Tag: pubmed

BMC Oral Health. 2026 Jun 1. doi: 10.1186/s12903-026-08755-z. Online ahead of print.

ABSTRACT

BACKGROUND: Polymethyl methacrylate (PMMA) denture base materials are routinely exposed to chemical cleansers during daily use, yet the material effects of unconventional agents, such as oral probiotics, remain unclear.

OBJECTIVES: This study investigated the effects of experimental exposure to a BLIS M18 oral probiotic solution and conventional denture cleansers on the color stability and surface properties of conventionally processed, milled, and 3D-printed PMMA during simulated denture care for up to 90 days.

METHODS: One hundred and twenty PMMA discs were fabricated using conventional processing, CAD/CAM milling, and 3D-printing, and were then immersed in distilled water, an effervescent tablet cleanser, 1% sodium hypochlorite, or BLIS M18 oral probiotic solution (experimental). Color change (ΔE₀₀), surface roughness, and Vickers hardness were measured at baseline (T0) and after 90 days (T3), with additional color and hardness measurements at 30 (T1) and 60 (T2) days. Surface morphology was examined using scanning electron microscopy. Data were analyzed using mixed repeated-measures ANOVA with Bonferroni post hoc tests (α = 0.05).

RESULTS: Manufacturing techniques significantly influenced baseline and post-exposure material properties, with 3D-printed PMMA exhibiting higher roughness and lower hardness than milled and conventionally processed materials (p < 0.001). Simulated denture cleansing increased surface roughness Ra, with post-exposure values ranging from 0.31 to 0.46 μm and reduced hardness (5.8-30.7%) over time, whereas cleanser-related effects were statistically significant but small. Color changes remained limited for all groups (0.50-1.73). Experimental exposure to BLIS M18 resulted in minimal changes in color, roughness and hardness compared with conventional cleansers.

CONCLUSIONS: PMMA surface integrity is primarily determined by the manufacturing technique rather than the cleanser chemistry. Under simulated denture care conditions, experimental exposure to BLIS M18 demonstrated compatibility with PMMA denture base materials without compromising surface properties or color stability.

PMID:42219474 | DOI:10.1186/s12903-026-08755-z

BMC Prim Care. 2026 Jun 1. doi: 10.1186/s12875-026-03394-3. Online ahead of print.

ABSTRACT

BACKGROUND: Early diagnosis and prompt referral are critical for improving outcomes in systemic sclerosis (SSc), yet disparities in diagnostic capabilities between healthcare levels may delay treatment and impact survival. This study aimed to compare mortality risk among SSc patients based on their diagnostic pathway: initial diagnosis at a secondary care hospital before referral versus prompt referral and diagnosis at a tertiary center.

METHODS: Using National Health Security Office cohort data (fiscal years 2016-2023), we identified 17,036 patients aged ≥ 18 years with SSc (ICD-10 M34) diagnosed at tertiary or university hospitals. The primary outcome was mortality risk through December 31, 2024. Mortality rates (95% CI) were stratified by the initial diagnostic facility. Cox regression analysis with a time-dependent interaction term for age was used to evaluate factors associated with mortality.

RESULTS: A total of 4,404 patients with SSc from 102 tertiary care hospitals were referred from secondary care hospitals. Patients first diagnosed at secondary care hospitals exhibited a significantly higher mortality rate (0.89 per 100 person-months; 95% CI 0.85-0.93) compared to those first diagnosed at tertiary care hospitals (0.67 per 100 person-months; 95% CI 0.65-0.69; p < 0.001). Increased mortality risk was associated with older age (HR 1.055), referral duration > 180 days vs. ≤ 7 days (HR 1.300), acute myocardial infarction (HR 1.895), and primary pulmonary hypertension (HR 1.654). An interaction between age and log(time) demonstrated that the effect of age on mortality decreased by approximately 0.5% per month of follow-up.

CONCLUSION: The initial diagnosis of SSc at tertiary care hospitals was associated with a better prognosis than that at secondary care hospitals. A longer referral duration was associated with poorer survival. Advanced age and coexisting cardiopulmonary diseases were significantly associated with mortality in patients with SSc. These findings highlight the need for standardized referral criteria and “red flag” checklists to facilitate earlier specialized care.

PMID:42219459 | DOI:10.1186/s12875-026-03394-3

BMC Anesthesiol. 2026 Jun 1. doi: 10.1186/s12871-026-03949-y. Online ahead of print.

ABSTRACT

BACKGROUND: Antimicrobial resistance (AMR) is a global public health threat associated with poor patient outcomes; however, there are major gaps in routine surveillance and reporting. In low-income countries like Ethiopia, antibiotics tend to be misused, particularly in intensive care units (ICU).

