Tag: pubmed

Turk Arch Pediatr. 2025 Dec 29;61(2):152-161. doi: 10.5152/TurkArchPediatr.2025.25261.

ABSTRACT

OBJECTIVE: This study explores whether GSTM1, GSTT1, and TP53 rs1042522 polymorphisms, key regulators of detoxification and oxidative stress responses, influence obesity risk and related metabolic profiles in children.

MATERIALS AND METHODS: Blood samples from 60 obese children and 60 healthy controls were analyzed. GSTM1 and GSTT1 deletions were assessed via polymerase chain reaction melting curve analysis, and TP53 rs1042522 was genotyped by direct DNA sequencing. Deviations from Hardy-Weinberg expectations and genotype frequencies in controls were evaluated, and the association of genetic variants with obesity, clinical complications, and metabolic parameters was examined.

RESULTS: In obese children, GSTM1 and GSTT1 genotype frequencies deviated from Hardy-Weinberg expectations and differed from controls, whereas TP53 rs1042522 conformed to expected distributions yet was statistically underpowered. The GSTM1 null genotype increased obesity risk 3.28-fold (95% CI: 1.36-7.93, P < .05). The GSTT1 null genotype conferred a 4.76-fold higher risk (95% CI: 2.08-10.88, P < .001). TP53 rs1042522 showed no association (OR = 1.12, 95% CI: 0.44-2.87). The GSTM1 null carriers had elevated cholesterol, low-density lipoprotein (LDL), and gamma-glutamyl transferase, while TP53 Arg/Arg and Pro/Pro carriers exhibited higher LDL and alanine aminotransferase, respectively. No significant links were observed with insulin resistance or hepatic steatosis.

CONCLUSION: The GSTM1 and GSTT1 null genotypes are significant genetic risk factors for childhood obesity, likely through reduced detoxification capacity and subsequent oxidative stress-related metabolic disruption. These findings highlight the importance of considering detoxification pathways when assessing genetic predisposition to obesity in children.

PMID:42044432 | DOI:10.5152/TurkArchPediatr.2025.25261

Turk Arch Pediatr. 2025 Dec 22;61(2):139-146. doi: 10.5152/TurkArchPediatr.2025.25342.

ABSTRACT

OBJECTIVE: To describe oral health status and its relationship with glycemic control in children with type 1 diabetes mellitus (T1DM) using standardized indices.

MATERIALS AND METHODS: A comparative cross-sectional study was conducted with 30 children aged 6-14 years with T1DM and 30 healthy controls. Oral examinations recorded DMFS/dfs (Decayed, Missing, Filled Surfaces), PUFA/pufa (Pulpal involvement, Ulceration, Fistula, Abscess), Plaque Index (PI), Gingival Index (GI), and Simplified Oral Hygiene Index (OHI-S). Glycated hemoglobin (HbA1c) levels were categorized as ≤7% or >7%. Non-parametric tests, Spearman’s correlation analyses were performed. The level of statistical significance was set at P < .05.

RESULTS: The T1DM group had significantly lower DMFS/dfs and PUFA/pufa scores than controls (P < .001 and P = .004, respectively), and no significant differences were found in PI, GI, and OHI-S values. In the T1DM group, correlation analyses between HbA1c levels and oral health indices (DMFS/dfs, PUFA/pufa, PI, GI, and OHI-S) revealed no statistically significant associations (P > .05). No statistically significant correlations were found between HbA1c and any of the oral health indices (P > .05).

CONCLUSION: Children with T1DM showed lower caries experience, possibly due to regular medical follow-up, nutritional counseling, and improved oral hygiene. Routine oral health monitoring should be integrated into pediatric diabetes care.

PMID:42044430 | DOI:10.5152/TurkArchPediatr.2025.25342

Am J Manag Care. 2026 Apr;32(4):230-236. doi: 10.37765/ajmc.2026.89919.

ABSTRACT

OBJECTIVES: Significant variation in coding intensity exists across patients and institutions, with important implications for reimbursement and risk-adjusted quality metrics. The degree to which coding intensity for hospitalized patients may be a function of primary payer is not well understood. We sought to measure differences in coding intensity between commercially insured and Medicare, Medicaid and Medicare, and self-pay and Medicare inpatient encounters for the same cohort of patients.

