Tag: pubmed

Hernia. 2025 Nov 24;30(1):23. doi: 10.1007/s10029-025-03539-w.

ABSTRACT

PURPOSE: Pre-existing comorbidities may negatively impact surgical outcomes, yet risk profiles based on combinations of comorbidities are underutilized. We aimed to identify comorbidity clusters associated with adverse surgical outcomes after inguinal or ventral hernia repair.

METHODS: We performed a retrospective cohort study using the ACS-NSQIP database (2016-2023). Adults undergoing elective inguinal or ventral hernia repair were identified using CPT and ICD-10 codes. Latent class analysis (LCA) identified subgroups of patients who shared similar patterns of comorbidities. Outcomes included postoperative complications, hospital length of stay, and 30-day mortality.

RESULTS: Among 224,522 patients, LCA identified six profiles: no comorbidities, smoking, bleeding disorder or congestive heart failure (CHF), obesity with diabetes or smoking, obesity without diabetes or smoking, and hypertension. Compared with no comorbidities, risk of complications was higher in the smoking (OR 1.32, 95% CI 1.18-1.49), bleeding disorder or CHF (OR 1.68, 95% CI 1.23-2.29), obesity with diabetes or smoking (OR 1.41, 95% CI 1.25-1.58), obesity without diabetes or smoking (OR 1.17, 95% CI 1.06-1.29), and hypertension (OR 1.16, 95% CI 1.05-1.28) clusters. These clusters also had longer hospital stays compared to patients with no comorbidities. 30-day mortality was significantly increased in the “bleeding disorder or CHF” (OR 3.22, 95% CI 1.52-6.84) and hypertension (OR 1.66, 95% CI 1.09-2.54) clusters.

CONCLUSION: Distinct comorbidity clusters predict complications, prolonged hospitalization, and mortality following hernia repair. Incorporating comorbidity profiles into preoperative risk stratification may enhance surgical decision-making, allow targeted interventions, and improve outcomes in high-risk patients.

PMID:41284100 | DOI:10.1007/s10029-025-03539-w

J Magn Reson Imaging. 2025 Nov 24. doi: 10.1002/jmri.70183. Online ahead of print.

ABSTRACT

BACKGROUND: Silicosis is an occupational lung disease characterized by inflammation and fibrosis. As it is irreversible, early identification of high-risk individuals is clinically important, but biomarkers for progression remain lacking.

PURPOSE: To determine whether ventilation and perfusion defects quantified by phase-resolved functional lung (PREFUL) MRI can predict silicosis progression.

STUDY TYPE: Prospective.

SUBJECTS: Thirty participants with silicosis (29 males and 1 female) and 30 healthy controls (29 males and 1 female).

SEQUENCE: 2D spoiled gradient echo, 3.0 T.

ASSESSMENT: All participants underwent baseline PREFUL MRI, pulmonary function tests (PFTs), and chest CT, with quantitative calculation of ventilation defect percentages (VDP_RVent and VDP_FVL-CM) and perfusion defect percentage (QDP). Silicosis was followed for 1 year with assessments including forced vital capacity percent predicted (FVC% predicted), diffusing capacity of the lungs for carbon monoxide percent predicted (DL_co% predicted), symptoms, and CT. Disease progression was defined by any two of: (a) CT evidence of progression, (b) worsening symptoms, or (c) ≥ 10% decline in FVC% predicted or ≥ 15% decline in DLco% predicted.

STATISTICAL TESTS: Spearman correlation coefficients were used to evaluate the correlation between ventilation/perfusion metrics and PFT parameters. Receiver operating characteristic (ROC) curves were used to assess the ability of PREFUL MRI parameters to classify disease progression, reporting the area under the curve (AUC), sensitivity, and specificity. Significance was set at p < 0.05.

RESULTS: Eight patients progressed and 22 remained stable. Baseline VDP_RVent, VDP_FVL-CM, and QDP were significantly higher in progressors (36%, 34%, 40%) than in non-progressors (22%, 15%, 22%). QDP showed strong predictive performance with AUC of 0.72 (95% CI: 0.51-0.93) for radiological progression, 0.90 (95% CI: 0.79-1.00) for PFTs decline, and 0.97 (95% CI: 0.92-1.00) for global progression.

DATA CONCLUSION: Increased ventilation and perfusion defects on PREFUL MRI are associated with silicosis progression.

EVIDENCE LEVEL: 2.

TECHNICAL EFFICACY: Stage 2.

TRIAL REGISTRATION: NCT06431555.

PMID:41277498 | DOI:10.1002/jmri.70183

J Clin Psychol. 2025 Nov 24. doi: 10.1002/jclp.70069. Online ahead of print.

