Tag: pubmed

JAMA. 2025 Sep 15. doi: 10.1001/jama.2025.14194. Online ahead of print.

ABSTRACT

IMPORTANCE: Preterm infants with severe thrombocytopenia (platelet count <50 × 109/L) frequently receive platelet transfusions. However, it is unclear in what cases prophylactic transfusion truly reduces bleeding risk or whether it does more harm than good.

OBJECTIVE: To develop and validate a dynamic prediction model for major bleeding or mortality if prophylactic platelet transfusion were or were not to be given to infants with severe thrombocytopenia.

DESIGN, SETTING, AND PARTICIPANTS: The dynamic prediction model was developed in an international multicenter cohort (2017-2021) comprising 14 neonatal intensive care units in the Netherlands, Sweden, and Germany. Model evaluation was performed in a national multicenter cohort (2010-2014) including 7 Dutch neonatal intensive care units. The study population consisted of infants with severe thrombocytopenia less than 34 weeks’ gestation.

EXPOSURE: Two transfusion strategies were contrasted at each prediction point: receiving a platelet transfusion within 6 hours (prophylaxis) vs no platelet transfusion for 3 days (no prophylaxis).

MAIN OUTCOMES AND MEASURES: The primary outcome was the 3-day risk of major bleeding or mortality, reestimated every 2 hours during the first week after severe thrombocytopenia onset. Predictors included gestational and postnatal age, small-for-gestational-age infant, necrotizing enterocolitis, sepsis, mechanical ventilation, vasoactive agents, platelet count, and prior platelet transfusion(s). Landmarking combined with the clone-censor-weight approach enabled dynamic prediction under the 2 transfusion strategies, accounting for time-varying confounding. Model performance was evaluated in the external validation cohort.

RESULTS: In both the development (n = 1042) and validation (n = 637) cohorts, the median gestational age was 28 weeks and median birth weight was 900 g; there were 613 (59%) and 370 (58%) males, respectively. Major bleeding or death occurred in 235 infants (23%) in the development cohort and 135 (21%) in the validation cohort. In the validation cohort, the time-dependent area under the receiver operating characteristic curve was 0.69 (95% CI, 0.60-0.76) for the prophylaxis strategy and 0.85 (95% CI, 0.76-0.92) for the no prophylaxis strategy, with calibration plots showing good calibration. Estimated risks under both strategies varied considerably depending on the infant’s clinical condition at the time of prediction.

CONCLUSIONS AND RELEVANCE: Among preterm infants with severe thrombocytopenia, this modeling study found substantial variation among individuals in predicted benefits and harms of prophylactic platelet transfusion based on their current clinical characteristics. The dynamic prediction model performed well in a validation cohort, and its value to support individualized decisions warrants evaluation in future studies.

PMID:40952748 | DOI:10.1001/jama.2025.14194

JAMA Netw Open. 2025 Sep 2;8(9):e2531568. doi: 10.1001/jamanetworkopen.2025.31568.

ABSTRACT

IMPORTANCE: Some shift work arrangements allow for less than 11 hours off between shifts. The consequences of short daily rest periods are currently not well understood.

OBJECTIVE: To determine the effect and cost-benefit of reducing the number of short daily rest periods on sickness-related absence among health care workers.

DESIGN, SETTING, AND PARTICIPANTS: This 2-arm cluster-randomized clinical trial was conducted between January 11, 2021, and May 22, 2022, in hospital care units at Haukeland University Hospital in Bergen, Norway. Statistical analysis was performed from April to May 2025.

INTERVENTION: The intervention group followed a 6-month shift schedule with reduced instances of short daily rest periods, whereas the control group adhered to a 6-month shift schedule maintaining the usual number of short daily rest periods.

MAIN OUTCOMES AND MEASURES: Primary analyses followed intention-to-treat principles. The outcome was change in sickness-related absence days and absence spells (ie, each uninterrupted period of ≥1 consecutive sickness-related absence days) over the final 5 months of the intervention (allowing a 1-month stabilization period), compared with the same period in the preceding year and against a control group. The economic returns, measured as the increase in net present value of production from reduced sickness-related absence days due to the intervention, was estimated using a standard cost-benefit formula.

