Tag: pubmed

JAMA Netw Open. 2026 May 1;9(5):e2612332. doi: 10.1001/jamanetworkopen.2026.12332.

ABSTRACT

IMPORTANCE: Undocumented immigrants are more than 5 times as likely as US citizens to be uninsured. Before 2020, undocumented young adults aged 19 to 25 years in California were eligible for restricted-scope Medi-Cal, which only covers emergency services.

OBJECTIVE: To examine the association of the California 2020 full-scope Medi-Cal expansion to young adults aged 19 to 25 years regardless of immigration status with coverage outcomes and to assess subgroup differences by race and ethnicity, sex, and age.

DESIGN, SETTING, AND PARTICIPANTS: This cross sectional study included American Community Survey respondents who were noncitizens aged 19 to 25 years before (2016-2019) and after (2021-2022) the policy’s implementation in California; the treatment group was compared with California noncitizens aged 26 to 32 years and young adults aged 19 to 25 and 26 to 32 years from 6 comparison states (Arizona, Florida, Illinois, Nevada, New York, and Texas). Analysis was conducted from January 2024 to August 2025.

EXPOSURE: California’s 2020 Medi-Cal expansion.

MAIN OUTCOMES AND MEASURES: Triple difference analysis was used to estimate the association of the California Medi-Cal expansion with health insurance coverage (any, Medicaid, and private coverage) among noncitizens aged 19 to 25 years relative to California noncitizens aged 26 to 32 years and young adults in the 6 comparison states.

RESULTS: The sample included 19 773 and 32 515 noncitizen American Community Survey respondents in California aged 19 to 25 years and 26 to 32 years, respectively, and 28 535 and 43 213 individuals aged 19 to 25 years and 26 to 32 years, respectively, residing in comparison states. Baseline weighted percentages for the 19- to 25-year treatment group included 52.1% (95% CI, 51.0%-53.2%) male, 31.9% (95% CI, 30.7%-33.0%) Asian non-Hispanic, 1.8% (95% CI, 1.5%-2.2%) Black non-Hispanic, 54.6% (95% CI, 53.4%-55.9%) Hispanic, 9.7% (95% CI, 8.9%-10.5%) White non-Hispanic, and 2.0% (95% CI, 1.6%-2.3%) other race non-Hispanic. Medi-Cal expansion was associated with a 4.2 (95% CI, 1.3-7.1)-percentage-point increase in Medicaid and a 3.5 (95% CI, 0.2-6.8)-percentage-point increase in any coverage. In subgroup analyses, percentage-point increases in Medicaid were statistically significant for Hispanic young adults (6.7 [95% CI, 2.6-10.9] percentage points), males (3.6 [95% CI, 0.1-7.1] percentage points), females (5.0 [95% CI, 0.7-9.3] percentage points), those aged 19 to 22 years (4.4 [95% CI, 0.7-8.1] percentage points), and those aged 23 to 25 years (4.0 [95% CI, 0.7-7.3] percentage points). In post hoc analyses, the estimates translated to increases in Medi-Cal and any coverage of 24.4 and 20.3 percentage points, or 30 665 and 25 554 young adults, respectively.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, the California 2020 Medi-Cal expansion was associated with significant coverage gains. Because the American Community Survey did not distinguish between restricted- and full-scope Medi-Cal, the analysis may have underestimated coverage increases, and further research is warranted to understand the health care and economic costs and benefits of California’s expansion.

PMID:42126877 | DOI:10.1001/jamanetworkopen.2026.12332

JAMA Netw Open. 2026 May 1;9(5):e2612390. doi: 10.1001/jamanetworkopen.2026.12390.

ABSTRACT

IMPORTANCE: Understanding toilet avoidance and stool withholding at school is essential, as this can adversely affect children’s health and well-being.