ABSTRACT

BACKGROUND: Depression and anxiety are increasingly common among children and adolescents. While school-based cognitive behavioral therapy (CBT) is a promising intervention, most research has focused on its effects in high-risk or symptomatic populations. This leaves a critical gap in our understanding of its effectiveness as a universal prevention strategy for the general, low-risk student population. Establishing whether CBT can benefit low-risk students is crucial for developing proactive, school-wide mental health systems aimed at preventing future problems before they emerge. This study aimed to fill this gap by evaluating the short- and long-term effects of universal school-based CBT on low-risk children and young people, providing insights for optimizing intervention programs.

METHODS: Systematic searches of MEDLINE, Embase, the Cochrane Library, Web of Science, and PsyInfo were conducted from inception to January 15, 2025 to identify randomized controlled trials (RCTs) of school-based CBT for depression and anxiety in low-risk populations. Paired and regression meta-analyses of these results were conducted using Bayesian hierarchical models.

RESULTS: The 31 RCTs included a total of 19,865 children and young people. Compared to the control group, school-based CBT produced a statistically significant but very small improvement in depressive symptoms (SMD: -0.06, 95% CrI: -0.08 to -0.04) and a small reduction in anxiety symptoms (SMD: -0.19, 95% CrI: -0.22 to -0.17). These effects appeared to be maintained for up to 1 year. Exploratory analyses suggested that males may benefit more from anxiety interventions.

CONCLUSION: This study provides the first meta-analytic evidence that universal school-based CBT can produce small but durable, long-term preventive effects in low-risk youth. Although the very low quality of the underlying evidence means the findings are not robust enough to support widespread implementation at this time, they establish a crucial signal of effectiveness. The primary implication is that universal CBT is a promising strategy that warrants significant investment in future high-quality, large-scale trials to confirm its real-world value.

PMID:41277494 | DOI:10.1002/jclp.70069

J Am Geriatr Soc. 2025 Nov 24. doi: 10.1111/jgs.70210. Online ahead of print.

ABSTRACT

BACKGROUND: Recent payment reforms in the United States have been credited with reducing the use of institutional post-acute care (PAC) after total knee arthroplasty (TKA) and total hip arthroplasty (THA). This dual-country study of Canada and the United States compares longitudinal trends in discharge to institutional PAC after primary TKA or THA.

METHODS: We conducted serial cross-sectional analyses to compare discharge to institutional PAC trends among adults aged ≥ 66 years undergoing primary TKA or THA in the United States and Canada from 2013 to 2019. Patient-level data were obtained from population-based Medicare claims in the United States and analogous datasets in Ontario. Discharge trends were assessed using standardized differences and linear regression models to evaluate relative changes over time.

RESULTS: Patients receiving TKA (2,308,001) and THA (1,234,149) in the United States and Ontario (106,721 and 53,371, respectively) were similar in age (73-74 years) and sex (~60% female). The absolute reduction in institutional PAC discharge over time for TKA was greater in the United States (slope = -3.59) than in Canada (slope = -0.53) (p < 0.0001), but relative reductions (slope = -8.78 in the United States, slope = -6.99 in Canada) were statistically similar (p = 0.08). THA showed a similar trend of absolute reductions; however, the relative reduction trend in the United States (slope = -9.98) was steeper than in Canada (slope = -6.46) (p = 0.0009).

CONCLUSIONS: The US payment reforms from 2013 to 2019 were associated with a greater impact on reducing institutional PAC utilization for THA than for TKA.

PMID:41277482 | DOI:10.1111/jgs.70210

Clin Endocrinol (Oxf). 2025 Nov 24. doi: 10.1111/cen.70062. Online ahead of print.

ABSTRACT

OBJECTIVE: Polycystic ovary syndrome (PCOS) is a common condition, that manifests as menstrual irregularities, subfertility, or symptoms of hyperandrogenism – including hirsutism, adult acne, and alopecia. Current pharmacological treatment of the hyperandrogenic symptoms includes the combined oral contraceptive pill. However, there are multiple contraindications and side-effects, which limit their use. Anti-androgens, such as spironolactone, are commonly prescribed off-label but its efficacy in PCOS is uncertain. This review aims to evaluate the efficacy and safety of spironolactone, when compared to other nonhormonal medications in the management of PCOS hyperandrogenic symptoms.

METHODS: Comprehensive literature searches were conducted across MEDLINE, EMBASES, PUBMED and SCOPUS. RCTs published in English assessing the use of spironolactone for hyperandrogenism in PCOS were included. The quality of papers was assessed using Cochrane RoB 2.0 tool. Meta-analysis was conducted using a random-effects model, reporting as standardised mean differences and 95% confidence intervals.

