Tag: pubmed

Health Serv Res. 2026 Apr;61(2):e70109. doi: 10.1111/1475-6773.70109.

ABSTRACT

OBJECTIVE: To examine the plausibly causal effect of Medicaid home- and community-based services (HCBS) use on Medicare community-initiated home health care (CIHHC) utilization among dual-eligible older adults and to provide evidence on whether access to home-based long-term care (LTC) reduces use of Medicare home health care, with potential implications for whether Medicare home health care is used as a substitute for LTC services when they are not or less accessible.

STUDY SETTING AND DESIGN: To address the endogeneity of Medicaid HCBS use, we employ an instrumental variable, the proportion of Medicaid HCBS enrollment in other counties within the same state in the previous quarter, in conjunction with a state-border design in estimating the effect of Medicaid HCBS use on Medicare CIHHC and its heterogeneity.

DATA SOURCES AND ANALYTIC SAMPLE: We use national Medicare and Medicaid claims data along with home health and nursing home assessment data from 2016 to 2019. Our sample consists of 36,955,226 beneficiary-quarter-level observations of older adults (65+) dually enrolled in Medicaid and Medicare and residing in contiguous state-border counties.

PRINCIPAL FINDINGS: Medicaid HCBS use reduces Medicare CIHHC utilization by approximately 1.02 percentage points (95% CI: -1.73 to -0.32), representing about 44% of the sample mean. This effect is concentrated among beneficiaries enrolled in Medicare-Medicaid integrated care plans and those living in urban counties. Moreover, the reduction is most pronounced among older adults who live alone and have around-the-clock assistance needs.

CONCLUSIONS: Our findings suggest a substitution between Medicaid HCBS and Medicare CIHHC among dual-eligible older adults at the margin of using Medicaid HCBS, a relationship that should be taken into account when evaluating either program. These findings also align with the hypothesis that Medicare CIHHC is being used as a substitute for LTC, and the availability of home-based LTC may help to alleviate this potentially inefficient use.

PMID:41919377 | DOI:10.1111/1475-6773.70109

Orthop Surg. 2026 Apr 1. doi: 10.1111/os.70302. Online ahead of print.

ABSTRACT

OBJECTIVE: Subtrochanteric shortening osteotomy (SSO) with autogenous cortical plate grafting is a critical but technically demanding procedure in total hip arthroplasty for Crowe type IV developmental dysplasia of the hip. Conventional instruments often result in inaccurate osteotomies and unstable graft fixation. This study aimed to evaluate a novel surgical instrumentation system designed to address these challenges.

METHODS: A retrospective cohort study was conducted on 49 patients (60 hips) with Crowe type IV DDH who underwent primary THA with SSO. The control group included 25 patients (30 hips) treated with conventional instruments. The novel instrumentation group included 24 patients (30 hips) treated with the newly developed system. All surgeries were performed by a single senior surgeon. Demographic and clinical data were analyzed, and all patients completed the 24-month postoperative follow-up. Statistical analysis was performed using t-tests and chi-squared tests as appropriate.

RESULTS: The mean operative time was significantly shorter in the novel instrumentation group than in the control group (t = 2.123, p = 0.040). The novel instrumentation system was estimated to reduce the time required for the autogenous cortical plate technique by 43%. Patients in the novel instrumentation group also reported significantly less intraoperative blood loss (t = 3.078, p = 0.003). The satisfaction rate regarding autogenous graft and wire positions was significantly higher in the novel instrumentation group (χ² = 5.455, p = 0.020). No significant differences were observed in clinical scores between the two groups during the 24-month follow-up. No severe perioperative or postoperative complications occurred in either group.

CONCLUSION: The novel surgical instrumentation system demonstrated advantages over conventional devices in terms of operating time, blood loss, and satisfaction with autogenous graft and wire positioning. It represents an ideal set of surgical tools for Crowe type IV DDH patients undergoing THA with SSO.

LEVEL OF EVIDENCE: Level III, retrospective study.

PMID:41919348 | DOI:10.1111/os.70302

J Dermatolog Treat. 2026 Dec;37(1):2650070. doi: 10.1080/09546634.2026.2650070. Epub 2026 Apr 1.

ABSTRACT

BACKGROUND: The emergence of systemic targeted therapies for atopic dermatitis (AD) has significantly transformed the treatment landscape.

OBJECTIVE: This network meta-analysis aims to systematically evaluate the relative efficacy of approved systemic targeted therapies in adult patients with moderate-to-severe AD.

METHODS: Phase 3 or 4 randomized controlled trials (RCTs) assessing approved systemic targeted therapies for moderate-to-severe AD published up to July 29, 2025, were systematically identified. A Bayesian network meta-analysis was performed to analyze the proportion of patients achieving key efficacy indicators, including EASI-75, EASI-90, IGA 0/1, and NRS response.

