Tag: pubmed

JAMA Netw Open. 2026 Apr 1;9(4):e269274. doi: 10.1001/jamanetworkopen.2026.9274.

ABSTRACT

IMPORTANCE: Pediatric hemovigilance is a nascent field in transfusion medicine. The lack of standardized hemovigilance reporting in the US makes it difficult to determine age-specific transfusion reaction rates and risks.

OBJECTIVE: To evaluate the rates and epidemiology of transfusion reactions reported to transfusion services in neonatal and pediatric populations.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study analyzed transfusion reactions occurring in children younger than 18 years reported to 8 hospitals’ transfusion services during April 1, 2019, through December 31, 2023. Data were evaluated from March 2024 to June 2025 using standardized data collection forms and associated electronic health records.

EXPOSURE: Patients who received transfused blood products (red blood cells [RBCs], platelets, plasma, or cryoprecipitate) with at least 1 transfusion reaction reported to the transfusion service.

MAIN OUTCOMES AND MEASURES: Reaction rates per 100 000 products transfused were calculated. Pediatric transfusion reactions were characterized in detail, including reported severity and imputability; product type; patient age, sex, race, and ethnicity; and reported symptoms, premedication, and clinical management.

RESULTS: The sample included 228 886 products transfused to 22 628 patients (median [IQR] age, 4.2 [0.3-12.4] years; 127 903 males [55.9%]). The products were transfused to patients of Asian (18 649 [8.2%]), Black (37 673 [16.5%]), White (93 824 [41.0%]), multiracial (3680 [1.6%]), other (68 857 [30.1%]), or unknown race (6203 [2.7%]) and Hispanic or Latinx (52 398 [22.9%]), non-Hispanic and non-Latinx (144 017 [62.9%]), and unknown ethnicity (32 471 [14.2%]). A total of 1165 imputable transfusion reactions were reported, with an overall reaction rate of 0.52% (95% CI, 0.49%-0.55%). Patients aged 5 to 11 years had the highest reported transfusion reaction rate (891.11 [95% CI, 799.81-989.11] per 100 000 products transfused). Platelet transfusions had the highest transfusion reaction rates (821.75 [95% CI, 754.14-893.80] per 100 000 products transfused), with allergic reactions being most common (506.04 [95% CI 453.30, 563.24] per 100 000 products transfused), whereas RBC transfusions had more reported febrile nonhemolytic transfusion reactions (FNHTRs; 296.20 [267.06, 327.67] per 100 000 products transfused) than other types of reactions. The most common symptoms were urticaria (69.6% [368 of 529 patients]) in allergic reactions, fever (96.5% [559 of 579 patients]) in FNHTRs, and acute respiratory distress (87.5% [21 of 24 patients]) in transfusion-associated circulatory overload (TACO); the most common treatments were antihistamines (80.3% [425 of 529 patients]) for allergic reactions, antipyretics (67.9% [393 of 579 patients]) for FNHTRs, and diuretics (83.3% [20 of 24 patients]) for TACO. Many patients (35.8% [107 of 299]) did not receive premedication after the first reaction in subsequent transfusions, regardless of reaction type. When transfusion reactions recurred, they were often of the same type (77.9% of reactions [120 of 154] after allergic reactions were allergic; 72.1% of reactions [98 of 136] after FNHTRs were FNHTRs).

CONCLUSIONS AND RELEVANCE: In this cohort study of pediatric transfusion reactions, reactions appeared to be age dependent, and rates of allergic reactions and FNHTRs were higher than rates from previously published, possibly underreported, predominantly adult data. These findings underscore the importance of pediatric-specific hemovigilance to improve recognition, reporting, and safety monitoring of transfusion reactions.

PMID:42043816 | DOI:10.1001/jamanetworkopen.2026.9274

JAMA Netw Open. 2026 Apr 1;9(4):e269328. doi: 10.1001/jamanetworkopen.2026.9328.

ABSTRACT

IMPORTANCE: Enrollment in Medicaid expansion may improve financial outcomes for low-income adults, but this association has not been studied in the longer-term postenrollment period.

OBJECTIVE: To estimate the association of enrollment in Medicaid expansion with financial outcomes for enrollees as long as 7 years after enrollment.

DESIGN, SETTING, AND PARTICIPANTS: This longitudinal cohort study used an event study analysis to compare changes in credit outcomes after relative to before enrollment, controlling for changes in outcomes over time, differences between individuals who enroll at different times, and linear trends in outcomes prior to enrollment. Participants included first-time enrollees in the Healthy Michigan Plan (HMP), Michigan’s Medicaid expansion plan, between April 1, 2014, and December 31, 2017. Enrollees were linked with their credit reports from a large national credit agency at 6-month intervals from 2013 to 2021, with outcomes obtained on the final business day of January and July of each calendar year. Data were analyzed from January 4, 2023, to December 9, 2025.