RESULTS: Of 66 hospital units with 811 health care workers (mean [SD] age, 39.8 [12.8] years; 626 of 808 women [77.5%]) in 80% or more full-time positions, 31 units (344 workers) were randomized to the intervention group and 35 units (467 workers) to the control group. The mean (SD) number of short daily rest periods among the intervention group was halved from 18.0 (8.4) during the reference period to 9.1 (6.2) in the intervention period, while the frequency remained unchanged among the control group (reference period, 18.3 [8.3] days; and intervention period, 17.5 [8.4] days). The intervention group showed a significantly smaller increase in sickness-related absence days (incidence rate ratio [IRR], 0.56; 95% CI, 0.41-0.79; P < .001) and spells (IRR, 0.73; 95% CI, 0.61-0.86; P < .001) compared with the control group. The effect on sickness-related absence days in the intervention units resulted in a positive estimated net economic return of approximately NOK 2 174 620 (USD $213 600) over 5 months.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial of health care workers, reducing the frequency of short daily rest periods had positive effects on sickness-related absences and reduced expenses. These findings should guide organizational practices and inform legislative policies to enhance the health of workers by increasing daily rest periods to 11 hours or more between shifts.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04693182.

PMID:40952742 | DOI:10.1001/jamanetworkopen.2025.31568

J Spinal Cord Med. 2025 Sep 15:1-7. doi: 10.1080/10790268.2024.2414146. Online ahead of print.

ABSTRACT

OBJECTIVES: In all patients, LFAS To explore the effect of low frequency antidromic stimulation (LFAS) of the pelvic somatic serves on intestinal peristalsis and heart rate in individuals with chronic spinal cord ird injury and spasticity.

SETTING: Hospital in Zürich, Switzerland.

METHODS: Ten consecutive patients underwent laparoscopic implantation of neuroprosthesis to sciatic/femoral nerves – the LION procedure: 5 patients with Thoracic (T) SCI AIS A, 1 patient T4 AIS C, 1 patient C3 AIS A, and 3 patients with cervical injury (AIS B/C). At the end of the implantation, intestinal peristalsis observed laparoscopically was recorded before and after starting with LFAS at 10 Hz. On the first postoperative day, heart rates before and after the beginning of the same LFAS were checked. Statistical analyses were performed using a paired Student’s t-test.

RESULTS: LFAS Of the pelvic somatic nerves induced strong peristalsis in the small bowel and ascending/transverse colon without affecting the urinary bladder or descending colon/rectum, and a significant slowing of the heart rate in 8 patients with an overall reduction from 96.3 bpm (bpm) (P < 0.01).

CONCLUSIONS: This case series study reports on the effect of continuous antidromic pelvic neuromodulation (CAPN) on extraspinal somatic and autonomic pathways in chronic SCI. The discussion poses a novel hypothesis about the effect of CAPN on spinal pathways and activation of corticospinal pathways and neuroplasticity via the Renshaw cells. A rationale is provided for CAPN-induced activation of the vagus nerve (VN) and the existence of anastomotic pathways between the lumbosacral somatic nerves and the VN, and the capability of an activation of the motor functions of the VN. A second hypothesis is posed for the activation of cortico-vagal plasticity that may improve recovery after complete SCI by combining CAPN with neuromodulation of the VN.Trial registration NCT03441256.

PMID:40952735 | DOI:10.1080/10790268.2024.2414146

JAMA. 2025 Sep 15. doi: 10.1001/jama.2025.14389. Online ahead of print.

NO ABSTRACT

PMID:40952725 | DOI:10.1001/jama.2025.14389

Psychol Methods. 2025 Sep 15. doi: 10.1037/met0000796. Online ahead of print.

ABSTRACT

When comparing relationships between latent variables across groups, measurement invariance (MI) needs to be established to ensure that the test results are valid and meaningful conclusions can be drawn. Common tests of MI are not ideal for investigating many groups and are of limited value during the development of measurement models. In addition, popular network-based alternatives to latent variable modeling lack established methods for MI testing. Therefore, we propose exploratory graph analysis trees (EGA trees) that apply the idea of model-based recursive partitioning to correlation matrices and combine it with EGA-which can be used instead of exploratory factor analysis. In a simulation study, we test the approach regarding its ability to detect configural or metric noninvariance in common factor models given numerous covariates and illustrate its usefulness in conditions with severe violations of configural invaraince based on the diverging number of factors. The results demonstrate that EGA trees can be a valuable tool for the exploration of MI when constructing scales and working on measurement models. We provide R functions within the R package EFAtree to easily implement EGA trees. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

PMID:40952703 | DOI:10.1037/met0000796

Neuropsychology. 2025 Sep 15. doi: 10.1037/neu0001029. Online ahead of print.

