Tag: pubmed

JAMA Netw Open. 2026 Apr 1;9(4):e268641. doi: 10.1001/jamanetworkopen.2026.8641.

ABSTRACT

IMPORTANCE: Few environmental risk factors for ovarian cancer have been discovered. Women exposed to ionizing radiation from the atomic bomb during World War II experienced an increased risk of ovarian cancer. Today, the largest source of ionizing radiation is radon gas in the home, but whether ionizing radiation is associated with increased risk of ovarian cancer more broadly is unknown.

OBJECTIVE: To evaluate whether higher home radon levels are associated with increased risk of ovarian cancer.

DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study included 127 547 women from the Women’s Health Initiative, including 40 clinical centers across the US, with outcomes followed up for 31 years (1993-2024). Postmenopausal women aged 50 to 79 years were enrolled in an observational study or 1 or more randomized clinical trials. All cases of ovarian cancer were physician adjudicated.

EXPOSURE: Radon measurements from the 1993 US Geological Survey, classified into low (<2 pCi/L), medium (2-4 pCi/L), and high zones (>4 pCi/L), were linked with the geocoded home addresses of participants at baseline (1993-1998).

MAIN OUTCOMES AND MEASURES: Hazard ratios (HRs) for ovarian cancer, adjusted for covariates with 95% CIs.

RESULTS: Among the 127 547 women (mean [SD] age, 63.1 [7.2] years) with available radon zone values, 1645 incident ovarian cancers and 1048 ovarian cancer deaths were observed over a mean (SD) follow-up of 17.7 (8.4) years. After adjustment for covariates, the HR for all ovarian cancers for women living in the medium radon zone compared with women living in the low radon zone was not significantly higher (HR, 1.13 [95% CI, 1.00-1.29]). However, the HR was significantly higher for women living in the high radon zone compared with those living in the low radon zone (HR, 1.31 [95% CI, 1.11-1.54]). Similar findings were observed for the most common histologic type, serous ovarian cancer, for which the HR in the medium zone was 1.06 (95% CI, 0.88-1.27) and the HR in the high zone was 1.38 (95% CI, 1.09-1.74). Ovarian cancer mortality also was significantly higher in the high radon zone compared with the low radon zone (HR, 1.31 [95% CI, 1.07-1.60]). Sensitivity analyses using 3 alternate radon measures produced similar results.

CONCLUSIONS AND RELEVANCE: In this large, prospective cohort of postmenopausal women, the risks of ovarian cancer incidence and mortality were significantly higher for women living in homes in the high radon zone. Residential radon is a ubiquitous and modifiable risk factor. This is the first epidemiologic study of radon and ovarian cancer among postmenopausal women to date, and its findings suggest a potential target for mitigating cancer risk.

PMID:41961496 | DOI:10.1001/jamanetworkopen.2026.8641

JAMA Health Forum. 2026 Apr 3;7(4):e260624. doi: 10.1001/jamahealthforum.2026.0624.

ABSTRACT

IMPORTANCE: The population of adults experiencing homelessness in the US is aging, with 20% now 55 years or older. Individuals who are unhoused, but especially those who are older, experience substantial morbidity and mortality and incur the high costs of acute health care.

OBJECTIVE: To assess the health outcomes and cost of providing stable housing to older adults experiencing homelessness in the US.

DESIGN, SETTING, AND PARTICIPANTS: This was an economic evaluation using a model-based cost-effectiveness analysis of adults experiencing homelessness in 2025 in the US. Two simulated cohorts of 1000 adults were used to compare those aged 55 years and older to those aged 18 to 54 years.

INTERVENTION: Provision of stable housing, with no requirement to enter treatment for opioid use disorder.

MAIN OUTCOMES AND MEASURES: Overdoses and deaths during a 5-year period, lifetime per person discounted quality-adjusted life-years (QALYs) and costs, and incremental cost-effectiveness ratios compared to the status quo (no housing provision).