OBJECTIVE: To assess the prevalence of toilet avoidance and stool withholding at school, and to explore the differences of withholding behavior by gender and geographic location of the school, identify reasons for withholding, and describe physical symptoms and health care utilization.

DESIGN, SETTING AND PARTICIPANTS: This cross-sectional study used an online questionnaire developed by experts from Amsterdam University Medical Center and the Dutch Digestive Health Fund. Children aged 8 to 16 years from primary schools (aged 8-12 years) and high schools (aged 13-16 years) were recruited by Verian, an external research agency, through a nationwide online panel in the Netherlands.

EXPOSURE: In July 2024, school-aged children completed the questionnaire.

MAIN OUTCOMES AND MEASURES: The primary outcomes were the prevalence of stool withholding, reasons for withholding, gastrointestinal symptoms, and health care utilization. Secondary outcomes included differences between gender and geographic location of the school, children’s reasons for avoiding school toilets, and toilets’ perceived cleanliness. To assess potential differences in withholding behavior according to gender and geographic location, a Cochran-Armitage test was performed.

RESULTS: A total of 1000 children, 518 aged 8 to 12 years (264 [51.0%] male) and 482 aged 13 to 16 years (234 [48.5%] male) completed the questionnaire. Stool withholding was reported by 265 primary school children (51.2%) and 344 high school children (71.4%), with no significant differences by gender or geographic location. Hygiene and privacy concerns were the most commonly reported reasons for withholding stool with 610 (84.3%) of children accounting for hygiene and 574 (79.3%) citing privacy concerns, and 410 (41.0%) of children rated school toilet cleanliness as insufficient. Abdominal pain was frequently reported (365 of 724 [50.4%]) and 15 of 336 primary school children (4.5%) experienced fecal incontinence. Overall, 42 primary school children (12.5%) had consulted a physician for symptoms related to withholding.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, toilet avoidance and stool withholding at school were common among both primary and high school children, mostly due to hygiene and privacy concerns. Improving school toilet facilities may reduce withholding behavior, gastrointestinal symptoms, and related physician visits, thereby supporting children’s physical, psychological, and educational well-being.

PMID:42126876 | DOI:10.1001/jamanetworkopen.2026.12390

JAMA Dermatol. 2026 May 13. doi: 10.1001/jamadermatol.2026.1070. Online ahead of print.

ABSTRACT

IMPORTANCE: Cardiovascular disease (CVD) is the leading cause of mortality in patients with psoriasis, yet structured CVD prevention is not routinely embedded in dermatology care.

OBJECTIVE: To evaluate the effectiveness of a text-messaging intervention in improving patient activation and cardiovascular risk factors among patients with psoriasis.

DESIGN, SETTING, AND PARTICIPANTS: This single-center, parallel-group randomized clinical trial took place at a tertiary hospital dermatology clinic in Australia from February 2024 to February 2025. Adults with dermatologist-confirmed psoriasis were randomized 1:1 during outpatient dermatology visits between April and July 2024. Data were analyzed from February to April 2025.

INTERVENTION: A 6-month text-messaging intervention (Tobacco, Exercise, and Diet Messages for Psoriasis [TEXTME PSO]), comprising 4 text messages per week, compared with standard care.

MAIN OUTCOMES AND MEASURES: The primary outcome was score on the 13-item Patient Activation Measure. Secondary outcomes included Mediterranean Diet Score, physical activity, cardiometabolic measures, psoriasis-CVD knowledge, medication adherence, Psoriasis Area and Severity Index, Dermatology Life Quality Index, and user feedback. Analysis of covariance was used to adjust for baseline values under an intention-to-treat framework with multiple imputation.