STUDY DESIGN: Regression discontinuity, leveraging the fact that patients typically enroll in Medicare at age 65 years.

METHODS: A multivariable linear regression was estimated to evaluate the relationship between the outcomes of interest and primary payer, controlling for age, age by payer interaction term, and inpatient visit count. Our analysis included Florida inpatients with at least 1 commercially insured, Medicaid, or self-pay inpatient hospitalization before age 65 years and at least 1 inpatient Medicare hospitalization at 65 years and older, with patients serving as their own controls. The outcome of interest was the number of hospital discharge diagnoses. Outcomes were measured separately for each group (commercial insurance to Medicare, Medicaid to Medicare, and self-pay to Medicare).

RESULTS: Medicare inpatient encounters were associated with 0.8 (95% CI, 0.4-1.2), 1.0 (95% CI, 0.5-1.5), and 2.0 (95% CI, 1.2-2.8) more discharge diagnoses than commercially insured, Medicaid, and self-pay inpatient encounters, respectively.

CONCLUSIONS: Our findings suggest that Medicare inpatient encounters are associated with higher coding intensity than commercially insured, Medicaid, or self-pay inpatient encounters for those same individuals prior to age 65 years. This has important implications for the impact that insurance status may have on risk-adjusted quality measures.

PMID:42044421 | DOI:10.37765/ajmc.2026.89919

Am J Manag Care. 2026 Apr;32(4):212-217. doi: 10.37765/ajmc.2026.89917.

ABSTRACT

OBJECTIVES: This study aimed to quantify the economic impact of missed billing opportunities for tobacco cessation counseling at an academic medical center to identify what may be a systematic defect in the administration of tobacco cessation services and to highlight opportunities to improve patient outcomes and revenue. Patient surveys show that evidence-based tobacco cessation interventions are provided at low rates despite guidelines supporting the use of these services at every eligible encounter.

STUDY DESIGN: Retrospective cohort study.

METHODS: The study analyzed deidentified patient health data from electronic health records at an academic medical center, focusing on primary care encounters from January 1, 2020, to December 31, 2023, involving patients 18 years and older with a history of current tobacco use. Billing data for tobacco cessation counseling ( Current Procedural Terminology codes 99406 or 99407) were examined to estimate revenue loss from unbilled eligible encounters.

RESULTS: Of 1,068,875 primary care visits, 16.8% (179,304) involved tobacco users. However, only 1.0% of these encounters were billed for cessation services, representing an estimated potential revenue loss of $3.2 million over 4 years.

CONCLUSIONS: These findings identify a significant discrepancy between the billing of tobacco cessation services and the opportunities to do so. Better provision and billing of tobacco cessation counseling can improve patient health outcomes, advance value-based care goals, and enhance financial sustainability.

PMID:42044419 | DOI:10.37765/ajmc.2026.89917

Am J Manag Care. 2026 Apr 1;32(4):e133-e137. doi: 10.37765/ajmc.2026.89926.

ABSTRACT

OBJECTIVE: To examine trends in Dual-Eligible Special Needs Plan (D-SNP) offerings and enrollment before and after permanent authorization in 2018.

STUDY DESIGN: Retrospective descriptive analysis.

METHODS: We analyzed publicly available monthly SNP Comprehensive Reports, comparing preauthorization (2010-2018) and postauthorization (2019-2025) periods. We calculated annual totals of D-SNPs and enrollees along with mean annual growth rates for both periods.

RESULTS: The mean annual growth rate of unique D-SNP offerings increased from 10.0% preauthorization to 16.2% post authorization. Enrollment of dually eligible beneficiaries increased from a mean annual growth rate of 0.3% preauthorization to 12.8% post authorization. D-SNP enrollment has steadily increased, more than doubling over the past 5 years. By January 2025, there were 986 D-SNPs with 6,030,665 dual enrollees, representing approximately 44% of total dual enrollees.

CONCLUSIONS: The significant acceleration in both D-SNP offerings and enrollment reflects notable changes in the D-SNP market following permanent authorization. As states transitioned plans into D-SNPs through 2025, these specialized Medicare Advantage plans are positioned to play an increasingly vital role in addressing the complex needs of Medicare-Medicaid dual enrollees.

