Tag: pubmed

Health Aff (Millwood). 2026 Aug;45(8):871-879. doi: 10.1377/hlthaff.2025.01475.

ABSTRACT

Vertical integration between Medicare Advantage (MA) plans and hospital providers is increasingly common, but little is known about how vertically integrated plans pay affiliated providers for medical services. Providers may accept lower prices from affiliated plans to give those plans a competitive edge in the MA market. Conversely, plans may pay vertically integrated providers higher prices to increase their medical loss ratios-a measure of revenues spent directly on health care required by the Centers for Medicare and Medicaid Services. Using a novel data set of vertically integrated MA plans matched with negotiated hospital pricing data, we found that in 2024, 66-73 percent of hospitals charged similar prices to affiliated and unaffiliated plans, but prices differed at a sizeable minority of hospitals. On average, affiliated plan prices were 5.3 percent higher than unaffiliated plan prices for the same procedure at the same hospital. Affiliated plan prices were higher relative to unaffiliated plan prices in the inpatient (rather than outpatient) setting, in more concentrated MA markets, and where MA hospital prices were lower relative to traditional Medicare hospital prices. Our results suggest that vertically integrated MA plans behave differently from standard MA plans, but strategies vary by market and hospital characteristics.

PMID:42546239 | DOI:10.1377/hlthaff.2025.01475

Health Aff (Millwood). 2026 Aug;45(8):943-951. doi: 10.1377/hlthaff.2025.01754.

ABSTRACT

The opioid crisis has remained a public health challenge in the US for more than two decades. After increasing from 2002 to 2012, opioid-related hospitalizations decreased from 2016 to 2019, but more recent trends are unknown. We sought to determine trends in incidence and outcomes of US opioid-related hospitalizations in recent years. We conducted a serial cross-sectional study of adult primary and secondary opioid-related hospitalizations, using the 2016-23 National Inpatient Survey and regression models, annual percent change, and z-tests to examine change during the study period. Measures included annual opioid-related hospitalizations, hospital stay outcomes, and sociodemographic characteristics. Among the 1.48 million opioid-related hospitalizations during 2016-23, survey-weighted to 7.42 million, 0.93 million were classified as primary and 6.49 million as secondary opioid-related hospitalizations. Hospitalizations decreased through 2023 for all groups except patients who were Hispanic or Native American, who reported Medicaid as their payer, or who were older than age sixty-five. The greatest decline occurred among people younger than age thirty-five. The proportion of hospitalizations ending in death and self-directed discharge increased by 0.58 percentage points and 2.68 percentage points, respectively. Overall, differential reductions in opioid-related hospitalizations and increasing mortality and self-directed discharge highlight opportunities for interventions.

PMID:42546237 | DOI:10.1377/hlthaff.2025.01754

Health Aff (Millwood). 2026 Aug;45(8):897-905. doi: 10.1377/hlthaff.2025.01535.

ABSTRACT

The rapid growth of private equity (PE) and publicly traded corporation (PTC) ownership in hospice has raised concerns that investor-driven profit incentives may undermine care quality. Evidence on how these acquisitions affect care delivery remains limited. We linked a national PE and PTC acquisition database to Medicare claims for a beneficiary sample for the period 2010-21 and used a difference-in-differences event study to compare acquired versus nonacquired for-profit hospices on process-based quality measures and Medicare reimbursement. After PE acquisition, registered nurse, social worker, and home hospice aide minutes per thirty days declined 5.14 percent, 12.32 percent, and 6.62 percent, respectively; after PTC acquisition, registered nurse and home hospice aide minutes per thirty days declined 4.63 percent and 9.09 percent. Declines in visit minutes also were observed in the last seven days of life. Reductions in visit minutes were driven by four large acquirers. These findings highlight the need for increased transparency and oversight policies, as well as payment reforms that align reimbursement with care intensity and quality.

PMID:42546235 | DOI:10.1377/hlthaff.2025.01535

Health Aff (Millwood). 2026 Aug;45(8):915-924. doi: 10.1377/hlthaff.2025.01656.

ABSTRACT

The 2021 expansion of the Child Tax Credit provided advance monthly cash transfers to most US households with children. Although prior evaluations documented overall improvements in household well-being, less is known about variation by household structure. This study examined policy-period changes in parental mental health and material hardship among female-headed households. Using data from 1.3 million respondents to the Census Bureau’s Household Pulse Survey (2020-25) and an intersectional framework, we applied difference-in-differences and multilevel models to estimate changes in parental mental health and material hardship before, during, and after expanded Child Tax Credit implementation. Non-female-headed households showed improvements in depression, anxiety, and housing insecurity, whereas female-headed households, particularly those with low incomes and Black, Hispanic, and Asian households, showed smaller or no comparable gains. Food insecurity did not improve across groups. Intersectional analyses showed that the highest burdens and smallest improvements were concentrated among low-income, female-headed households across racial and ethnic groups. Findings suggest that the expanded Child Tax Credit did not fully close baseline disparities, underscoring the importance of household structure and intersecting social positions in policy design and evaluation.