RESULTS: A total of 27 reports encompassing 33 trials and 16,334 participants were included. The network meta-analysis demonstrated that Upadacitinib 30 mg consistently exhibited the highest probability of achieving each clinical endpoint. While pairwise comparisons revealed statistically significant differences among multiple targeted therapies, no significant differences were observed between dupilumab 300 mg and stapokibart 300 mg, or between ivarmacitinib 8 mg and upadacitinib 15 mg.

CONCLUSION: Among currently approved targeted systemic therapies, upadacitinib 30 mg once daily ranked highest across all evaluated efficacy outcomes. However, these findings are derived primarily from indirect comparisons, and head-to-head randomized trials are needed to confirm the relative effectiveness of these therapies.

PMID:41919337 | DOI:10.1080/09546634.2026.2650070

Turk J Orthod. 2026 Mar 31;39(1):35-42. doi: 10.4274/TurkJOrthod.2026.2025.141.

ABSTRACT

OBJECTIVE: To evaluate the scientific literature on impacted canines using bibliometric and altmetric analyses.

METHODS: A systematic search of the Web of Science Core Collection was performed using keywords related to impacted canines. Three independent reviewers identified, screened, and evaluated the 100 most-cited articles. Citation data were cross-verified with Scopus and Google Scholar. Extracted information included citation counts, study design, publication year, authors, institutions, journals, and countries. Bibliometric mapping was conducted using VOSviewer, and altmetric indicators were obtained from dimensions. Statistical analysis was performed using Spearman’s rank correlation, with significance set at p<0.05.

RESULTS: The 100 most-cited articles received 10,429 citations in the Web of Science, and citation counts were strongly correlated across databases (p<0.001). Most studies were observational (69%), followed by narrative reviews (12%) and interventional studies (10%). Research topics primarily addressed the etiology, radiographic assessments, and associated anomalies. The most cited article in the Web of Science database was Ericson and Kurol’s 1988 study on the interceptive extraction of primary canines. Publications were concentrated in orthodontic specialty journals, with the USA, Italy, and Israel being the leading countries.

CONCLUSION: Analysis of the 100 most-cited articles revealed that influential research on impacted canines is predominantly, focusing on etiology and diagnosis. Areas such as mandibular impactions, periodontal outcomes, and long-term treatment effects remain underexplored.

PMID:41919331 | DOI:10.4274/TurkJOrthod.2026.2025.141

Public Health Nutr. 2026 Apr 1:1-26. doi: 10.1017/S1368980026102316. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine the association between dietary patterns and MetS in western China, which has not been previously reported.

DESIGN: A population based cross-sectional study design. Dietary intake was assessed using a semi-quantitative food frequency questionnaire. Principal component analysis identified dietary patterns, and multivariate logistic regression evaluated their associations with MetS.

SETTING: Population-based Cohort Study of Chronic Diseases in Xinjiang (PCCDX), conducted in 2022.

PARTICIPANTS: A total of 3 208 individuals from PCCDX (mean age: 53.1 ± 10.8 years; 49.1% male).

RESULTS: MetS was diagnosed in 1 762 participants (54.9%). Four distinct dietary patterns were identified, with the refined grain-animal products dietary pattern being the dominant one. After adjusting for general demographic and lifestyle factors, a higher score in the refined grain-animal product pattern was associated with an increased risk of MetS. The odds ratios for the second, third, and fourth quartiles of the dietary score were 1.07 (95% CI: 0.860∼1.322), 1.14 (0.923∼1.413), and 1.48 (1.189∼1.853), with a statistically significant trend (P = 0.003). Higher dietary scores in this pattern were also associated with increased risks of elevated waist circumference, high triglycerides, and low high-density lipoprotein cholesterol (HDL-C) (P < 0.05). Mediation analysis showed that visceral fat percentage partially mediated the association between the refined grain-animal product dietary pattern and low HDL-C, accounting for 17.2% of the total effect (indirect effect = 0.005, P = 0.006). The other three dietary patterns showed no significant associations with MetS or its components.

CONCLUSIONS: This study highlights the high prevalence of MetS in western China and links a refined grains-animal products diet to poorer metabolic health, emphasizing the need for region-specific dietary strategies.

PMID:41919321 | DOI:10.1017/S1368980026102316

Psychol Med. 2026 Apr 1;56:e87. doi: 10.1017/S0033291726103717.

ABSTRACT

BACKGROUND: Parental violent offending and offspring suicidal behavior are associated, but a deeper understanding of the risk within this population is needed to best identify and support those most in need. This study examined the risk of suicidal behavior among offspring of parents with violent convictions, primarily aiming to identify high-risk subgroups.