PMID:42044401 | DOI:10.37765/ajmc.2026.89926

J Phys Chem Lett. 2026 Apr 27. doi: 10.1021/acs.jpclett.6c00978. Online ahead of print.

ABSTRACT

Precise control of nucleation pathways under nonequilibrium optical trapping conditions remains a fundamental challenge. Here, we report an enantiomer-specific reversal in phase selection during the optical trapping-induced crystallization of binary systems containing acetaminophen and either l- or d-phenylalanine. Switching the handedness of circularly polarized light reverses the dominant product between a thermodynamically stable cocrystal and a metastable phenylalanine phase. In situ Raman spectroscopy reveals constant local stoichiometry during irradiation, indicating the absence of a macroscopic polarization-induced concentration gradient. Instead, the results are consistent with a proposed mechanism where phase selection is driven by a polarization-dependent kinetic bias under strongly nonequilibrium conditions. We propose that this bias originates from subtle differences in the residence dynamics of transient nanoscale clusters within the optical trapping field, which are statistically amplified over time. These findings highlight a sophisticated kinetic route for controlling crystallization beyond conventional thermodynamic strategies.

PMID:42043851 | DOI:10.1021/acs.jpclett.6c00978

JAMA Intern Med. 2026 Apr 27. doi: 10.1001/jamainternmed.2026.1085. Online ahead of print.

ABSTRACT

IMPORTANCE: The Centers for Medicare & Medicaid Services Oncology Care Model (OCM) was an episode payment model for patients with cancer; episodes were triggered by receipt of systemic cancer therapy. OCM provided monthly care management payments, and all practices were engaged in 1-sided risk in its early years. A concern about episode payment models triggered by use of a particular service is that they may prompt increases in episode volume.

OBJECTIVE: To assess if OCM is associated with an increase in the likelihood of initiating systemic therapy for cancer.

DESIGN, SETTING, AND PARTICIPANTS: This quasi-experimental study used matched difference-in-differences analysis of serial cross sections of Medicare beneficiaries with an index visit for cancer from January 2010 to December 2019 who were treated at OCM practices or matched practices not participating in the OCM and followed up for 1 year, comparing changes in outcomes before vs after OCM began in July 2016. Data were analyzed from October 2021 to November 2025.

MAIN OUTCOMES AND MEASURES: Systemic therapy initiation in the year after an index visit for newly diagnosed (incident) or poor-prognosis cancer; a secondary outcome examined total Medicare payments in the year after the index visit.

RESULTS: The study included 754 182 patient episodes (750 483 patients; mean [SD] age, 74.1 [9.0] years; 467 071 female [62.2%]) in the incident population and 517 858 patients (mean [SD] age, 72.4 [9.7] years; 270 416 female [52.2%]) in the poor prognosis cohort treated at 197 intervention and 197 comparison practices. There was no statistically significant differential change in the initiation of systemic therapy in the incident population (-0.9 percentage point difference; 95% CI, -2.2 to 0.3 percentage points; P = .14). Among patients with poor-prognosis cancers, there was a statistically significant differential decrease in the likelihood of systemic therapy initiation (1.5 percentage points, 95% CI, -2.8 to -0.2 percentage points; P = .03). Following OCM, there was a non-statistically significant relative decrease in spending (-$898.26; 95% CI, -$1890.31 to $93.80; P = .08) in the year after the index incident diagnosis and a statistically significant relative decrease (-$2192.15; 95% CI, -3559.66 to -833.63; P = .002) in the poor prognosis cohort.

CONCLUSIONS AND RELEVANCE: Despite concerns about greater use of systemic therapy for patients with cancer under 1-sided risk, this study found that the OCM was not associated with an increase in the likelihood of initiating systemic therapy episodes among patients with incident cancers but was associated with less chemotherapy initiation and lower spending among patients with poor-prognosis cancers. By not examining changes in chemotherapy initiation, the OCM evaluation may have underestimated savings related to the model.

PMID:42043828 | DOI:10.1001/jamainternmed.2026.1085

JAMA Netw Open. 2026 Apr 1;9(4):e267479. doi: 10.1001/jamanetworkopen.2026.7479.