PMID:42546234 | DOI:10.1377/hlthaff.2025.01656

Nurs Educ Perspect. 2026 Aug 3. doi: 10.1097/01.NEP.0000000000001587. Online ahead of print.

ABSTRACT

AIM: The purpose of this study was to examine the relationship between undergraduate nursing student burnout and faculty immediacy behaviors.

BACKGROUND: Undergraduate nursing students in the United States are experiencing burnout syndrome at alarming rates. There have been many attempts to improve the issue in this population, but few focus on the impact that nursing faculty have on student burnout.

METHOD: A quantitative, nonexperimental, correlational research design was used. Data were collected from Bachelor of Science in Nursing students using three valid and reliable survey tools.

RESULTS: Statistical analysis revealed the existence of a significant relationship between faculty nonverbal immediacy and all three tenets of student burnout (emotional exhaustion, cynicism, and academic efficacy). A statistically significant relationship between verbal immediacy and academic efficacy also existed.

CONCLUSION: This research demonstrates that nursing faculty who engage in immediacy behaviors may have a positive impact on the experiences of undergraduate nursing students.

PMID:42545728 | DOI:10.1097/01.NEP.0000000000001587

J Trauma Acute Care Surg. 2026 Aug 3. doi: 10.1097/TA.0000000000005148. Online ahead of print.

ABSTRACT

BACKGROUND: The risk of venous thromboembolism (VTE) in subsets of the most severely injured patients can approach 30%. Statins have anti-inflammatory properties and exert beneficial effects on the endothelium, but few previous studies have evaluated their effects on VTE in risk-stratified groups. We hypothesized that statin use was associated with lower VTE in high-risk trauma patients.

METHODS: All patients admitted to the trauma intensive care unit (ICU) from 1/2024 to 11/2024 at a single level 1 trauma center were risk-stratified using the Greenfield Risk Assessment Profile (RAP). Nontrauma patients and burn patients were excluded. Outcomes were compared between patients with and without VTE, defined by deep vein thrombosis or pulmonary embolism. Univariate analyses and multivariate logistic regression evaluated the association between statin use and VTE. Statistical significance was assessed at p≤0.05.

RESULTS: In 509 patients (age 52±22 y, 71% male, 18% penetrating injury), the average RAP score was 10±5, the overall VTE rate was 17%, and mortality was 5%. Compared with statin nonusers, statin users (n=100) were older, with more blunt injury, similar RAP scores and thromboprophylaxis use, but had a significantly lower VTE rate (8 vs. 19%, P=0.007). After RAP-based stratification, the high-risk group (RAP≥10) had a VTE rate of 28%. After controlling for confounding variables with multivariate logistic regression, statin use was independently associated with decreased VTE with an odds ratio of 0.209 (95% CI: 0.065-0.670, P=0.008).

CONCLUSIONS: Severely injured patients have high rates of VTE despite thromboprophylaxis;, however, the incidence of VTE was significantly lower among statin users. In the highest risk patients, statin use was independently associated with decreased odds of VTE. Because of their pleiotropic effects, including anti-inflammatory and endothelial protective properties, statins may be an important adjunctive therapy in VTE chemoprophylaxis. (J Trauma Acute Care Surg. 2026;00: 000-000 Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved.).

LEVEL OF EVIDENCE: Level III, therapeutic/care management.

PMID:42545722 | DOI:10.1097/TA.0000000000005148

Am J Physiol Cell Physiol. 2026 Aug 3. doi: 10.1152/ajpcell.00023.2026. Online ahead of print.