METHODS: The study included 2,956,465 individuals born in Sweden 1977-2010, and their parents. Data were obtained from nationwide registers available until the end of 2020. The authors examined the risk of suicidal behavior among offspring with none, one, or both parents with violent convictions by offspring’s age 10, and further investigated the risk among exposed offspring by parental psychiatric disorders, child-parent coresiding, and other factors. Children-of-siblings analyses were conducted to better understand the nature of the association.

RESULTS: There were 254,793 (8.6%) and 11,777 (0.4%) offspring with one or both parents with violent convictions. Absolute risk of suicidal behavior was highest among those with both parents convicted; 14.3% (95% CI, 13.0-15.7) of male and 16.6% (95% CI, 15.3-18.0) of female offspring engaged in suicidal behavior by age 30, compared to 4%-4.5% of offspring of parents without convictions. The more adversities accumulated in families with parental offending, the higher the cumulative incidence of suicidal behavior. Genetic factors partly accounted for the association.

CONCLUSIONS: Offspring of parents with violent convictions are a group at high risk of suicidal behavior in need of early identification, multiagency coordination, and measures to reduce the risk of self-harm and suicide.

PMID:41919313 | DOI:10.1017/S0033291726103717

Int J Paediatr Dent. 2026 Apr 1. doi: 10.1111/ipd.70087. Online ahead of print.

ABSTRACT

BACKGROUND: Epidermolysis bullosa (EB) is a rare disorder characterized by recurrent blisters on the skin and oral mucosa, occurring spontaneously or after minor trauma.

AIM: Evaluate the oral health status of children with EB and parents’ perceptions of its impact on their child’s and family’s quality of life.

DESIGN: A cross-sectional study with age-matched groups was conducted with 42 children (14 with EB and 28 without EB), aged 2-10 years, along with their parents/guardians. Participants were recruited from a reference center and a school clinic. Data demographic and socioeconomic were collected. Oral health-related quality of life (OHRQoL) was measured using the Parental-Caregiver Perceptions Questionnaire (P-CPQ-short form) and Family Impact Scale (FIS). Oral examination included evaluation of gingival condition, malocclusions, dental caries, and oral lesions. Statistical analysis included Chi-square, Mann-Whitney, t-test, and Kruskal-Wallis tests (α = 5%).

RESULTS: Children with EB had significantly higher gingival and plaque indices (p = 0.001; p < 0.001). Parents reported worse OHRQoL for children with EB, especially in “oral symptoms” and “functional limitations” (p < 0.001). FIS scores were similar between groups (p > 0.05). Oral lesions were significantly associated with poorer OHRQoL (p = 0.001).

CONCLUSIONS: Oral lesions were responsible for impacts experienced in children’s daily lives, with significant negative effects occurring through symptoms.

PMID:41919311 | DOI:10.1111/ipd.70087

Front Public Health. 2026 Mar 16;14:1782478. doi: 10.3389/fpubh.2026.1782478. eCollection 2026.

ABSTRACT

BACKGROUND: Physical inactivity poses serious health risks. Message framing is a strategy to encourage healthy behaviors, but its effectiveness in promoting physical activity (PA) is unclear, creating challenges for professionals in choosing optimal strategies.

OBJECTIVE: To compare the effects of gain-framed versus loss-framed messages on PA attitudes, intentions, and behaviors among inactive adults.

METHODS: Seven electronic databases were searched from inception to December 15, 2024. Randomized controlled trials examining gain- versus loss-framed messages targeting physically inactive adults were included. Independent reviewers selected the studies, extracted the data, and performed the risk of bias. Standardized mean differences (SMDs) and 95% confidence intervals (CIs) werepooled using random-effects models. Heterogeneity was assessed using I ² and Q statistics. Subgroup and sensitivity analyses were conducted to explore heterogeneity sources and assess result stability.

RESULTS: Ten RCTs involving 1,355 participants were included. Three articles tested the gain-loss framing effect through PA attitudes, and eight studies each tested message framing through PA intentions and behaviors. There were no statistically significant differences between gain-framed and loss-framed messages in promoting PA attitudes [SMD:-0.60, 95%CI: (-2.09, 0.90), P = 0.44], intentions [SMD: 0.10, 95%CI: (-0.12, 0.33), P = 0.37] and behaviors [SMD: 0.15, 95%CI: (-0.04, 0.34), P = 0.13]. Subgroup analyses suggested that gain-framed messages may have a potential advantage in promoting PA behaviors among general populations [SMD: 0.39, 95%CI: (0.03, 0.55), P = 0.03] and young adults [SMD: 0.38, 95%CI: (013, 0.63), P = 0.003].