RESULTS: The analysis assessed and compared 2 simulated cohorts of 1000 unhoused adults each: an older cohort of those aged 55 years and older (mean [SD] age, 62.6 [7.5] years; 321 females [32.1%], 679 males [67.9%]) and a younger cohort of those aged 18 to 54 years (mean [SD] age, 39.2 [9.5] years; 319 females [31.9%], 679 males [67.9%]). Among the older cohort, under the status quo, 218 (95% CI, 209-229) deaths occurred over 5 years, with 5.64 (95% CI, 5.11-6.20) lifetime QALYs and $308 598 (95% CI, $299 000-$318 000) in costs per person. With the stable housing intervention, 184 (95% CI, 176-194) deaths occurred over 5 years, with 7.52 (95% CI, 6.82-8.26) lifetime QALYs and $460 673 (95% CI, $438 000-$485 000) in costs per person. The intervention cost $80 700 (95% CI, $67 900-$96 100) per QALY gained. Among the younger cohort, under the status quo, 72 (95% CI, 60-90) deaths occurred over 5 years, with 9.60 (95% CI, 8.65-10.67) lifetime QALYs and $391 976 (95% CI, $367 000-$415 000) in costs per person. With the stable housing intervention, 62 (95% CI, 50-78) deaths occurred over 5 years, with 12.13 (95% CI, 10.94-13.37) lifetime QALYs and $530 492 (95% CI, $496 000-$564 000) in costs per person. The intervention cost $54 800 (95% CI, $44 200-$68 500) per QALY gained. In sensitivity analyses, the housing intervention for older adults experiencing homelessness consistently cost less than $100 000 per QALY gained.

CONCLUSIONS AND RELEVANCE: In this economic evaluation, investing in stable housing for adults of any age who were experiencing homelessness saved lives, improved health outcomes, and was cost-effective. As the homeless population continues to age, meeting the housing and care needs of older adults in vulnerable conditions is an increasingly urgent national priority. These findings strengthen the evidence demonstrating that permanent supportive housing for older adults experiencing homelessness is a health intervention with strong humanitarian, clinical, and economic justification.

PMID:41961493 | DOI:10.1001/jamahealthforum.2026.0624

JAMA Health Forum. 2026 Apr 3;7(4):e260631. doi: 10.1001/jamahealthforum.2026.0631.

ABSTRACT

IMPORTANCE: Although electronic nicotine delivery systems (ENDS) use is decreasing among youth in the US, the frequency of use is increasing among current users, particularly high school students.

OBJECTIVE: To evaluate the effectiveness of local flavored tobacco ban policies and assess whether policies may have unintended outcomes in youth in California.

DESIGN, SETTING, AND PARTICIPANTS: Repeated cross-sectional study using a confounder-adjusted dynamic difference-in-difference (DID) analysis to obtain estimates of the average treatment effect among the treated (ATT) over 6 years. Participants were middle school and high school students in the 2017-2022 California Healthy Kids Survey. Data were analyzed from February 1 to October 1, 2025.

EXPOSURES: Policy exposure (treated group) defined as attending a school in person within a jurisdiction with an active flavored tobacco ban at the time of survey administration.

MAIN OUTCOMES AND MEASURES: The primary outcome was current ENDS use, and the secondary outcome was current cigarette use. To address confounding, additional measures included racial and ethnic diversity, federal poverty level, and educational attainment, which were aggregated to the local policy jurisdiction area.

RESULTS: Among 2 805 708 middle and high school student tobacco users, local flavored tobacco bans were associated with a reduction in current ENDS use of 2.4 percentage points (ATT, -0.024; 95% CI, -0.031 to -0.017) and were not associated with current cigarette use (ATT, 0.002; 95% CI, -0.002 to 0.005). Three years after policy implementation, ENDS use was lower in jurisdictions with flavor ban compared with jurisdictions without by 1.9 percentage points (ATT, -0.019; 95% CI, -0.027 to -0.010). Four years after policy implementation, ENDS use was lower in jurisdictions with flavor ban compared with jurisdictions without by 9.3 percentage points (ATT, -0.093; 95% CI, -0.117 to -0.069).