ABSTRACT

Prolonged exposure to high oxygen levels (hyperoxia) is unavoidable in managing severe Acute Respiratory Distress Syndrome (ARDS), but can itself worsen lung injury and increase mortality. Rats conditioned to be hyperoxia-tolerant (H-T) or hyperoxia-susceptible (H-S) provide a system for assessing the contribution of mitochondrial bioenergetics to the differential susceptibility to hyperoxia-induced ARDS and for identifying potential therapeutic targets. Due to the system’s complexity, interpreting lung mitochondrial bioenergetics data from these rat models requires a computational model to define which processes are altered and how changes influence overall lung tissue bioenergetics. We developed a thermodynamically constrained computational model of lung mitochondrial bioenergetics that extends prior models by incorporating regulation by ions (Ca^2⁺, H^⁺, etc.) and metabolites. The model was parameterized using experimental respirometry data from isolated lung mitochondria of conditioned (H-T, H-S) and control rats with different substrates and ADP concentrations. Model parameterization showed distinct bioenergetic changes. H-S mitochondria had reduced activity in adenine nucleotide translocase (ANT), cytochrome c oxidase (CIV), complex I (CI), and glutamate-oxaloacetate transaminase (GOT). Conversely, H-T mitochondria showed an increased activity of ANT and CIV. This supports greater metabolic flexibility in H-T mitochondria compared to H-S. Simulations of ARDS-related changes predicted divergent outcomes. H-S mitochondria underwent rapid failure, with redox collapse, loss of membrane potential, and ATP depletion. H-T mitochondria maintained bioenergetic homeostasis by enhancing electron supply via CI and complex II, with higher CIV activity. This comprehensive computational model provides a framework for identifying critical mitochondrial processes and therapeutic strategies to mitigate mitochondrial dysfunction in ARDS.

PMID:42545720 | DOI:10.1152/ajpcell.00023.2026

JAMA Pediatr. 2026 Aug 3. doi: 10.1001/jamapediatrics.2026.3239. Online ahead of print.

ABSTRACT

IMPORTANCE: Public concern and speculation have emerged around a possible link between neonatal male circumcision (NMC) and autism spectrum disorder (ASD). Evidence is limited and inconsistent.

OBJECTIVE: To examine associations between NMC and child ASD and autism-related traits and behaviors.

DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study was conducted among cohort sites participating in the Environmental Influences on Child Health Outcomes (ECHO) Cohort between February 2003 and September 2025. Statistical analyses were conducted from November 2025 to February 2026. The analysis included male, singleton children with data on NMC status and child ASD.

EXPOSURE: NMC status within 28 days of birth at a medical facility.

MAIN OUTCOMES AND MEASURES: ASD diagnosis was based on parent report of diagnosis by a medical professional or documentation of criterion standard clinical assessments. Social Responsiveness Scale (SRS-2) T-scores assessed the presence and distribution of autism traits, and Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) Autism Spectrum Problems subscale T-scores from the Child Behavior Checklist (CBCL) 1.5/5 assessed the occurrence of child autism-related behaviors.

RESULTS: The sample included 2771 male children from 14 ECHO sites, of whom 1840 (66%) were circumcised before hospital discharge, and 192 (7%) had an autism diagnosis. Among 1840 circumcised males, 108 (6%) had autism, compared with 84 of 931 uncircumcised males (9%). Mean (SD) age at autism diagnosis was 3.8 (2.2) years. Among circumcised males, 31 (4%) were administered acetaminophen during the procedure, and 128 (7%) within the 30 days after birth. After adjusting for confounders, there was no association between NMC and ASD diagnosis (odds ratio [OR], 0.83; 95% CI, 0.59-1.17). After stratification by region, preterm birth, and neonatal intensive care unit admission, an inverse or no association was observed between NMC and ASD diagnosis. Adjusted analyses showed no associations between NMC and SRS-2 continuous (β = -0.62; 95% CI, -1.46 to 0.22) or binary (OR, 0.75; 95% CI, 0.48-1.15) T-scores. Similarly, no associations were observed between NMC and CBCL 1.5/5 continuous (β = 0.01; 95% CI, -0.54 to 0.56) or binary (OR, 1.30; 95% CI, 0.75-2.26) T-scores. Overall, inverse or no associations were observed across all strata for SRS-2 and CBCL 1.5/5 outcomes.

CONCLUSIONS AND RELEVANCE: This cohort study yielded no evidence that NMC was associated with ASD risk, whether assessed by parent report of medical professional diagnosis or validated instruments measuring autism-related traits and behavior. These findings may provide reassurance for families who are considering or have elected NMC for their child.

PMID:42545713 | DOI:10.1001/jamapediatrics.2026.3239

JAMA Pediatr. 2026 Aug 3. doi: 10.1001/jamapediatrics.2026.3247. Online ahead of print.

ABSTRACT

IMPORTANCE: Current treatment for type 1 retinopathy of prematurity (ROP), including laser photocoagulation and intravitreal anti-vascular endothelial growth factor therapy, is invasive but necessary to prevent blindness. Experimental evidence and limited clinical experience suggest that topical steroids may reduce disease progression and the need for invasive treatment.

OBJECTIVE: To evaluate whether dexamethasone eye drops reduce the proportion of preterm infants with prethreshold ROP progressing to treatment-requiring type 1 ROP.