EXPOSURE: Enrollment in HMP.

MAIN OUTCOMES AND MEASURES: The event study analysis compared changes in 4 credit outcomes: medical debt in collections, nonmedical debt in collections, a subprime credit score (<600), and bankruptcy in the prior 2 years.

RESULTS: The study cohort included 575 283 enrollees (308 814 male [53.7%]; mean [SE] age, 42.1 [10.6] years). HMP enrollment was associated with large reductions in medical debt in collections (from -$101.9 [95% CI, -$127.6 to -$76.3] in postenrollment quarter 8 to -$983.0 [95% CI, -$1090.8 to -$875.1] in postenrollment quarter 29) and rates of subprime credit scores (from -0.038 [95% CI, -0.041 to -0.035] in postenrollment quarter 8 to -0.234 [95% CI, -0.247 to -0.221] in postenrollment quarter 29), with the magnitude of association increasing over time. No associations were observed between HMP enrollment and nonmedical debt in collections or bankruptcy.

CONCLUSIONS AND RELEVANCE: In this cohort study of HMP enrollees, Medicaid expansion enrollment was associated with reductions in medical debt in collections and rates of subprime credit scores as long as 7 years after enrollment. These results suggest enrollment in Medicaid expansion was associated with excellent protection from out-of-pocket costs of medical care and overall improved financial stability, which in turn may be associated with improvements in enrollees’ health and well-being.

PMID:42043815 | DOI:10.1001/jamanetworkopen.2026.9328

JAMA Netw Open. 2026 Apr 1;9(4):e2610114. doi: 10.1001/jamanetworkopen.2026.10114.

ABSTRACT

IMPORTANCE: Missed pediatric preventive care visits can delay essential developmental screenings, immunizations, and management of chronic conditions, adversely impacting child health. Understanding the relationship between extreme temperatures and missed preventive care is essential for developing adaptive strategies to maintain care access amid increasing climate variability.

OBJECTIVE: To assess the association of extreme temperatures with rates of missed pediatric preventive care visits and evaluate differences by patient age, insurance, and neighborhood socioeconomic status (SES).

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional time-series study used electronic health record data of patients aged younger than 19 years with scheduled preventive care visits at 32 primary care practices in the Children’s Hospital of Philadelphia primary care network in Pennsylvania and New Jersey from January 1, 2009, to December 31, 2023. Statistical analyses were completed between March and October 2025.

EXPOSURE: Daily maximum temperature (°F), derived from the National Oceanic and Atmospheric Administration’s weather stations and averaged at the county level for each practice.

MAIN OUTCOME AND MEASURES: Daily rate of missed preventive care visits (the proportion of scheduled visits resulting in same-day cancellation or no-show). Generalized linear quasi-Poisson models estimated associations of daily maximum temperature (in °F) with daily rate of missed preventive care visits overall and stratified by age, insurance, and neighborhood SES. Associations were evaluated separately for warm (May-October) and cold (November-April) months. Heterogeneity across strata was evaluated using the Cochran Q test.

RESULTS: Among 504 428 patients, 51% were male, 36% had public insurance, and 27% were from very low SES neighborhoods. Mean (SD) patient age was 6.0 (5.7) years. Among 4 137 542 scheduled preventive care visits, 13% were missed. Each 1 °F decrease below a maximum daily temperature of 41.5 °F in cold months and 1 °F increase above 88.0 °F in warm months was associated with a higher rate of missed visits (rate ratios, 1.01 [95% CI, 1.01-1.01] and 1.01 [95% CI, 1.00-1.01], respectively). Significant heterogeneity in missed visits across age, payer, and neighborhood SES was observed in cold months, with higher rates of missed visits among patients with commercial vs public or other types of insurance (RR, 1.02; 95% CI, 1.02-1.02) as well as among younger patients and those from high SES neighborhoods.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, extreme outdoor temperatures were associated with increased rates of missed pediatric preventive care visits, with heterogeneity across age, payer, and neighborhood SES during cold months. The findings suggest proactive scheduling strategies and alternative care delivery models should be assessed to maintain access to essential pediatric preventive care services during temperature extremes.

PMID:42043814 | DOI:10.1001/jamanetworkopen.2026.10114

Curr Protoc. 2026 Apr;6(4):e70371. doi: 10.1002/cpz1.70371.