RESULTS: Of 3378 studies identified, five open-label RCTs met the inclusion criteria, three of which were included in the meta-analysis. Spironolactone, monotherapy or combination with metformin, showed no statistically significant difference in reducing Ferriman-Gallwey scores, total testosterone levels or BMI compared to metformin monotherapy. Side effects of spironolactone included menstrual irregularities, polyuria, and gastrointestinal symptoms.

CONCLUSION: Current evidence does not show any significant difference in the use of spironolactone when compared to metformin. Given its widespread use and limited safety concerns, spironolactone remains an off-label option, especially for those unable to take hormonal contraceptives. However, larger, better quality studies are needed to establish its efficacy in PCOS management.

PMID:41277478 | DOI:10.1111/cen.70062

Nutr Diet. 2025 Nov 24. doi: 10.1111/1747-0080.70058. Online ahead of print.

ABSTRACT

AIM: Caring for people with higher weight and complex health needs is increasingly common in hospitals. This study aimed to explore and compare inpatient and staff perspectives on the care of people with higher weight.

METHODS: Cross-sectional study using purpose-designed surveys within Metropolitan Victoria, Australia. Inpatients (who weighed over 100 kg) and hospital staff who provide care across four hospitals were invited to complete an inpatient-specific or staff-specific survey, respectively. Surveys contained questions related to clinical care, environment and dignity/respect. Data was analysed using descriptive statistics of scale-based items, and textual synthesis of free-text responses.

RESULTS: Thirty inpatients and 59 staff participated. Most inpatients reported their clinical care needs were met (73%-83%) and described appropriate equipment and staff support. However, 25% felt judged or emotionally unsupported, with some experiencing delays in care due to staffing or equipment availability. Staff were less positive, with 73% reporting difficulty accessing equipment, 71% citing inadequate staffing and only 39% agreeing that non-stigmatising care was provided. Differences in weight-related terminology preferences emerged: inpatients favoured the terms ‘higher weight’ (27%) or ‘obese/overweight’ (34%), while staff preferred ‘bariatric’ (71%). Three themes were identified: (1) Inappropriate equipment, delays to equipment-access can negatively impact on inpatient experience of care; (2) Processes of care and communication influence inpatient experience of care; and (3) Weight-related stigma.

CONCLUSIONS: Addressing gaps in care requires improved training, better resource access and alignment of language with consumer preferences to reduce stigma and deliver person-centred care.

PMID:41277470 | DOI:10.1111/1747-0080.70058

J Community Psychol. 2025 Nov;53(8):e70057. doi: 10.1002/jcop.70057.

ABSTRACT

We described the experiences of a sample of rural Latinx young adults to identify relevant adult roles and events from their unique perspectives at ages 21 and 26 focusing on heterogeneity by age, sex, and immigrant generational status. Using survey data collected in 2014 (n = 308) and 2019 (n = 285) from respondents who grew up in two rural US towns, we qualitatively examined responses to an open-ended question; explored thematic patterns across age, sex, and immigration generation; and contextualized with quantitative data. Rural Latinx young adults identified milestones typical of young adults (e.g., work, school, relationships, family, living arrangements) and diverse pathways into adulthood. They expressed positive and challenging sentiments regarding transitions, but mostly optimism about their futures. We observed heterogeneity within and between ages, sexes, and generational statuses. Increasing work and educational opportunities for Latinx young adults in rural communities can help them navigate this transition more successfully.

PMID:41277465 | DOI:10.1002/jcop.70057

J Helminthol. 2025 Nov 24;99:e124. doi: 10.1017/S0022149X25100928.

ABSTRACT

Anurans are bioindicators and key components of ecosystem functions. Although South America harbors more than 4,000 identified anuran species, fewer than 10% have been analyzed regarding their trematode fauna. When tadpoles are considered, the paucity of studies becomes even more evident. Considering the ability of digeneans to serve as indicators of ecosystem health, it is evident that there is a gap in the knowledge of trematodes occurring in anuran biodiversity hotspots. Herein, we provide an ecological and morphological analysis of the trematode component community recovered in tadpoles and adult anurans. During a long-term herpetological and helminthological study conducted in a Cerrado fragment in Brazil, 569 anurans from 17 species were necropsied. Eleven species were common to both adults and tadpoles, and six species occurred only in adults. The total prevalence was 61% (352/569), in separate analyses, 65% (192/296) for adult anurans, and 58% (160/273) for tadpoles. A total of 12,397 trematodes belonging to 16 taxa were recovered. The component community was composed mostly of metacercariae. We provided a brief morphological description for each trematode taxa recovered. Additionally, statistical analysis was performed to elucidate the differences between tadpoles and adult anurans trematode communities. The trematode community analyzed in our study revealed 24 new host records and was the first to include tadpoles in such an analysis, highlighting the importance of faunistic inventories for a better understanding of parasitism in their hosts, as well as providing a foundation for further research.