ABSTRACT

OBJECTIVE: The Mattis Dementia Rating Scale (DRS), a widely used cognitive assessment tool, has been revised to align with contemporary diagnostic criteria and cognitive domain classifications such as those outlined in Diagnostic Statistical Manual for Mental Disorders, fifth edition-text revision (DSM-5-TR) and eleventh version of the International Classification of Diseases (ICD-11). This study proposed a reorganization of DRS items into five new subscales based on cognitive domains of those classificatory manuals, aiming to enhance its construct validity and clinical utility.

METHOD: The DRS and other neuropsychological tests were used for the assessment of 407 older adults with low formal education and heterogeneous cognitive backgrounds. We used confirmatory factor analysis to test different arrangements of DRS items and correlated the final model with other neuropsychological tests.

RESULTS: Our final model (following the DSM-5-TR/ICD-11 cognitive domains) showed better model fit in multiple indexes when compared with the original DRS subscales. They showed significant correlation with specific neuropsychological tests corresponding to their respective cognitive domains, supporting its validity. Group comparisons across cognitive impairment levels (cognitively unimpaired, mild neurocognitive disorder, major neurocognitive disorder) revealed progressive cognitive decline patterns consistent with clinical expectations.

CONCLUSIONS: The proposed DRS item division based in DSM-5-TR and ICD-11 cognitive domains showed more consistent evidences of validity than the original. The proposed revision can use the original DRS subtests and scoring system, just reorganizing the subscales to better fit the DSM-5-TR/ICD-11 model and can in any translation/local version of the test. Further research is needed to replicate this findings and establish normative values and cutoff scores for clinical application. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

PMID:40952694 | DOI:10.1037/neu0001029

Personal Disord. 2025 Sep 15. doi: 10.1037/per0000745. Online ahead of print.

ABSTRACT

This study explores the structural properties of the Personality Inventory for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, Brief Form (PID-5-BF) by applying network analysis and community detection as a data-driven alternative to traditional factor models. Traditionally, the PID-5-BF assesses personality traits across five domains-Negative Affectivity, Detachment, Antagonism, Disinhibition, and Psychoticism-but has shown notable inconsistencies in item alignment and factorial coherence. To examine these issues, data were collected from 2,766 Italian participants (71.7% female, 28.3% male, M_age = 32.94 years, SD = 13.2). The estimated network revealed a stable structure, supported by robust centrality measures (closeness = 0.59, expected influence = 0.75, strength = 0.75). Community detection identified five empirically coherent clusters-Disinhibition, Demoralization, Detachment and Irritability, Psychosocial Alienation, and Pathological Egocentrism-suggesting an alternative organization of maladaptive traits in this population. To assess generalizability, a second analysis was conducted on a Hungarian sample (N = 355), yielding a five-structure solution with different item compositions. While the network approach emphasizes item-level associations, the specific configurations varied across samples in ways that reflect contextual influences. Nonetheless, this method offers complementary insights to traditional factorial models, highlighting how personality traits may organize differently across populations and supporting the use of network-based approaches in refining dimensional models of personality pathology. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

PMID:40952676 | DOI:10.1037/per0000745

Lang Speech Hear Serv Sch. 2025 Sep 15:1-8. doi: 10.1044/2025_LSHSS-25-00053. Online ahead of print.

ABSTRACT

PURPOSE: Understanding children’s speech perception strategies in noise is very important for improving their living environment. Previous studies with adults reported that closing the eyes improves speech understanding in noise by increasing the activation of cortical systems involved in listening and attention, while increased cognitive load makes speech understanding in noise more difficult. This study aimed to investigate the effects of listening conditions on speech perception in noise in children.

METHOD: The study recruited 102 typically developing children, 51 girls and 51 boys, aged between 7 and 12 years with typical hearing. Speech intelligibility tests were performed in noise under three different conditions: eyes open (EO), eyes closed (EC), and watching cartoon (WC), which is assumed to increase cognitive load. All conditions were applied randomly (without any order in the conditions) to each participant.

