activation markers, compared with the LPS-stimulated HDN group, the LPS-stimulated LDN group showed increased CD11b expression (MFI: 11 684±2 131 vs. 7 782±373, P<0.05) and decreased CD62L expression [(59.75±7.42)% vs. (82.18±14.06)%, P<0.05]. Chemotaxis assays showed that after LPS stimulation, CD, CCR, and CI of HDN and LDN were all decreased, with more pronounced decreases in the LPS-stimulated LDN group than in the LPS-stimulated HDN group [CD (μm): 886.5±342.7 vs. 1 633.0±295.0, CCR: (0.69±0.25)% vs. (2.44±1.40)%, CI: (9.63±8.94)% vs. (34.62±8.31)%, all P<0.05].

CONCLUSIONS: LPS induces LDN generation through a NET formation-dependent pathway. This LDN subpopulation displays a unique phenotype characterized by high expression of CD66b, CXCR4, CD11b and low expression of CD16, CXCR2, CD62L, accompanied by chemotactic dysfunction.

PMID:42200239 | DOI:10.3760/cma.j.cn121430-20250801-00417

Acta Obstet Gynecol Scand. 2026 May 27. doi: 10.1111/aogs.70267. Online ahead of print.

ABSTRACT

INTRODUCTION: Induction of labor (IOL) rates have been increasing in high-income countries. Although IOL aims to reduce maternal and neonatal morbidity, the benefits for many common indications remain uncertain. Because IOL may also have disadvantages and place a burden on the health-care system, it is important to clarify the factors underlying the rising national IOL rates.

MATERIAL AND METHODS: This descriptive study included all singleton births in cephalic presentation delivered at 37⁺⁰ gestational weeks or later between January 1, 2005, and December 31, 2023, in Finland. Data from the Finnish Medical Birth Register were used to examine temporal trends in maternal characteristics, gestational age at delivery, pregnancy complications, and other pregnancy-related problems across three periods: 2005-2010, 2011-2016, and 2017-2023. Induced deliveries were analyzed separately. Risk ratios with 95% confidence intervals were calculated to describe changes over time, and odds ratios with 95% confidence intervals were estimated to assess associations between IOL and risk factors. Logistic regression models were adjusted for maternal age, body mass index (BMI), and parity.

RESULTS: The study sample included 880 478 births. The IOL rate doubled from 18% to 36%. In the IOL group, the most prevalent and increasingly common factors were maternal age ≥35 years, BMI ≥30 kg/m², and gestational diabetes. Prelabor rupture of membranes, fear of childbirth, and other pregnancy-related problems-despite their lower overall proportions-showed the steepest increases. Similar but less pronounced trends were seen in the total study cohort. The odds of IOL remained stable across the study periods for maternal age ≥35 years, BMI ≥30 kg/m², gestational diabetes, prelabor rupture of membranes, fear of childbirth, and other pregnancy-related problems; and all associations remained statistically significant after adjustment. The proportion of post-term pregnancy decreased significantly in both the total study cohort and the IOL group. In the IOL group, gestational age at birth shifted from post-term to late- and full term.

CONCLUSIONS: The main contributors to the increasing IOL rate were the increased prevalence of advanced maternal age, obesity, and gestational diabetes. The increases in the prevalence of other IOL indications were less extensive.

PMID:42200222 | DOI:10.1111/aogs.70267

JDR Clin Trans Res. 2026 May 27:23800844261446256. doi: 10.1177/23800844261446256. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to analyze the public’s perception of fluoride by investigating the most-viewed YouTube videos and their associated comments addressing fluoride in dental/public health contexts.

METHODS: Metadata and comments of YouTube videos were retrieved using the YouTube Data application programming interface (YouTube Data API) via Python. The top 100 most-viewed YouTube videos related to fluoride and their comments were analyzed. Sentiment analysis, Latent Dirichlet Allocation (LDA) topic modeling, word co-occurrence analysis, and word frequency analysis were performed. Statistical analyses including Spearman’s correlation, Kruskal-Wallis tests, and Mann-Whitney U tests were conducted to assess potential associations.

RESULT: A total of 76 eligible videos and 88,126 comments were analyzed. Approximately half (45%) of the retrieved videos were uploaded in 2024 and 2025. The mean (±standard deviation) and median sentiment scores were 9.5 ± 15.9 and 5.4, respectively. Significant negative correlations were observed between sentiment scores and both video views (r = -0.247, P = 0.032) and the number of comments (r = -0.486, P < 0.001). Among professional uploaders, videos by dental hygienists had a higher sentiment score compared with those by dentists (17.5 vs. -0.5). Topic modeling revealed that the term “poison” appeared 6 times more frequently in negative comments than in positive comments, followed by “conspiracy” and “bad,” whereas “love,” “care,” and “safe” were predominant in positive comments.