ABSTRACT

India accounts for one-third of the global incidence and mortality of oral cancer. The national oral cancer screening program uses Conventional Oral Examination by Primary Healthcare (PHC) workers. This subjective assessment leads to unnecessary referrals to higher centers for biopsy and false negatives due to inappropriate biopsy site selection. Angiogenesis is one of the steps in early carcinogenesis, as solid tumors, such as oral cancers, cannot grow beyond 2-3 mm in diameter without inducing their own blood supply. The increased vascular supply and metabolic rate in malignant cells lead to a rise in temperature, which can be detected by sensitive digital infrared (IR) cameras. An Artificial Intelligence-enabled automatic analysis of intraoral IR images of oral lesions can be used for screening, early detection of Stage I and II oral cancers, and biopsy site selection as an objective Point-of-Care (POC) adjunct. A standardized protocol for passive and active IR imaging of intraoral lesions (index test) with a smartphone-based IR camera will be prepared to train a Medical Scientist and Technician. IR images of already diagnosed normal, Inflammatory, potentially malignant disorders, and malignant oral lesions (N = 100 each) will be used in Phase I to train an AI model to classify images as malignant or non-malignant. A second set of IR images of these oral lesions will be used in Phase II (N = 100 each) for evaluating the performance of the AI model. The reference test for malignancy will be histopathology (Gold standard). The intra/inter observer reliability will be assessed using the kappa statistics A clinical trial and validation of the proof of concept are proposed for IR imaging of intraoral lesions as a noninvasive POC adjunct for early detection and screening of oral cancer by PHC workers, and for the selection of biopsy sites by surgeons. © 2026 Wiley Periodicals LLC.

PMID:42043801 | DOI:10.1002/cpz1.70371

Alzheimers Dement. 2026 Apr;22(4):e71372. doi: 10.1002/alz.71372.

ABSTRACT

INTRODUCTION: We investigated the association between retirement, age at retirement, and domain-specific cognitive decline.

METHODS: Three hundred twenty-one participants aged 65+ from the Study of Healthy Aging in African Americans completed verbal episodic memory (VEM) and executive function (EF) assessments across three waves (every 16 months). Linear mixed-effects models with random intercepts and slopes examined associations of retirement status (retired, not retired) and timing (retired before age 65, retired at 65+, and not retired) with cognitive decline adjusting for demographics and parental education.

RESULTS: Participants’ mean age was 74.6 ± 6.9, 65% were women, and 87% were retired (33% at age 65+). Retirement status and timing were not associated with baseline cognition. Over 2.11 ± 0.66 years, non-retirees had slower EF decline than retirees (b = 0.11 [0.03, 0.19]). Participants who retired at 65+ had slower VEM decline than those who retired before 65 (b = 0.11 [0.02, 0.21]).

DISCUSSION: Retirement and early retirement were associated with faster cognitive decline among Black/African American adults.

PMID:42043792 | DOI:10.1002/alz.71372

Nurs Educ Perspect. 2026 Apr 27. doi: 10.1097/01.NEP.0000000000001537. Online ahead of print.

ABSTRACT

In this pilot study, which utilized a pretest/posttest design, baccalaureate nursing students used artificial intelligence to generate a case scenario and nursing care plan and analyzed the content for accuracy, bias, and holistic nursing practices. The authors found that students had statistically significant improvements in their perceived ability to identify accurate nursing content, bias, and holistic nursing concepts. This article provides recommendations for nurse educators to improve students’ ability to analyze artificial intelligence-generated content.

PMID:42043776 | DOI:10.1097/01.NEP.0000000000001537

Indian Pediatr. 2026 Apr 27. doi: 10.1007/s13312-026-00340-5. Online ahead of print.

ABSTRACT

OBJECTIVE: This survey was conducted to explore the current status of empyema thoracis management practices of pediatricians in India, as a prelude to developing evidence-based guidelines for managing empyema.

METHODS: A questionnaire examining various aspects of empyema management (diagnosis, investigations, treatment, monitoring and follow-up) was prepared, refined, and pilot-tested. It was disseminated to pediatricians across the country, through a Google form link, using email and a social media platform. Responses were collated, analyzed, and presented with descriptive statistics.

RESULTS: Ninety-four complete responses were received, mostly from pediatricians in teaching/ tertiary-care hospitals. There were significant variations in all aspects of empyema management. There was overuse of computed tomography (CT) scan (27%) and pleural fluid Cartridge Based Nucleic Acid Amplification Test (CBNAAT) (61%) in children with pleural effusion. Whilst > 80% pediatricians used ceftriaxone empirically for pneumonia and empyema, co-amoxiclav (18%), vancomycin (56%), and teicoplanin or linezolid (16%) were also used for empyema. Less than three quarters of respondents used intercostal drainage appropriately. 25% pediatricians routinely used intrapleural fibrinolytic therapy (most often streptokinase); 37% did not use it at all. The common indications were septations/loculations on ultrasonography (57%), thick pus (38%), and persisting clinical features (33%). The duration of antibiotics ranged from < 4 weeks (18%), 4-6 weeks (59%), and > 6 weeks (15%). The indications for surgical referral also varied widely, as did monitoring during therapy, and post-treatment follow-up protocols.