RESULTS: Among 111 participants (mean [SD] age, 51.8 [13.2] years; 71 [65.1%] male), the intervention showed a statistically significant improved patient activation at 6 months compared with usual care (adjusted mean difference, 10.8 points; 95% CI, 7.0-14.6 points; P < .001). Statistically significant improvements were also observed in Mediterranean diet adherence (adjusted mean difference, 1.7; 95% CI, 1.0-2.4; P < .001), medication adherence (adjusted mean difference, 1.6; 95% CI, 0.8-2.5; P < .001), and psoriasis-CVD knowledge (adjusted mean difference, 6.6; 95% CI, 4.7-8.4; P < .001). Minutes per week of physical activity increased (adjusted mean difference, 127.9; 95% CI, 21.9-234.0; P = .02), and body mass index, calculated as weight in kilograms divided by height in meters squared, decreased (adjusted mean difference, -1.0; 95% CI, -1.4 to -0.7; P < .001). No statistically significant between-group differences were observed for lipid parameters, hemoglobin A1c, smoking behavior, dermatology-specific quality of life, or psoriasis severity.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, a text-messaging intervention improved patient activation and cardiovascular risk behaviors in adults with psoriasis. While biomarker changes were modest or not statistically significant, findings support digital tools as an adjunct to cardiovascular risk in dermatology care.

TRIAL REGISTRATION: ANZCTR Identifier: ACTRN12624000498594.

PMID:42126867 | DOI:10.1001/jamadermatol.2026.1070

JAMA. 2026 May 13. doi: 10.1001/jama.2026.5663. Online ahead of print.

ABSTRACT

IMPORTANCE: Occupational burnout threatens care quality, workforce retention, and physician health. Childbearing physicians in training are at high risk due to stigma, low workplace support, and physical challenges compounding role transitions and increased home responsibilities, yet evaluations of mitigation strategies remain scarce.

OBJECTIVE: To assess the efficacy of a parental support package targeting perinatal stressors in reducing burnout and distress among childbearing physicians in training.

DESIGN, SETTING, AND PARTICIPANTS: Pragmatic, randomized, controlled, parallel-group clinical trial. Pregnant (≥12 weeks’ gestation) residents and fellows were enrolled across 7 training institutions in the northeastern US from May 2023 to July 2024. Nonbirthing parents were excluded. Follow-up concluded in May 2025.

INTERVENTIONS: Participants were randomized 1:1, stratified by site and specialty type (procedural vs nonprocedural), to receive a parental support package (n = 78) or usual support (n = 78) from early pregnancy through 24 weeks post partum. The parental support package included a smart bassinet, wearable breast pump, virtual perinatal support, and formal faculty mentorship.

MAIN OUTCOMES AND MEASURES: The primary outcome was change in burnout (Stanford Professional Fulfillment Index; score range, 0-10; and the emotional exhaustion and interpersonal disengagement subscales), from enrollment during pregnancy to 24 weeks post partum. Secondary outcomes included changes in professional fulfillment, organizational and personal values alignment, relationship strain, career dissatisfaction, and sleep-related impairment. Mixed-effects models analyzed outcomes. Effect sizes were standardized using the Cohen d (0.2: small; 0.5: medium; 0.8: large).

RESULTS: Of 156 randomized participants, 143 were included in the primary analysis (median age, 32 [IQR, 31-34] years; 71 in the parental support package group and 72 in the usual support group). From enrollment during pregnancy to 24 weeks post partum, mean burnout scores increased from 2.96 to 3.03 in the parental support package group and from 3.13 to 3.79 in the usual support group (adjusted between-group difference in change, -0.58; 95% CI, -1.10 to -0.07; P = .03; d = 0.65). Differences were driven by interpersonal disengagement (adjusted between-group difference in change, -0.70; 95% CI, -1.24 to -0.15; P = .01; d = 0.57). Emotional exhaustion scores were not statistically different between groups.

CONCLUSIONS AND RELEVANCE: Among childbearing physicians in training, a parental support package significantly mitigated postpartum burnout.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06014892.

PMID:42126852 | DOI:10.1001/jama.2026.5663

JAMA Psychiatry. 2026 May 13. doi: 10.1001/jamapsychiatry.2026.0668. Online ahead of print.