CONCLUSION: Fluoride has emerged as a controversial societal topic. The terms “poison” and “conspiracy” reflect prominent public concerns. Dental hygienists play a critical role in disseminating online information on fluoride, highlighting the need for targeted strategies to mitigate public anxiety and promote the appropriate use of fluoride in dental care.Knowledge Transfer Statement:The present study provides insights into public health communication. First, empowering professionals and optimizing video formats (eg, tutorials, skills-based demonstration, and short dramas) could enhance the reach and acceptance of evidence-based fluoride advocacy. Second, policymakers should address societal and historical factors shaping public distrust, rather than relying solely on scientific dissemination. Finally, due to contagion of negative emotions, there is a need to monitor and alleviate negative sentiments.

PMID:42200218 | DOI:10.1177/23800844261446256

Front Physiol. 2026 May 11;17:1811438. doi: 10.3389/fphys.2026.1811438. eCollection 2026.

ABSTRACT

BACKGROUND: Vascular dementia (VaD) is characterized by progressive cognitive impairment associated with chronic cerebral hypoperfusion. Monoaminergic neurotransmitter dysfunction has been implicated in its pathogenesis. Acupuncture has shown neuroprotective potential in experimental models; however, its regulatory effects on monoaminergic systems remain to be systematically clarified. This study aimed to evaluate the effects of acupuncture on monoaminergic neurotransmitters and cognitive function in animal models of VaD through a preclinical systematic review and meta-analysis.

METHODS: In accordance with the PRISMA 2020 guidelines, a comprehensive search across eight English and Chinese databases was conducted from inception to October 2025 to identify randomized controlled animal studies investigating acupuncture in VaD models. Primary outcomes focused on the levels of monoaminergic neurotransmitters, including serotonin (5-HT), norepinephrine (NE), and dopamine (DA). Secondary outcomes encompassed acetylcholine (ACh) levels, long-term potentiation (LTP), and behavioral performance. Risk of bias was systematically assessed using the SYRCLE tool, and statistical synthesis was performed using R software (version 4.3.1).

RESULTS: Nine studies involving 386 rodents were included. Meta-analysis demonstrated that acupuncture elevated the levels of 5-HT (SMD = 1.35), NE (SMD = 2.67), and DA (SMD = 1.43). Furthermore, acupuncture treatment was associated with increased ACh levels (SMD = 3.75) and enhanced synaptic plasticity, as evidenced by improved LTP (SMD = 4.75). Behavioral assessments revealed substantial cognitive improvements, indicated by a reduction in escape latency (SMD = -4.66) and an increased number of platform crossings (SMD = 3.00) in the Morris water maze test.

CONCLUSION: Acupuncture may ameliorate cognitive impairment in VaD by modulating monoaminergic systems and enhancing synaptic plasticity. However, substantial heterogeneity and small sample sizes underscore the exploratory nature of these findings. To avoid overgeneralization of mechanistic pathways, further rigorous studies are essential.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, identifier CRD420251179267.

PMID:42200180 | PMC:PMC13198999 | DOI:10.3389/fphys.2026.1811438

Front Physiol. 2026 May 11;17:1805547. doi: 10.3389/fphys.2026.1805547. eCollection 2026.

ABSTRACT

BACKGROUND: This study aims to examine the effects of moderate-to-low-intensity exercise snacks on glucose and lipid metabolism in sedentary adults and to identify the optimal exercise intervention protocol.

METHODS: We systematically searched five databases (PubMed, Web of Science, Google Scholar, Wan fang, and China National Knowledge Infrastructure) from their inception to July 28, 2025, to identify randomized controlled trials evaluating exercise-based snacking interventions. Meta-analyses were performed using Stata (version 12.0) and R (version 4.5.0), with additional subgroup analyses, meta-regression, sensitivity analyses, and assessments of publication bias.