ABSTRACT

IMPORTANCE: Collaborative statisticians and methodologists are essential members of multidisciplinary teams, yet little is known about how their diverse responsibilities, including technical analysis, project leadership, and domain-specific consultation across multiple concurrent projects, affect their work-life balance and professional well-being.

OBJECTIVE: To assess perceptions of work-life balance and identify individual, job-related, and organizational factors associated with work-life balance among collaborative statisticians and methodologists working in multidisciplinary settings.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional survey study collected data from November 2022 to May 2024, with analysis conducted in December 2024. Anonymous electronic surveys were distributed through international professional statistical societies, including organizations in North America, Europe, Africa, South America, and Asia. Participants were recruited via a convenience sample through society email listservs and newsletters. Eligible respondents were statisticians, data scientists, or methodologists working in multidisciplinary collaborative settings who had been continuously employed full-time during the previous year.

MAIN OUTCOMES AND MEASURES: Work-life balance was assessed using the 15-item Work-Life Balance Self-Assessment Scale, which consists of 3 subscales: Work Interference With Personal Life, Personal Life Interference With Work, and Work/Personal Life Enhancement. Regression analyses were used to identify the demographic, organizational, and discipline-specific factors associated with respondents’ perception of work-life balance.

RESULTS: Of 627 individuals who accessed the survey, 450 (71.8%) met eligibility criteria and completed the survey. Of the 450 respondents who completed the survey, the mean (SD) age was x (y) years, 240 (53.7%) were female, and 270 (60.0%) worked in academia; 143 (31.8%) reported dissatisfaction with their work-life balance, and an additional 47 (10.4%) reported neutral satisfaction. Factors associated with higher work interference scores included unmanageable workload (mean difference, 0.70; 95% CI, 0.48 to 0.92), work-related health issues (mean difference, 0.58; 95% CI, 0.33 to 0.83), inability to complete work during regular hours (mean difference, 0.56; 95% CI, 0.34 to 0.78), and lack of organizational support for work-life balance (mean difference, 0.48; 95% CI, 0.24 to 0.73). Organizational flexibility to attend to personal matters (mean difference, -0.33; 95% CI, -0.64 to -0.01) and adequate compensation (mean difference, -0.29; 95% CI, -0.49 to -0.09) were associated with lower interference scores.

CONCLUSIONS AND RELEVANCE: These findings suggest that targeted educational initiatives, effective mentorship, and wellness-focused organizational policies can foster sustainable work-life balance among statisticians and methodologists in multidisciplinary settings.

PMID:42043821 | DOI:10.1001/jamanetworkopen.2026.7479

JAMA Netw Open. 2026 Apr 1;9(4):e268823. doi: 10.1001/jamanetworkopen.2026.8823.

ABSTRACT

IMPORTANCE: Patient delays in recognizing and acting on acute coronary syndrome (ACS) symptoms worsen outcomes.

OBJECTIVE: To evaluate the effectiveness of a heart attack education intervention (Heart Matters) aiming to improve recognition and response to ACS symptoms in communities with elevated cardiovascular risk and low emergency medical service (EMS) use.

DESIGN, SETTING, AND PARTICIPANTS: This stepped-wedge cluster randomized clinical trial was conducted in 8 high-risk communities (local government areas; 4 metropolitan and 4 rural with a combined population of approximately 792 000 adult residents) in Victoria, Australia (December 2021 to March 2023 with follow-up to March 2024), with clusters crossing to the intervention every 4 months. Data were obtained from administrative datasets and registries (analysis complete June 2025).

INTERVENTION: A multicomponent community education program including 490 community sessions (approximately 10 088 residents), more than 174 110 households mailouts, more than 50 000 resource handouts, opportunistic media, and a geotargeted social-media campaign (reach of approximately 350 000 residents). The control period did not include any educational campaign.

MAIN OUTCOME AND MEASURES: The primary outcome was the proportion of patients with ACS transported to hospitals by EMS, as recorded in the Victorian Emergency Minimum Dataset. Outcomes were analyzed at the patient level using mixed-effects regression models, reporting risk differences (RDs) and odds ratios (ORs). A program evaluation was also conducted to assess implementation and inform potential replication and scale-up.