AIM: To determine the bacterial profile, antimicrobial resistance patterns, and associated clinical outcomes among ICU patients at Tikur Anbessa Specialized Hospital (TASH), Addis Ababa.

METHODS: An institution-based, six-month (May 1, 2023-October 31, 2023) retrospective cross-sectional study was conducted in the ICU of TASH on 216 patients. Data regarding sociodemographic and clinical characteristics, antimicrobial susceptibility testing (AST), and patient outcomes were collected from the health management information system (HMIS). Statistical Package for the Social Sciences (SPSS) version 27 was used for data analysis. Bivariate and multivariate logistic regression analysis were performed to assess the association between AMR and intra-ICU mortality. A p-value of < 0.05 was considered statistically significant.

RESULTS: Eighty nine point four percent of infections were due to Gram-negative bacteria. Of the Gram-negative isolates, the most commonly isolated pathogen was Acinetobacter baumannii (31.5%), followed by Klebsiella pneumoniae (22.7%), and Escherichia coli (14.8%). Acinetobacter baumannii was predominantly carbapenem resistant. Eighty point one percent of bacterial isolates exhibited multidrug resistance. The lowest level of resistance was observed with amikacin across all microorganisms. Bloodstream infections (BSIs) were the most frequently reported infection type. Intra-ICU mortality was determined to have a significant association with BSI (AOR 2.89, 95% CI 1.11, 3.94), septic shock (AOR 5.34, 95% CI 2.32, 12.25), CRAB infection (AOR 2.22, 95% CI 1.11, 4.43), and surgical intervention (AOR 0.46, 95% CI 0.24, 0.88).

CONCLUSION: The study demonstrates a high burden of multi-drug resistant gram-negative infections in the ICU. The findings also show the clinical impact of AMR on mortality, particularly in critically ill patients with septic shock and BSI. The study highlights the urgent need to strengthen antimicrobial stewardship programs, enhance infection prevention and control practices, and improve microbiological surveillance systems in ICU settings.

PMID:42219453 | DOI:10.1186/s12871-026-03949-y

Appl Health Econ Health Policy. 2026 Jun 1. doi: 10.1007/s40258-026-01051-5. Online ahead of print.

ABSTRACT

BACKGROUND: Universal health coverage has become central to health policy debates, particularly as a strategy to protect households from financial hardship and impoverishment related to out-of-pocket (OOP) spending. Many low- and middle-income countries (LMICs), including India, have relied predominantly on publicly funded health insurance (PFHI) to improve financial protection against OOP spending. PFHI generally covers low-frequency, high-cost hospitalization expenses, even though non-hospitalization expenses are the main contributors to OOP. Global evidence suggests that stronger primary health care (PHC) provision is crucial for reducing catastrophic health expenditure (CHE). This issue becomes particularly important in the context of climate-sensitive diseases (CSDs), whose incidence is increasing due to more frequent and extreme weather events, which may increase the risk of CHE.

OBJECTIVE: This study estimates the causal impact of publicly provided PHC and PFHI on CHE arising from CSDs.

METHODS: Using district-level data for all 640 Census districts in India, we applied propensity score matching and inverse probability weighting to compare the effects of PHC and PFHI on CHE associated with CSDs.

RESULTS: The findings show that strengthened PHC substantially reduces OOP spending and CHE associated with CSDs, whereas PFHI shows no statistically significant effect.

CONCLUSION: These results highlight the need to prioritize climate-resilient PHC systems to address the escalating health impacts of climate change and advance equitable progress toward universal health coverage in LMICs.

PMID:42219435 | DOI:10.1007/s40258-026-01051-5

Drugs Aging. 2026 Jun 1. doi: 10.1007/s40266-026-01304-x. Online ahead of print.

ABSTRACT

INTRODUCTION: Multi-dose dispensing (MDD) is a medication management system in Sweden that pre-packages regularly used prescription medicines into unit doses. Despite widespread use, there are no recent national estimates of MDD prevalence in Sweden, and little is known about how use evolved through the coronavirus disease 2019 (COVID-19) pandemic or which patient groups account for most MDD utilisation.

OBJECTIVE: The purpose of this study was to describe the prevalence of multi-dose dispensing in older adults in Sweden from 2014 to 2023, spanning the COVID-19 pandemic, and describe trends by patient subgroups.

METHODS: We conducted a repeated cross-sectional study of older adults aged ≥ 70 years old in Sweden, 2014-2023. We used nationwide data from the Swedish Prescribed Drug Register linked at the individual level with several other administrative and healthcare registers. The primary outcome was annual period prevalence of MDD, stratified by age, sex, education level, living status, civil status, health status and geography.