RESULTS: A total of 15 studies comprising 334 participants were included. Meta-analysis demonstrated statistically significant effects of moderate-to-low intensity exercise on fasting plasma glucose [SMD=-0.52, 95%CI=(-0.93,-0.12), P = 0.012], total cholesterol [SMD=-0.33, 95%CI=(-0.62,-0.04), P = 0.026], triglycerides [SMD=-0.42, 95%CI=(-0.81,-0.02), P = 0.041] and low-density lipoprotein cholesterol [SMD=-0.51, 95%CI=(-0.84,-0.18), P = 0.003]. In contrast, no significant effects were observed for fasting insulin[SMD=-0.13, 95%CI=(-0.68,0.43), P = 0.652] or high-density lipoprotein cholesterol [SMD = 0.31, 95% CI=(-0.15,0.78), P = 0.104]. Subgroup analyses showed that walking, exercising more than five times per day, and acute interventions lasting ≤3 weeks were associated with greater improvements in fasting plasma glucose and triglycerides levels. In addition, total cholesterol improved more markedly when interruptions of sedentary behavior lasted >30 minutes and exercise bouts lasted >3 minutes. Meta-regression analyses further identified sample size and body mass index as significant moderators of fasting plasma glucose and triglycerides levels.

CONCLUSION: Moderate-to-low-intensity exercise combined with exercise snacks significantly improved fasting plasma glucose, total cholesterol, triglycerides, and low-density lipoprotein cholesterol levels in sedentary adults, but had no significant effects on fasting insulin or high-density lipoprotein cholesterol levels. Moreover, walking, exercising more than five times per day, and maintaining the intervention for 1 to 3 weeks may be associated with greater improvements in glucose and lipid metabolism in this population.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, identifier CRD420251090803.

PMID:42200178 | PMC:PMC13199107 | DOI:10.3389/fphys.2026.1805547

Front Sociol. 2026 May 11;11:1743049. doi: 10.3389/fsoc.2026.1743049. eCollection 2026.

ABSTRACT

OBJECTIVE: The aim of this study was to analyze the relationship between dating violence and mental health issues in young university students in Ecuador examining differences between men and women.

METHODS: This investigation used a quantitative, descriptive and explanatory approach, cross-sectional design with a sample of 1,033 students. Two psychological scales were applied: Dating Violence Questionnaire-R (DVQ-R) and General Health Questionnaire-28 (GHQ-28). Statistical analyses included chi-square tests, Pearson’s correlation coefficient and multivariate analysis of variance (MANOVA).

RESULTS: Revealed significant differences (p < 0.01) in the prevalence of dating violence, which was slightly higher in men, while women scored higher on mental health symptoms. In addition, it was observed that dating violence was significantly associated (p < 0.01) with poorer mental health, being associated of psychosomatic symptoms, anxiety, depression and social dysfunction, especially in woman.

CONCLUSION: This study found that dating violence represents a significant issue affecting both women and men. It is essential to adopt an inclusive and gender-sensitive approach to dating violence regardless of gender.

PMID:42200172 | PMC:PMC13199077 | DOI:10.3389/fsoc.2026.1743049

Front Allergy. 2026 May 11;7:1800197. doi: 10.3389/falgy.2026.1800197. eCollection 2026.

ABSTRACT

BACKGROUND: Pollen-induced allergic rhinitis (PIAR) is a major public health burden in high-pollen regions of northern China (e.g., Ordos, southern Inner Mongolia Plateau). However, regional variations in PIAR across ecological zones (urban, agropastoral, desert, and mining zones), dominant allergens, and key risk factors remain understudied due to prior small-sample or narrow-scope research.

OBJECTIVE: This study aimed to investigate the prevalence, major risk factors, and current treatment patterns for PIAR in Ordos.

METHODS: From March to July 2023, a multicenter, randomized, stratified cross-sectional survey was conducted across nine areas in Ordos. Participants were recruited to complete in-person questionnaires and undergo skin prick tests (SPTs) for 16 common allergens. Pollen was collected and counted to monitor exposure levels.

RESULTS: Among the 4,303 participants, the prevalence rates of self-reported allergic rhinitis (SRAR), physician-diagnosed allergic rhinitis (PDAR), and PIAR were 52.89% (2,276/4,303), 34.70% (1,493/4,303), and 31.51% (1,356/4,303), respectively. The prevalence rates of PIAR in urban, agropastoral, desert, and mining areas were 30.46%, 39.55%, 29.09%, and 19.72%, respectively. Among patients with PIAR, the incidence of symptom onset was highest among urban residents and lowest among mining area residents. Poplar pollen allergen dominated in spring, whereas in autumn, Artemisia pollen was predominant. Clinical symptoms were greatest in July, preceding the autumn pollen peak in September.