CONCLUSIONS AND RELEVANCE: In this study, a local flavored tobacco ban policy was associated with reduced ENDS use among youth but not with cigarette use within this population. Future research should also examine trends in other states to evaluate policy adoption and enforcement.

PMID:41961492 | DOI:10.1001/jamahealthforum.2026.0631

Echocardiography. 2026 Apr;43(4):e70447. doi: 10.1111/echo.70447.

ABSTRACT

BACKGROUND: Quantitative assessment of right ventricular (RV) function by transthoracic echocardiogram (TTE) commonly relies on tricuspid annular plane systolic excursion (TAPSE) and lateral tricuspid annulus peak systolic velocity (S’). However, full cardiac cycle data may provide additional information beyond these two systolic measures.

OBJECTIVE: We sought to (1) automate the estimation of systolic parameters (TAPSE and S’) from tissue spectral Doppler imaging (Tissue Doppler Imaging [TDI]) and (2) integrate these tabular systolic parameters and the full-cycle functional signal to estimate RV systolic function.

METHODS: We identified 387 patients who underwent both TTE and cardiac magnetic resonance imaging (CMR) within 24 h. We developed and validated an automated algorithm to extract TAPSE and S’ from raw TDI. We trained two classifier models for RV dysfunction (RVEF < 45%): (1) Tabular model (RVD_TABULAR) using algorithmic measurement of TAPSE/S’ and age/sex, and (2) Integrated model (RVD_INTEGRATED), an attention-based neural network model using the entire digitized TDI waveforms in addition to tabular data.

RESULTS: In the TTE-CMR paired dataset, the proposed algorithm accurately estimated S’ (mean error: -0.05 cm/s) and TAPSE (mean error: -0.97 mm). Tabular model RVD_TABULAR achieved an AUROC of 0.71 and an AUPRC of 0.48 for predicting RVEF <45%, while the integrated model RVD_INTEGRATED achieved significantly better performance (AUROC: 0.768; AUPRC: 0.56). In the external validation cohort with pulmonary hypertension (PH), the integrated model’s prediction was significantly associated with event-free survival (p = 0.036).

CONCLUSIONS: We developed a fully automated pipeline that integrates digitized TDI waveforms with both parametric and non-parametric features to classify RVEF <45%. This approach can effectively risk-stratify patients with PH.

PMID:41961465 | DOI:10.1111/echo.70447

Updates Surg. 2026 Apr 10. doi: 10.1007/s13304-026-02616-8. Online ahead of print.

ABSTRACT

Pancreaticoduodenectomy (PD) is associated with a long and complex recovery. Enhanced recovery programmes have improved short-term clinical outcomes, but there is a growing interest in patient-reported outcomes as an indicator for postoperative recovery. Health-related quality of life (HRQoL) and patient-reported postoperative recovery provide a wider perspective on the effects of surgery. However, the relationship between the two measures remains unexplored. Therefore, the aim of this study was to explore the relationship between HRQoL and patient-reported recovery in patients undergoing PD. This prospective, single-centre study included 77 participants who all underwent PD in the context of an enhanced recovery programme. Instruments used were the EQ-5D-3L and the SwQoL-24. Data was collected preoperatively and at 1,3,6,9, and 12 months postoperatively. Longitudinal trends were analysed using a mixed-effect repeated measures model. Predictive associations were explored via linear regression. The EQ-5D-3L improved, and the SwQoL-24 total score declined throughout the first year. The EQ-5D-3L Index and the VAS explained the SwQoR-24 value at six months and 12 months; R² 0.52/0.47 and 0.52/0.56, respectively. Preoperative EQ-5D-3L values predicted between (R²) 0.09-0.17 for 6 and 12-month SwQoR-24 values. Other tested factors were statistically non-significant. This study demonstrates a significant improvement in postoperative recovery as well as HRQoL during the first year after PD, with a strong association between the two measures. The findings also suggest that the EQ-5D-3L index and the EQ VAS have a significant but limited predictive value for postoperative recovery. Other demographical and care-related factors did not predict levels of recovery quality.