PMID:41277455 | DOI:10.1017/S0022149X25100928

J Otolaryngol Head Neck Surg. 2025 Jan-Dec;54:19160216251387622. doi: 10.1177/19160216251387622. Epub 2025 Nov 24.

ABSTRACT

ImportanceMost French Olfactory Questionnaires are time consuming, which may affect the patient participation.ObjectiveTo validate a short French version of the Olfactory Disorders Questionnaire (Fr-ODQ).DesignProspective controlled study.SettingMulticenter study.ParticipantsPatients with long-lasting olfactory dysfunction (OD) treated with platelet-rich plasma into the olfactory clefts and asymptomatic subjects.InterventionDevelopment and validation of a short ODQ.Main OutcomesIndividuals completed the full Fr-ODQ. The Threshold, Discrimination, and Identification (TDI) test was performed in OD patients. A combined statistical analysis was performed to determine the most informative items of the Fr-ODQ to develop a shorter version. The internal consistency was determined with Cronbach’s alpha. The reliability and external validity were evaluated through a test-retest approach and by correlating with the Fr-ODQ. Both the minimal clinically important difference (MCID) and the threshold of the short ODQ version were determined.ResultsA total of 263 patients (173 [65.8%] females) and 129 controls (92 [71.3%] females) completed the evaluations. The mean age of patients was 51.2 ± 15.3 years. The mean duration of OD was 42.4 ± 54.3 months. The biostatistical models selected 10 essential items composing the Fr-ODQ-10. The baseline Fr-ODQ-10 was significantly correlated with the TDI (r_s = 0.228; P = .001) and the Fr-ODQ (r_s = 0.875; P = .001), demonstrating high external validity. Fr-ODQ-10 was significantly lower in controls compared to OD patients (P = .001), highlighting high internal validity. The internal consistency was good (α = .796). The external consistency was adequate, with significant correlations between the test-retest Fr-ODQ-10. The Fr-ODQ-10 significantly decreased from baseline to 4 months post-treatment. A Fr-ODQ-10 score >7.5 was considered abnormal (sensitivity: 84.8%, specificity: 84.2%). The MCID of Fr-ODQ-10 was established at >3.Conclusion and RelevanceThe Fr-ODQ-10 is a valid and reliable clinical instrument, demonstrating correlation with the psychophysical olfactory assessment.

PMID:41277449 | DOI:10.1177/19160216251387622

Pulmonology. 2025 Dec 31;31(1):2591498. doi: 10.1080/25310429.2025.2591498. Epub 2025 Nov 24.

ABSTRACT

BACKGROUND: The clinical impact of bronchiectasis (BE) in acute exacerbations of COPD (AECOPD) remains controversial, with unclear phenotypic heterogeneity.

RESEARCH QUESTION: Does BE independently influence clinical outcomes and phenotypic heterogeneity in AECOPD patients?

STUDY DESIGN AND METHODS: This prospective multicenter cohort study analysed 11 759 hospitalised AECOPD patients from 10 Chinese medical centres. Propensity score matching (1:3) balanced baseline characteristics, and unsupervised cluster analysis identified phenotypic subgroups. Primary endpoints included mortality and exacerbation frequency, with secondary endpoints assessing mechanical ventilation, ICU admission, and length of stay (LOS).

RESULTS: AECOPD-BE patients had higher rates of non-invasive ventilation (23.5% vs 20.1%, p = 0.002), ICU admission (9.8% vs 6.5%, p < 0.001), and prolonged LOS (median 10 vs 9 days, p < 0.001). Mortality rates were similar (in-hospital: 1.1% vs 1.3%, p = 0.477; 3-year: 17.8% vs 21.6%, p = 0.652), but BE patients had more exacerbations (2.92 ± 4.30 vs 2.18 ± 2.72 events, p = 0.004). Cluster analysis revealed two phenotypes: a Systemic Inflammatory-High Risk (SI-HR) subgroup with severe inflammation and poorer outcomes, and a Stable Compensated (SC) subgroup with milder manifestations.

CONCLUSION: BE independently predicts increased acute healthcare utilisation and exacerbation risk in AECOPD without affecting mortality. The SI-HR phenotype identification supports targeted management strategies for this heterogeneous population.Clinical Trial Registration: Chinese Clinical Trail Registry NO.: ChiCTR2100044625; URL: http://www.chictr.org.cn/showproj.aspx?proj=121626.

PMID:41277420 | DOI:10.1080/25310429.2025.2591498