CONCLUSION: PIAR is highly prevalent in northern China’s grasslands, with marked zone-specific variations. Artemisia pollen exposure is the main sensitization driver, supporting targeted PIAR prevention/control.

PMID:42200171 | PMC:PMC13199316 | DOI:10.3389/falgy.2026.1800197

Patient Prefer Adherence. 2026 May 19;20:602433. doi: 10.2147/PPA.S602433. eCollection 2026.

ABSTRACT

INTRODUCTION: Existing instruments for assessing medication nonadherence lack sufficient insights into the specific barriers to Low-Middle-Income-Countries (LMICs), thus limiting their utility in developing tailored intervention approaches. This cross-sectional scale development and validation study therefore aimed to develop and validate a patient-centered, self-reported scale to identify patients’ medication adherence and barriers relevant to LMICs contexts among people with chronic diseases.

METHODS: This study had three-phases: (i) item development, (ii) content and face validity, and (iii) psychometric analysis. After item development, the items were refined through Item Content Validity Index (I-CVI) assessment and patient pre-testing. The third phase evaluated psychometric properties along with an assessment of agreement with objective clinical indicators (blood pressure and fasting blood glucose) and comparison with the validated scales Medication Adherence Report Scale-5 (MARS-5) and VAS Adherence using 419 patients. Statistical analyses included confirmatory factor analysis (CFA) to determine model fit. We also determined reliability and assessed test-retest reliability.

RESULTS: A final set of 15 items were selected, which were grouped into 4 dimensions: patient, medication, healthcare system, and socioeconomic related-barriers. The CFA showed that the data was fit for the model (χ²⁼179.477, P<0.001, RMSEA=0.052, CFI=0.961, GFI=0.947). The reliability test showed a good internal consistency (Cronbach’s-α=0.727 and McDonalds- Ω=0.812) and test-retest reliability (correlation coefficient 0.802). The new scale exhibited strong negative correlations with MARS-5 (r=-0.707) and VAS Adherence (r=-0.725), and a moderate negative correlation with clinical measurements (r=-0.632).

CONCLUSION: A psychometrically validated 15-item scale to assess medication adherence and its barriers in patients with chronic disease was developed, offering a reliable, contextually relevant tool that addresses information gaps and supports tailored interventions for improved patient outcomes in LMIC settings.

PMID:42200170 | PMC:PMC13199714 | DOI:10.2147/PPA.S602433

Patient Prefer Adherence. 2026 May 19;20:611334. doi: 10.2147/PPA.S611334. eCollection 2026.

ABSTRACT

BACKGROUND: Elderly chronic disease management is often complicated by multimorbidity and the need for lifelong polypharmacy, yet poor adherence severely impedes progress. Existing studies mainly focus on exploring influencing factors of medication adherence, while most predictive models lack model interpretability and rarely integrate psychological and social support factors for community elderly populations. Predictive models identifying risk of adherence could enable proactive intervention.

OBJECTIVE: To develop an interpretable machine learning prediction model that fills the above research gap to predict the medication adherence of elderly patients with chronic diseases in China.

METHODS: From January to December 2024, data were collected from chronic disease patients aged 60 years and older receiving home-based medication therapy through face-to-face interviews conducted by pharmacists. Variables included demographic information, comorbidities, chronic diseases and medications information, medication adherence, self-efficacy in rational drug use, medication beliefs, social support, and medication literacy. The dataset was randomly divided into a training set and a test set at a 7:3 ratio. Multivariate logistic regression analysis was performed on all data, and predictors were selected from the training set via the Least Absolute Shrinkage and Selection Operator (LASSO). Six machine learning algorithms were applied in R software to develop predictive models using the training set, and their performance was compared on the test set. The Shapley Additive Explanations (SHAP) approach was used to interpret the optimal model.

RESULTS: A total of 1722 patients were included in the statistical analysis. The gradient boosting machine (GBM) exhibited the best predictive performance among the six models (AUC = 0.811, 95% CI 0.774-0.840), with its core predictors being self-efficacy in rational drug use, medication practice, concern beliefs, and availability of social support. Through SHAP analysis, the interpretability of the model was significantly enhanced, providing a clear decision-making basis for clinicians.

CONCLUSION: We constructed a prediction model for home medication adherence in elderly patients with chronic diseases, which incorporates important social and psychological factors affecting patients’ adherence and provides robust evidence for developing targeted interventions.

PMID:42200167 | PMC:PMC13199717 | DOI:10.2147/PPA.S611334