PMID:41961460 | DOI:10.1007/s13304-026-02616-8

AMB Express. 2026 Apr 10. doi: 10.1186/s13568-026-02041-5. Online ahead of print.

NO ABSTRACT

PMID:41961440 | DOI:10.1186/s13568-026-02041-5

Int J Cardiovasc Imaging. 2026 Apr 10. doi: 10.1007/s10554-026-03702-z. Online ahead of print.

ABSTRACT

Providing insights into the feasibility of pulmonary function assessment in real-world cardiovascular magnetic resonance (CMR) practice by applying Phase-REsolved FUnctional Lung imaging (PREFUL). We retrospectively analyzed consecutive patients who underwent PREFUL imaging in addition to routine 1.5T CMR between September 2023 and January 2024. PREFUL was acquired in three coronal slices, with a prototype tool used to derive quantitative perfusion and ventilation defect percentages (QDP and VDP, respectively). Cardiac function was assessed from short-axis cine images. Subgroup analyses included patients with primary pulmonary disease and reduced left ventricular ejection fraction (LVEF). Statistical analyses comprised linear regression, correlation analysis, and Kruskal-Wallis test. The final cohort included N = 172 patients (74 females), median age 60 years (IQR 46-71). PREFUL was feasible in all cases (mean scan time 60 s/slice). Multivariable regression with bootstrap-based backward selection showed associations of QDP with LVEF, pulmonary disease, age, and BMI (all p ≤ 0.005), while VDP was associated with pulmonary disease, age, and male sex (all p < 0.001). QDP correlated negatively with LV stroke volume (ρ (Spearman’s rho) – 0.336, p < 0.001) and cardiac output (ρ – 0.360; p < 0.001) and was higher in patients with LVEF < 50% (p < 0.001). Patients with primary pulmonary disease had higher QDP (p = 0.005) and VDP (p = 0.036). No correlations between cardiac function and VDP were detected (all p > 0.05). Application of PREFUL is feasible and fast in CMR routine. While QDP and VDP are affected by pulmonary disease, QDP is additionally associated with markers of cardiac function and was higher in patients with reduced LVEF.

PMID:41961412 | DOI:10.1007/s10554-026-03702-z

Environ Monit Assess. 2026 Apr 10;198(5):436. doi: 10.1007/s10661-026-15174-8.

ABSTRACT

The longstanding reliance on synthetic herbicides for aquatic weed management has imposed a significant chemical legacy on freshwater ecosystems. While effective for short-term control, these compounds often persist in water and sediments, leading to bioaccumulation and long-term ecological shifts. This review critically re-evaluates this dependency, synthesizing evidence of direct and indirect impacts on non-target organisms, including phytoplankton, invertebrates, and fish, often via sublethal physiological and behavioral effects. The rapid degradation of plant biomass can trigger regime shifts, such as algal blooms and oxygen depletion, thereby altering ecosystem structure and function. Furthermore, the challenges of herbicide resistance and the underestimated risks of commercial formulations and chemical mixtures underscore the limitations of a purely chemical approach. We argue for an urgent paradigm shift towards integrated weed management (IWM). This review provides a critical synthesis that repositions herbicides as a targeted, last-resort tool within a broader, ecologically sustainable framework. This framework prioritizes prevention, biological control, and ecological restoration to safeguard aquatic health, moving beyond the entrenched, chemical-centric paradigm. Clinical trial number: not applicable.

PMID:41961347 | DOI:10.1007/s10661-026-15174-8

Environ Monit Assess. 2026 Apr 10;198(5):435. doi: 10.1007/s10661-026-15295-0.