CONCLUSION: There are significant variations in all facets of empyema management amongst pediatricians working in diverse Indian healthcare settings, underscoring the need for evidence-based guideline recommendations.

PMID:42043772 | DOI:10.1007/s13312-026-00340-5

Ophthalmol Ther. 2026 Apr 27. doi: 10.1007/s40123-026-01381-6. Online ahead of print.

ABSTRACT

INTRODUCTION: Keratoconus (KC) is a progressive corneal disorder caused by impaired biomechanical integrity, leading to geometric deformation. Although corneal changes are well characterized, iris structural alterations across KC stages remain poorly studied. Accordingly, this study aims to compare quantitative iris characteristics among healthy controls and patients with different stages of KC.

METHODS: This retrospective cross-sectional study included 547 eyes: 497 from 264 keratoconus subjects classified according to the Topographic Keratoconus Classification (TKC) system as subclinical (n = 102), early stage (n = 219, TKC 1-2), and late-stage (n = 176, TKC 3-4), and single eyes from 50 healthy emmetropic controls. Anterior segment imaging was performed using Pentacam Scheimpflug tomography. Iris segmentation was achieved using a semi-automated Python-based pipeline incorporating the Segment Anything Model, followed by extraction of the anterior iris boundary. The iris was subdivided into basal, mid-iris, and pupil-edge regions. Region-specific geometric parameters, including curvature, arc length, and area under the curve (AUC), were computed using spline-based fitting and numerical integration. Group comparisons were conducted using one-way analysis of variance with false discovery rate correction, followed by age-adjusted analysis of covariance.

RESULTS: Mean basal and mid-iris curvature showed significant overall differences across TKC stages, with a progressive reduction from healthy controls to late-stage KC (p = 0.01 and p < 0.001, respectively). In contrast, pupil-edge curvature showed an opposite trend, with the highest values in late-stage KC (p = 0.02). Iris arc length did not differ significantly between groups, whereas AUC exhibited a region-specific difference limited to the pupil-edge iris (p = 0.02). These findings remained statistically significant after age adjustment.

CONCLUSIONS: Increased pupil-edge curvature in KC represents a geometric alteration that may be clinically relevant in eyes undergoing intraocular surgery, particularly in relation to anterior chamber dynamics and potential susceptibility to postoperative pupillary block. Conversely, mid-iris straightening may reflect structural variation within the iris in late-stage disease. Together, these findings suggest that corneal geometric changes in KC may be associated with subtle alterations in anterior chamber mechanical environment, potentially contributing to secondary changes in iris configuration.

PMID:42043741 | DOI:10.1007/s40123-026-01381-6

Environ Monit Assess. 2026 Apr 27;198(5):508. doi: 10.1007/s10661-026-15390-2.

ABSTRACT

This study analyzes the spatial dominance and regional differentiation of forest, agricultural, and water surface areas across Türkiye’s NUTS-2 regions for the period 2000-2024. Land use data were compiled from nationally authoritative sources and standardized in hectares to ensure interregional comparability. Spatial concentration patterns were evaluated using the location quotient (LQ) method, while principal component analysis (PCA), and cluster analysis were employed to identify structural dimensions and regional typologies. Results indicate a pronounced decline in agricultural dominance, contrasted with a relatively stable yet regionally differentiated structure of forest areas. Water surfaces exhibit localized but significant shifts, particularly in eastern and southeastern regions. PCA findings show that 84.6% of total variance is explained by two components representing the agriculture-forest balance and water surface distribution. Cluster analysis reveals two main regional groupings, with TRB2 displaying a distinct dominance pattern driven by water surfaces. The TR61 region emerges as a balanced land use structure where both agricultural and forest dominance remain comparatively strong. These findings demonstrate that land use dynamics in Türkiye are shaped by region-specific ecological and structural factors rather than uniform national trends. The study provides a quantitative, multidimensional framework for interpreting regional land use transformations and offers policy-relevant insights for sustainable resource management and regional planning.

PMID:42043641 | DOI:10.1007/s10661-026-15390-2

J Mol Neurosci. 2026 Apr 27;76(2):71. doi: 10.1007/s12031-026-02515-y.

NO ABSTRACT

PMID:42043620 | DOI:10.1007/s12031-026-02515-y