ABSTRACT

IMPORTANCE: Digital interventions are increasingly promoted as scalable options for reducing the treatment gap in eating disorders, with the evidence base expanding in recent years to include new populations, delivery formats, and therapeutic approaches. A comprehensive, up-to-date synthesis is needed to clarify the current evidence for digital treatment delivery formats in eating disorders.

OBJECTIVE: To evaluate the association of digital interventions for eating disorders with core and transdiagnostic symptom outcomes in the acute and longer-term phases.

DATA SOURCES: MEDLINE, PsycINFO, Web of Science, and Scopus were searched (October 2025) using terms related to eating disorder, digital health, and randomized clinical trials.

STUDY SELECTION: Randomized clinical trials evaluating a digital intervention for threshold or subthreshold eating disorders were eligible. Interventions had to be delivered via digital technologies (eg, websites, applications, chatbots), with or without support, and compared against a control.

DATA EXTRACTION AND SYNTHESIS: Two reviewers extracted data. Risk of bias was assessed using 4 Cochrane risk of bias criteria. Meta-analyses were conducted using random-effects models, calculating Hedges g for continuous outcomes and odds ratios for symptom abstinence.

MAIN OUTCOMES AND MEASURES: Primary outcomes included core eating disorder symptoms (global eating disorder psychopathology, binge eating frequency, compensatory behaviors, abstinence, and symptom-specific subscales). Secondary outcomes included comorbid mental health symptoms (depression, anxiety, general distress) and general well-being (quality of life, clinical impairment, self-esteem).

RESULTS: A total of 36 trials were included. At posttreatment assessment, digital interventions compared with controls produced significant improvements in primary eating disorder psychopathology (Hedges g = 0.49; 95% CI, 0.38-0.60) and objective binge eating (Hedges g = 0.37; 95% CI, 0.24-0.51) outcomes, as well as other symptom-specific and comorbid mental health outcomes. Effect sizes largely remained significant when adjusting for various sources of biases. Significant benefits were mostly observed across specific clinical populations (eg, bulimia nervosa, binge-eating disorder). Effect sizes were largest for trials that used a waiting list relative to other controls. At follow-up, digital interventions produced weaker but statistically significant sustained improvements for 7 of 9 outcomes.

CONCLUSIONS AND RELEVANCE: In this study, digital interventions were associated with consistent and durable benefits across numerous symptom-specific and transdiagnostic outcomes. These results highlight their potential to expand access to evidence-based support and to inform future clinical implementation efforts.

PMID:42126840 | DOI:10.1001/jamapsychiatry.2026.0668

Int J Nurs Knowl. 2026 May 13:20473087261443274. doi: 10.1177/20473087261443274. Online ahead of print.

ABSTRACT

ObjectiveTo analyze the effectiveness of a virtual educational intervention on care performance and knowledge of family caregivers of older adults with stroke sequels, when compared with usual guidance.MethodsA randomized pragmatic trial was carried out with 58 family caregivers of older adults with stroke sequels, randomized to the Intervention Group and Management Group. For Intervention Group a massive, open, online course was made available to equip caregivers with the necessary tools to assist older adults in activities of daily living after discharge. Moreover, telecommunication consultations were held on the seventh, thirtieth, sixtieth and eightieth days to check the course progress and possible difficulties. The course and telephone calls were made by research nurses. Caregiver assessment was carried out close to hospital discharge, before the intervention, and 90 days later, using three indicators of the outcome “Caregiver Performance: Direct Care” and six indicators of the outcome “Knowledge: Stroke Management” of the Nursing Outcomes Classification.ResultsA significant improvement was observed in intragroup assessment in Intervention Group for the indicator “Assists with care recipient’s activities of daily living needs” (p < 0.001) of the outcome “Caregiver Performance: Direct Care” and for the indicator “Causes and contributing factors” (p = 0.021) of the outcome “Knowledge: Stroke Management”. The indicator “Strategies to maintain skin integrity” of the outcome “Knowledge: Stroke Management” showed statistical significance in intergroup assessment, with better results for Control Group (p = 0.040), in addition to a significant improvement in intragroup assessment for Intervention Group (p = 0.008).ConclusionsThe intervention was effective for Intervention Group members, improving performance and knowledge about care for older adults when comparing baseline and final assessments.Implications for PracticeThe use of a massive, open, online course and telephone monitoring improves outcomes in care for older adults after discharge, which reflects the importance of nurses’ educational. Registered in Clinical Trials (NCT05553340).DescriptorsStroke; Family Caregiver; Educational Technology; Standardized Nursing Terminology; Geriatric Nursing; Transition from Hospital to Home.