RESULTS: Prevalence of MDD amongst adults aged 70 years or older increased by 1.5 percentage points between 2014 and 2023, reaching 12.1% in 2023, and there was no additional increase during the COVID-19 pandemic (2020-2022). In nursing home residents, MDD use approached near-universal levels (from 84.2 to 96.1%). Uptake also increased across other subgroups, most notably amongst people with a dementia diagnosis (+ 45.3 percentage points), those receiving home help services (+ 21.4 percentage points) and those with five or more chronic conditions (+ 15.3 percentage points). Over time, the characteristics of MDD users shifted towards community-dwelling adults receiving home help services, younger older adults (70-79 years old) and individuals with higher education.

CONCLUSIONS: Our nationwide study indicates that MDD has become an established standard of medication management in Swedish nursing homes and is progressively extending into community settings amongst older adults with complex health needs. Prescribing of MDD remained stable during the COVID-19 pandemic. Future studies should quantify risks and benefits of MDD use especially in vulnerable, older, and frail populations.

PMID:42219430 | DOI:10.1007/s40266-026-01304-x

Eur Heart J Cardiovasc Pharmacother. 2026 Jun 1:pvag037. doi: 10.1093/ehjcvp/pvag037. Online ahead of print.

ABSTRACT

Two contemporary randomized trials of β-blocker therapy after myocardial infarction (MI) reached apparently conflicting conclusions. REBOOT, conducted in Spain and Italy, found no reduction in death or major cardiovascular events among patients with preserved ejection fraction. In contrast, the BETAMI-DANBLOCK study, conducted in Scandinavia, reported a modest but statistically significant reduction in a composite endpoint. The prevailing response has been to reconcile this divergence by elevating left ventricular ejection fraction-particularly the 40-49% range-as the decisive explanatory variable. This interpretation offers analytic simplicity but rests on fragile statistical and conceptual grounds. Drawing on Nancy Cartwright’s account of causal capacities and Judea Pearl’s transportability framework, this paper argues that β-blockers exhibit stable physiological effects whose clinical benefits depend on the causal environment. Randomization secures internal validity within trials but cannot homogenize genetic, systemic, or environmental contexts. Meta-analysis, by averaging across heterogeneous environments and individual treatment effects, risks obscuring rather than clarifying dependencies. The divergence between REBOOT and BETAMI-DANBLOCK does not represent a failure of evidence-based medicine but exposes the limits of reductionist interpretation. Rather than seeking universal truths, cardiovascular medicine should map the causal environments in which therapeutic capacities become manifest.

PMID:42219422 | DOI:10.1093/ehjcvp/pvag037

Sci Rep. 2026 Jun 1. doi: 10.1038/s41598-026-54695-7. Online ahead of print.

ABSTRACT

College students face a higher risk of depression than their non-college peers. However, the predictors of depressive symptoms among college students and their relative importance remain inconclusive. This study aimed to develop predictive models for depressive symptoms among Chinese undergraduate students using a four-year longitudinal dataset and to explore the importance ranking of predictive factors. A cohort of 1,500 college students from Sichuan University was recruited and followed annually for four years. Computer-based questionnaires were used to collect demographic, behavioral and psychological data. Using a recurrent neural network (RNN), four predictive models were constructed to capture the temporal dynamics of depression risk as students progressed through college. The prevalence of depressive symptoms ranged from 3.60% to 6.27% across the four waves. All RNN models demonstrated strong predictive performance (AUC: 0.921-0.952), with sensitivity improving over longer follow-up periods, outperforming traditional models, such as multilevel linear regression, k-nearest neighbor and support vector machines. Analysis of feature importance revealed that family relationship issues were key predictors of early-stage depressive symptoms. Childhood traumatic experiences and preexisting mental health conditions had lasting impacts, while health-related factors, such as subjective sleep quality, sleep disorders, and self-rated health, were consistent indicators across years. These findings have important practical implications for university mental health programs, suggesting that early identification of high-risk students could enable targeted interventions such as family-based support, trauma-informed counseling, and sleep health education tailored to students’ developmental stages. Such data-driven strategies may improve prevention efforts and promote student well-being.

PMID:42219415 | DOI:10.1038/s41598-026-54695-7

J Hazard Mater. 2026 May 27;513:142544. doi: 10.1016/j.jhazmat.2026.142544. Online ahead of print.