RESULTS: In the speech intelligibility test in noise, the lowest signal-to-noise ratio (the best performance) was obtained in the EO, EC, and WC conditions, respectively. When EO-EC, EO-WC, and EC-WC were compared by the post hoc analysis, the largest effect size was obtained in EO-WC, EO-EC, and EC-WC, respectively. When evaluated in terms of genders, no statistically significant difference was found for the three listening conditions.

CONCLUSIONS: It has been shown that children’s speech perception abilities in noise are affected at different levels by various factors such as open-closed eyes, auditory attention, and cognitive load. The best speech perception performance in noise was obtained in the EO condition, which is the natural situation.

PMID:40952674 | DOI:10.1044/2025_LSHSS-25-00053

Psychol Trauma. 2025 Sep 15. doi: 10.1037/tra0002041. Online ahead of print.

ABSTRACT

OBJECTIVE: Extant literature has highlighted the links between experiences of racial discrimination and numerous symptoms of psychopathology, including posttraumatic stress disorder (PTSD) and racial trauma. This study aimed to further probe the relationship between racial discrimination, PTSD, and racial trauma through observing how the frequency of, and distress from experiences of racial discrimination relate to symptom clusters of racial trauma and PTSD, while controlling for nondiscrimination-based trauma history.

METHOD: Participants were 303 racial minority undergraduate students who completed an online battery of questionnaires including the General Ethnic Discrimination Scale, Trauma Symptoms of Discrimination Scale, and PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition.

RESULTS: Path analysis revealed a significant relationship between the frequency and distress caused by experiences of racial discrimination and each symptom dimension of racial trauma (as captured by the Trauma Symptoms of Discrimination Scale). However, a path analysis demonstrated that only the frequency of experiences of discrimination was related to symptom clusters of PTSD.

CONCLUSIONS: Findings from the present study suggest that the frequency of experiences of discrimination is related to symptoms of racial trauma and PTSD, but that discrimination-related distress may be more closely tied to symptoms of racial trauma than PTSD. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

PMID:40952670 | DOI:10.1037/tra0002041

Psychol Trauma. 2025 Sep 15. doi: 10.1037/tra0002007. Online ahead of print.

ABSTRACT

OBJECTIVE: Sources and symptoms of traumatic stress may vary in autistic versus nonautistic youth and be challenging to assess given phenotypic overlap; nonetheless, there is a dearth of autism-tailored measures.

METHOD: The Childhood Adversity and Social Stress Questionnaire-Parent Report (CASSQ-PR) was developed to assess stressful experiences (SE) and subsequent traumatic stress symptom (TSS) within the context of autism and tested in an online community sample of parents of autistic youth (N = 729; 8-17 years; 80% male; recruited February-December 2018) with communicative speech.

RESULTS: Per parent report, autistic youth experienced ≥ 2 SE in traditionally assessed (52.7%) and autism-nominated categories (i.e., derived from mixed method research with autistic individuals and caregivers; 58.3%); 39.5% (n = 288) of parents completed the CASSQ-TSS subscale. Bullying, stigma, sensory, change, and interaction-related stress were the most commonly endorsed SE. The CASSQ-SE subscale correlated positively with Child Behavior Checklist Total Problems, with both traditional and autism-nominated SE contributing to variance explained (supporting concurrent and incremental validity). Bivariate correlations demonstrated stronger convergence between the CASSQ-PR-TSS and parent-report Child Posttraumatic Stress Disorder Symptom Scale, than the Child Behavior Checklist externalizing subscale, supporting convergent and discriminant validity. Factor structure supported a second-order, four-factor, Diagnostic and Statistical Manual of Mental Disorders, fifth edition posttraumatic stress disorder model per confirmatory factor analysis; however, exploratory structural equation modeling suggested some adaptations to remove low-loading items, reduce item cross-loading, and enhance model fit.

CONCLUSIONS: The CASSQ-PR offers a valid estimate of SE and TSS as observed by parents in verbally communicative, school-age autistic youth; however, further research with more sociodemographically diverse and clinical samples is warranted. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

PMID:40952668 | DOI:10.1037/tra0002007