RESULTS: Among 1775 patients with ACS (865 intervention and 910 control; 924 [52.1%] aged ≥65 years; 1193 male [67.2%]), EMS use was unexpectedly high during the initial control period, coinciding with a COVID-19 wave. EMS transport occurred in 624 of 910 patients with ACS (68.6%) in the control period and 548 of 865 patients (63.4%) in the intervention period (adjusted RD, -8.98%; 95% CI, -17.50% to -0.46%; P = .04; adjusted OR, 0.67; 95% CI, 0.45 to 1.01; P = .05). Reductions were more pronounced in metropolitan areas (RD -10.73%; 95% CI -20.43% to -1.03%) and during a severe flooding event (RD -13.50%; 95% CI -26.52% to -0.47%). Early treatment-seeking was also lower, although estimates were imprecise. The program evaluation identified COVID-19 pandemic and seasonal impacts, as well as community concerns regarding EMS costs, demand, and wait times.

CONCLUSIONS AND RELEVANCE: In this community ACS education trial conducted in high-risk regions, the intervention did not improve EMS use or prehospital care-seeking. External contextual factors, including the COVID-19 pandemic and natural disasters, appeared to influence patient behavior and may have attenuated intervention effects, highlighting the complexity of achieving behavioral change through community education alone.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04995900.

PMID:42043820 | DOI:10.1001/jamanetworkopen.2026.8823

JAMA Netw Open. 2026 Apr 1;9(4):e269267. doi: 10.1001/jamanetworkopen.2026.9267.

ABSTRACT

IMPORTANCE: A thorough examination of the patient is a crucial component of providing high-quality care and is regarded as best practice in the assessment of female patients presenting with lower urinary tract symptoms (LUTS). Nevertheless, anecdotal reports suggest that pelvic examinations are infrequently performed in the outpatient setting, raising important questions regarding adherence to established standards of care.

OBJECTIVE: To explore the practices and attitudes of urologists toward pelvic examination for patients with LUTS.

DESIGN, SETTING, AND PARTICIPANTS: In this qualitative, mixed-methods study, a structured 9-question survey about digital rectal and pelvic examination practices was distributed between November 19, 2023, and May 19, 2024, to urologists and urology trainees via the Urological Society of Australia and New Zealand newsletter across Australia and New Zealand. The end of the survey invited clinicians to participate in a semistructured interview to further discuss their responses.

MAIN OUTCOMES AND MEASURES: The primary outcomes were urologist-reported responses to the survey assessing the numbers and percentages of male and female clinicians who routinely performed pelvic and digital rectal examinations for patients with LUTS at their initial appointment and qualitative semistructured interview responses to identify themes associated with clinician attitudes toward pelvic examinations.

RESULTS: Of 553 consultant urologists and 100 urology trainees sent the survey, 74 participants responded, a response rate of 11.8%. A total of 74 clinicians (46 [62.2%] male), comprising 63 urologists and 11 urology trainees, completed the survey. While 89.1% (95% CI, 80.1%-98.1%) of male clinicians and 92.9% (95% CI, 83.3%-100.0%) of female clinicians consistently performed digital rectal examinations for male patients presenting with LUTS, only 8.7% (95% CI, 5.5%-16.8%) of male clinicians routinely conducted pelvic examinations for female patients compared with 85.7% (95% CI, 72.8%-92.9%) of female clinicians (P < .001). In total, 10 semistructured interviews were conducted. Two major themes were identified: fear, including medicolegal reprimand, clinician and patient discomfort or reluctance, and failure to recognize pathology; and barriers to pelvic examinations, including perceived poor utility, limited access to chaperones, and concerns for patient discomfort.

CONCLUSIONS AND RELEVANCE: Findings of this study suggested that male clinicians were less likely than female clinicians to perform pelvic examination for female patients who presented with LUTS. Barriers to pelvic examination need to be addressed to enable female patients to receive optimal care. Focused training may help prevent unnecessary operative procedures and improve patient outcomes.

PMID:42043817 | DOI:10.1001/jamanetworkopen.2026.9267