CONCLUSIONS: Current evidence does not demonstrate a clear overall advantage of gain- over loss-framed messages in promoting PA among inactive adults. However, gain-framed messages may be more promising for general and young populations. Further high-quality trials with standardized methodologies and longer follow-up periods are needed to clarify their effectiveness.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023482474, identifier CRD42023482474.

PMID:41919308 | PMC:PMC13033674 | DOI:10.3389/fpubh.2026.1782478

Front Public Health. 2026 Mar 16;14:1781124. doi: 10.3389/fpubh.2026.1781124. eCollection 2026.

ABSTRACT

BACKGROUND: Chronic obstructive pulmonary disease (COPD) poses a significant global health burden, particularly in older adults. Pulmonary rehabilitation (PR) is a core management strategy, yet its implementation remains limited and imbalanced, especially within primary healthcare settings in China. The county medical community model aims to integrate healthcare resources, representing a potential platform for optimizing PR delivery. This study aimed to assess the knowledge, attitudes, and practices (KAP) regarding PR among older adults with COPD within a county medical community and to analyze the associated influencing factors.

METHODS: A convenience sampling approach was applied to select 150 older adults with COPD who visited medical community institutions between January 2024 and December 2024. Data were collected using a general information wquestionnaire and a pulmonary rehabilitation KAP questionnaire. Statistical analyses were conducted to evaluate KAP levels and to identify factors associated with pulmonary rehabilitation KAP.

RESULTS: The total pulmonary rehabilitation KAP score among the 150 older adults with COPD was 68.63 ± 19.23. Scores for the knowledge, attitude, and practice dimensions were 32.57 ± 11.79 (out of a possible 60), 15.77 ± 3.77 (out of a possible 20), and 20.28 ± 8.50 (out of a possible 50), respectively. Multiple linear regression analysis indicated that the type of hospital visited, age, the presence of a primary caregiver, and guidance from medical staff were significant influencing factors associated with pulmonary rehabilitation KAP among older adults with COPD (p < 0.05).

CONCLUSION: Older adults with COPD in the medical community demonstrated a generally positive attitude toward pulmonary rehabilitation, whereas knowledge and practice levels remained relatively low. Strengthened and targeted professional guidance from medical staff for patients and their caregivers across different age groups is warranted. Enhanced coordination within medical communities and the development of innovative service models may facilitate more effective implementation of pulmonary rehabilitation, thereby improving quality of life and health management among older adults with COPD.

PMID:41919306 | PMC:PMC13033687 | DOI:10.3389/fpubh.2026.1781124

Front Public Health. 2026 Mar 16;14:1790766. doi: 10.3389/fpubh.2026.1790766. eCollection 2026.

ABSTRACT

BACKGROUND: Physical activity is widely promoted as a cornerstone of healthy ageing; however, this assumption largely derives from leisure-time exercise and may not apply to labour-dependent older populations. In rural settings, occupational physical activity (OPA) is often necessity-driven, prolonged, and embedded within structural constraints, yet its associations with metabolic and vascular outcomes in later life remain poorly understood.

METHODS: We conducted a community-based cross-sectional study of 2,258 adults aged ≥65 years from a representative agricultural region in Northeast China. Labour-type physical activity was classified as inactive, moderate, or high intensity. To mitigate underdiagnosis, we defined total diabetes burden as either diagnosed diabetes or undiagnosed hyperglycemia. Systemic insulin resistance was assessed using the triglyceride-glucose (TyG) index. Urine occult blood (UOB) positivity was analyzed as an exploratory marker compatible with physiological stress. Associations were examined using modified Poisson regression with robust variance, robust linear regression, and prespecified sensitivity analyses.

RESULTS: High-intensity labour was associated with a modest reduction in insulin resistance among individuals without diagnosed diabetes (β = -0.079, p = 0.005) and a lower prevalence of undiagnosed hyperglycemia (PR 0.69, 95% CI 0.53-0.88). In contrast, high-intensity labour was more common among individuals with diagnosed diabetes (PR 1.43, 95% CI 1.11-1.85). These opposing associations did not show a significant net association with total diabetes burden (PR 0.99, p = 0.912). Independently of metabolic status, high-intensity labour was associated with a higher prevalence of UOB positivity (PR 1.25, 95% CI 1.09-1.44).

CONCLUSION: In labour-dependent rural older adults, heavy occupational labour may not confer metabolic benefit at the population level and is independently associated with a microvascular stress-related signal. This “Futile Labour Paradox” challenges the assumption that physical activity is uniformly beneficial in later life and underscores the need to distinguish occupational labour from discretionary exercise.

PMID:41919304 | PMC:PMC13033493 | DOI:10.3389/fpubh.2026.1790766