PMID:42126820 | DOI:10.1177/20473087261443274

Oncol Ther. 2026 May 13. doi: 10.1007/s40487-026-00438-7. Online ahead of print.

ABSTRACT

INTRODUCTION: Although the rising worldwide incidence of thyroid cancer (TC) has been largely attributed to changes in diagnostic means, the full spectrum of contributing factors remains unknown. We present a comprehensive registry-based study evaluating the impact of occupational background on the risk of TC in the Nordic countries.

METHODS: Data were from the Nordic Occupational Cancer (NOCCA) study from the Nordic countries from 1961 to 2005. Standardized incidence ratio (SIR) of TC in each occupational category was calculated using national incidence rates as reference.

RESULTS: The NOCCA cohort includes 14.9 million people (7.5 million women (50.3%), 7.4 million men (49.7%)). In total, 23,241 TCs were recorded: 16,758 (71.9%) in women and 6483 in men. Increased SIRs were observed in female farmers (SIR 1.19; 95% CI 1.07-1.30) and male fishermen (1.32;1.06-1.62), military personnel (1.29; 0.99-1.66), and clerical workers (1.19; 1.05-1.35).

CONCLUSION: Our results suggest an association between certain occupational backgrounds and TC. These findings may help elucidate new risk factors for TC to enable targeted diagnosis and surveillance of individuals most at risk.

PMID:42126815 | DOI:10.1007/s40487-026-00438-7

Updates Surg. 2026 May 13. doi: 10.1007/s13304-026-02670-2. Online ahead of print.

ABSTRACT

The development of incisional hernias (IH) is an uncommon but complex outcome following pancreatic surgery, especially through the open approaches. The etiology of this complication is multifactorial and can be related to the patient and to the surgical technique. We aimed to perform a systematic review and meta-analysis assessing the risk factors for development of IH following pancreatic surgery. Pubmed, Cochrane, and EMBASE databases were systematically searched from inception to September 2024. Observational studies and randomized controlled trials assessing patients > 18 years old undergoing pancreatic surgery and reporting data on incidence and risk factors for IH were selected. Outcomes were mean age, mean body mass index (BMI), diabetes mellitus, female and male gender, active smoking, and surgical site infections (SSI). We used RStudio for statistical analysis. 686 records were reviewed, and 7 observational retrospective studies were included, totaling 3,391 patients. The incidence of IH in the pooled analysis was 368 (10.8%), and after performing a proportional meta-analysis, we found that 12.5 per 100 (95% CI 7.1, 20.9) patients undergoing pancreatic surgery develop IH. Our pooled analysis found that older patients (MD 2.7 years; 95% CI 0.5, 4.8; p = 0.014) and patients with higher BMI (MD 1.8; 95% CI 0.9, 2.7; p < 0.001) present higher risk of developing IH. Female and male gender, active smoking, diabetes mellitus, and SSI were not significant risk factors for IH after pancreatic surgery. Our study showed that patients with older age and higher weight present a significantly higher risk of developing IH after pancreatic surgery. Considering pancreatic surgery is frequently carried out in emergent conditions, sometimes due to malignant causes, the preoperative optimization to reduce weight before surgery is not always a possible alternative. On the other hand, surgeons must consider the possibility of optimizing the patient in terms of weight loss if feasible, to reduce morbidity after the procedure.