DESIGN, SETTING, AND PARTICIPANTS: The DROPROP trial was a double-masked randomized clinical trial at 6 university hospitals and 8 county hospitals in Sweden. It evaluated infants born before 30 weeks’ gestational age (GA), from 2022 to 2025, with severe ROP. Data analysis was performed from November 2025 to January 2026.

EXPOSURES: Infants were randomized to receive dexamethasone eye drops (1 mg/mL) or placebo (saline). One eye drop was administered every day or every other day for up to 12 weeks.

MAIN OUTCOMES AND MEASURES: The primary outcome was progression to type 1 ROP requiring invasive treatment. Logistic regression adjusted for GA and site was used for the primary analysis. Intention-to-treat analysis was performed. Adverse events were monitored as safety outcomes.

RESULTS: Among 100 infants, the mean (SD) GA at birth was 25.1 (1.4) weeks, 42 (42.0%) were female, and the mean (SD) birth weight was 712.9 (202.1) g. In the intention-to-treat population, type 1 ROP occurred in 10 of 50 infants (20.0%) in the dexamethasone group and 19 of 50 infants (38.0%) in the placebo group (adjusted odds ratio, 0.44; 95% CI, 0.17-1.12; P = .08), corresponding to a relative risk reduction of 47%. In the per-protocol population, type 1 ROP occurred in 9 of 48 infants (18.8%) in the dexamethasone group vs 19 of 49 infants (38.8%) in the placebo group (adjusted odds ratio, 0.40; 95% CI 0.15-1.05). No clinically significant differences in adverse events were observed between groups.

CONCLUSIONS AND RELEVANCE: Timely administration of topical dexamethasone numerically reduced the risk of prethreshold ROP progressing to treatment-requiring type 1 ROP. Although the analysis did not reach statistical significance, these findings suggest that topical dexamethasone may be a safe, noninvasive strategy to reduce the need for invasive treatment.

TRIAL REGISTRATION: euclinicaltrials.eu Identifier: 2023-505318-97-00.

PMID:42545705 | DOI:10.1001/jamapediatrics.2026.3247

JAMA Netw Open. 2026 Aug 3;9(8):e2627092. doi: 10.1001/jamanetworkopen.2026.27092.

ABSTRACT

IMPORTANCE: Medical school graduates have nonrandom geographical preferences for their location of practice, which affects patient access. The association of state policies regarding specific health care issues with medical school graduates’ preferred location of practice is not well understood.

OBJECTIVE: To characterize the association between state-level policies specific to sexual and gender minority (SGM) people and health care services (eg, gender-affirming care) and medical students’ preferred state to practice.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was a secondary analysis of questionnaire responses from students graduating at Association of American Medical Colleges (AAMC) accredited US allopathic medical schools from 2020 to 2024. Eligible participants were US medical students graduating from AAMC-accredited allopathic medical schools who responded to the AAMC Matriculating Student Questionnaire in 2020 to 2024.

MAIN MEASURES AND OUTCOMES: The primary outcome was medical students’ self-reported preferred state to practice. State policy environment was categorized based on a year-by-year tally of existing laws and policies specific to SGM people and health care services. Medical students’ demographic characteristics (eg, SGM status) were self-reported. Proportional odds ordinal logistic regression estimates were performed adjusting for medical student demographic characteristics as well as additional medical student factors affecting anticipated future practice setting (ie, rurality, importance of social change in career decision-making).

RESULTS: From 2020 to 2024, there were 79 615 unique respondents (70.0% response rate), with 34 224 meeting inclusion criteria included in the analysis (18 587 aged 23 to 25 years [54.3%]; 19 549 female [57.1%]; 9755 Asian [28.5%], 2990 Black [8.7%], 4100 Hispanic [12.0%], and 19 642 White [57.4%]). A total of 4567 respondents (13.3%) reported an SGM identity. In adjusted proportional odds models, SGM status was associated with preference for higher-equality states (adjusted odds ratio [aOR], 1.56; 95% CI, 1.47-1.66; P < .001). Increasing rural practice preference was associated with lower preference for higher-equality states (aOR per category increase, 0.76 ; 95% CI, 0.75-0.77; P < .001). A greater emphasis on social change was associated with higher-equality state preference (aOR, 1.16; 95% CI, 1.13-1.19; P < .001).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, state-level policy environment was significantly associated with anticipated future practice setting preference of medical students, particularly SGM medical students; this association persisted after adjustment for demographic, professional, and temporal factors, and was resistant to extreme missing-data assumptions. Policy environment may be meaningfully associated with the anticipated distribution of the physician workforce.

PMID:42545697 | DOI:10.1001/jamanetworkopen.2026.27092