ABSTRACT

Microbial mercury (Hg) methylation and methylmercury (MeHg) demethylation critically govern MeHg production in paddy soils and its accumulation in rice. However, how the decline in microbial diversity under climate change affects these processes remains unclear. Here, we combined stable isotope tracing with a dilution-to-extinction approach to manipulate microbial diversity across paddy soils with Hg contamination gradient (HX: 165 ng/g, GX: 20,707 ng/g and SK: 659,303 ng/g), investigating its effects on Hg methylation and demethylation. Results showed that diversity loss suppressed methylation (to 0.31-0.82 times the original soil) while enhanced demethylation (to 1.33-7.00 times the original soil) in HX and GX soils, reducing net MeHg production. Conversely, in SK soil, it promoted methylation (to 0.31-0.71 times the original soil) and inhibited demethylation (0.14-0.48 times the original soil), increasing MeHg accumulation. Marginal density curves and linear regression analyses indicate that the regulatory effect of microbial diversity on MeHg production depends strongly on Hg levels, with a significant shift in MeHg concentration across a critical threshold of 30,000 ng/g. Nationwide expanded data further confirmed that diversity loss deceases MeHg production below this threshold but elevates it above. This divergence is attributed to Hg-induced shifts in microbial community structure induced. Our findings highlight the crucial role of microbial diversity in regulating net MeHg production in paddy soils, offering important insights for predicting Hg risks under climate change and ensuring food security.

PMID:42218839 | DOI:10.1016/j.jhazmat.2026.142544

J ECT. 2026 May 28. doi: 10.1097/YCT.0000000000001282. Online ahead of print.

ABSTRACT

OBJECTIVE: Evidence about nonvoluntary electroconvulsive therapy (ECT) is limited. Observational studies have suggested that nonvoluntary ECT is equally effective as voluntary ECT in treating psychotic and mood disorders. However, prior studies with short follow-up periods of ∼6 months have been inconclusive regarding long-term clinical outcomes following nonvoluntary ECT, particularly in patients with schizophrenia-spectrum disorders.

METHODS: We conducted a retrospective chart review and included patients who received ECT treatment between 2016 and 2023 at our hospital. The patients were assigned to the nonvoluntary and voluntary groups. We compared the short-term and long-term outcomes between the 2 groups over a 1-year period.

RESULTS: In total, 227 patients were included in this study: 58 in the nonvoluntary group and 169 in the voluntary group. No significant intergroup differences were observed in short-term outcomes, such as the clinical global impressions-improvement scale score, number of discharged patients, and duration of admission. Furthermore, the Cox proportional hazard model found that the nonvoluntary group was not significantly associated with treatment failure 1 year after discharge (hazard ratio: 0.94, 95% CI: 0.55-1.61). However, 6 patients in the nonvoluntary ECT group underwent the procedure again, representing a statistically significant difference.

CONCLUSIONS: Nonvoluntary ECT may be an effective treatment option for patients with life-threatening conditions when no alternative is available. However, further investigation is needed to explore ways to improve patient acceptance of future treatments.

PMID:42218831 | DOI:10.1097/YCT.0000000000001282

Pharmacogenet Genomics. 2026 Mar 26. doi: 10.1097/FPC.0000000000000599. Online ahead of print.

ABSTRACT

OBJECTIVES: Gastroesophageal reflux disease is primarily treated with proton pump inhibitors (PPIs), which are metabolized by cytochrome P450 2C19 (CYP2C19) in the liver. CYP2C19 polymorphisms affect PPI plasma levels, with rapid (2-27%) and ultra-rapid (<1-5%) metabolizers needing higher doses, while poor (3-15%) and intermediate (27-47%) metabolizers require lower doses for therapeutic effectiveness. Antireflux surgery is recommended for patients refractory to medical therapy or with symptomatic hiatal hernias.

METHODS: This is a multisite retrospective review of adult patients from 2012 to 2023 diagnosed with gastroesophageal reflux disease who underwent hiatal hernia operations and completed CYP2C19 testing. CYP2C19 phenotypes were grouped as poor metabolizer/intermediate metabolizer, normal metabolizers, or rapid metabolizer/ultra-rapid metabolizer. Hiatal hernia size was classified as small, medium, or large based on preoperative and intra-operative findings. Descriptive statistics were used.

RESULTS: Eighty patients [female: 66%, median age: 60.5 (interquartile range 53.3-67.0) years, 90% White, 6% Hispanic] had CYP2C19 testing and underwent a hiatal hernia repair. CYP2C19 phenotypes were poor metabolizer (4%), intermediate metabolizer (24%), normal metabolizers (30%), rapid metabolizer (31%), and ultra-rapid metabolizer (11%). About 28% were grouped as poor metabolizer/intermediate metabolizer and 43% as rapid metabolizer/ultra-rapid metabolizer. Among patients with small (n = 41) and medium (n = 23) hernias, 39% and 57%, respectively, were classified as rapid metabolizer/ultra-rapid metabolizer, suggesting they were resistant to PPIs.

CONCLUSION: The prevalence of rapid metabolizer/ultra-rapid metabolizer CYP2C19 phenotypes in patients undergoing antireflux surgery is higher than generally reported in the general population. These patients could potentially benefit from higher PPI doses or surgical intervention if ineffective. Prospective multisite studies with diverse, representative samples are needed to confirm these findings.

PMID:42218813 | DOI:10.1097/FPC.0000000000000599