PMID:42126783 | DOI:10.1007/s13304-026-02670-2

J Thromb Thrombolysis. 2026 May 13. doi: 10.1007/s11239-026-03306-3. Online ahead of print.

ABSTRACT

Early neurological deterioration (END) is a frequent and serious complication after intravenous thrombolysis in acute ischemic stroke (AIS), yet the clinical relevance of thrombotic molecular markers related to coagulation, fibrinolysis, and endothelial dysfunction remains incompletely understood. In this retrospective cohort study, 91 patients with AIS treated with intravenous thrombolysis were included between November 2022 and February 2025. Plasma levels of thrombin-antithrombin complex (TAT), plasmin inhibitor-plasmin complex (PIC), thrombomodulin (TM), and tissue-type plasminogen activator-plasminogen activator inhibitor-1 complex (t-PAIC) were measured before thrombolysis and at 1, 6, and 24 h thereafter. Stroke etiology was classified according to the Trial of Org 10,172 in Acute Stroke Treatment criteria into large artery atherosclerosis (LAA) and small vessel disease (SVD) subtypes, and patients were further categorized into END and non-END groups. Patients with LAA exhibited significantly higher plasma TAT levels at all time points and a higher incidence of END than those with SVD. Plasma TM levels were higher in the non-END group, with statistically significant differences observed at 24 h after thrombolysis. Multivariable analysis identified higher TM levels at 24 h as an independent protective factor against END, whereas elevated t-PAIC levels were independently associated with increased END risk. Given that END may occur early after thrombolysis, these associations should be interpreted cautiously in terms of temporal sequence. A combined model incorporating TM and t-PAIC demonstrated good discriminative performance for END, with an area under the curve of 0.849. These findings indicate distinct coagulation-endothelial response patterns between AIS subtypes and suggest that TM and t-PAIC may serve as complementary biomarkers associated with END risk following intravenous thrombolysis, although further validation is required.

PMID:42126778 | DOI:10.1007/s11239-026-03306-3

Int Urol Nephrol. 2026 May 13. doi: 10.1007/s11255-026-05196-z. Online ahead of print.

ABSTRACT

PURPOSE: Children with nephrotic syndrome (NS) receive long-term steroid therapy and hence there is an increased risk of bone mineral disease. The objective of the study was to compare the bone mineral density (BMD) in children with NS with that of healthy age-matched controls by using Dual-energy x-ray absorptiometry (DXA) and its correlation with metabolic parameters.

METHODS: A single-center cross-sectional study was conducted to assess the BMD using DXA scan in children aged 5-14 years with NS compared to age and gender-matched healthy children in a tertiary care center. Sixty-two children were included (31 with NS and 31 healthy children as controls), and BMD’s were assessed using a DXA scan. Z-scores were calculated and correlated with biochemical parameters such as serum alkaline phosphatase, calcium, phosphate, parathormone, and vitamin D.

RESULTS: Low BMD was observed in almost 64.5% of children with NS. The mean BMD and height adjusted Z score were lower in children with NS than healthy children. The mean BMD/Z-score in NS and controls were-left femur neck (- 2.18 ± 1.49 vs – 0.461 ± 0.94), right femur neck (- 2.47 ± 1.54 vs – 0.50 ± 0.88), spine (- 1.72 ± 1.16 vs – 0.603 ± 0.80), respectively and these differences were statistically significant (p < 0.05). The correlation between cumulative steroid dose and BMD/Z-score was not statistically significant.

CONCLUSION: Children with NS had lower BMD and serum vitamin D levels than healthy children despite calcium and vitamin D supplementation, and they need periodic evaluation.

PMID:42126769 | DOI:10.1007/s11255-026-05196-z