ABSTRACT

Heavy metal pollution in soil has become an environmental challenge attracting global concern. In China, the national standard GB15618-2018 is widely adopted for classifying heavy metal pollution risk in agricultural soils into three levels, including the background, screening, and intervention levels. However, it only specifies risk screening and intervention values for five heavy metals (Hg, Cd, As, Pb, Cr), which make systematic risk classification for other metals unfeasible. To address this limitation, an integrated method combining GB15618-2018 with the geo-accumulation index (I_geo) is proposed. Risk levels are determined preferentially through risk values specified in GB15618-2018, and otherwise by I_geo values (with new thresholds of 1.4 and 3.7). Analysis of 493 soil samples from the Yuanjiang area confirmed I_geo as a valid supplementary tool, enabling unified three-level risk classification for all heavy metals. Application in the Yuanjiang area showed most areas at the background level, with small screening-level patches requiring supervision and rare intervention-level spots requiring control. Source apportionment using multivariate statistical analyses mainly identified three distinct sources: ultramafic rocks (Cr, Ni, Co, Hg, As), Pb-Zn mineralization (Cd, Pb, Zn), and Cu mineralization (Cu and V). Although developed within China’s regulatory framework, the proposed method addresses a challenge common to many countries, namely incomplete regulatory coverage for certain heavy metals, and thus offers a template adaptable to other regions worldwide.

PMID:41961342 | DOI:10.1007/s10661-026-15295-0

Eur J Pediatr. 2026 Apr 10;185(5):252. doi: 10.1007/s00431-026-06917-3.

ABSTRACT

Alagille syndrome (ALGS) is a rare multisystem disorder most commonly resulting from pathogenic variants in JAG1 and, less frequently, NOTCH2. We evaluated long-term native liver survival (NLS) and overall survival (OS) in a Korean ALGS cohort and compared the genetic characteristics of this cohort with those of the Global ALagille Alliance (GALA) study cohort. We retrospectively reviewed 60 patients with clinically diagnosed ALGS at Seoul National University Hospital. Forty-three patients with genetically confirmed disease were analyzed. Eight patients (18.6%) underwent liver transplantation (median age: 3.9 years), revealing a lower rate than that in the comparator cohort. The estimated NLS percentages at 5, 10, and 18 years were 86.9%, 86.9%, and 76.6%, respectively, exceeding those in previous reports. The corresponding OS rates were 90.2%, 86.9%, and 86.9%, respectively. The following types of JAG1 variants were identified in 41 patients (95.3%): frameshift (34.1%), nonsense (26.8%), missense (24.4%), and splice-site (9.8%) variants and in-frame deletions (4.9%). Compared with the reference group, our cohort exhibited a greater frequency of non-protein-truncating variants (missense variants and in-frame deletions; p = 0.023) and no structural variants (p = 0.043). Two patients (4.7%) carried NOTCH2 nonsense variants. Mortality was significantly higher among patients with frameshift variants compared with patients with non-frameshift variants (4 of 5 deaths; p = 0.035).

CONCLUSION: Compared with the GALA cohort, Korean patients with ALGS exhibited more favorable long-term NLS and a higher proportion of non-protein-truncating JAG1 variants, alongside the absence of structural variants. These findings suggest potential genetic influences and highlight the need for multicenter validation.

WHAT IS KNOWN: • The Global ALagille Alliance (GALA) study reports native liver survival (NLS) rates of 66.8%, 54.4%, and 40.3% at 5, 10, and 18 years, respectively, in patients with Alagille syndrome. • NLS rates are higher among Asians, with unclear genotype-phenotype correlations.

WHAT IS NEW: • Compared to the GALA study cohort, the Korean cohort demonstrates superior NLS rates of 86.9%, 86.9%, and 76.6% at 5, 10, and 18 years and a higher frequency of non-truncating JAG1 variants, along with the absence of structural variants. • Protein-truncating variants are associated with higher initial gamma-glutamyl transferase levels, while frameshift variants are associated with reduced overall survival.

PMID:41961327 | DOI:10.1007/s00431-026-06917-3