Tag: pubmed

Schizophr Bull. 2026 Apr 10;52(3):sbag060. doi: 10.1093/schbul/sbag060.

ABSTRACT

STUDY DESIGN: Improving Thinking through Everyday Self-Assessment Training combines 16 weeks of daily mobile task-based training in IA with weekly individual coaching in applying IA to everyday behaviors. Sixty individuals with diagnoses of schizophrenia or schizoaffective disorder participated in an open trial of iTEST with assessments at baseline, 8, 12, and 16 weeks. Primary outcomes included IA on 2 trained tasks (mobile verbal learning and facial emotion recognition tests) and 3 untrained tasks (verbal memory, emotion recognition, and executive functioning).

STUDY RESULTS: Improving Thinking through Everyday Self-Assessment Training showed strong feasibility, retaining 86.7% of participants, and strong adherence with an average daily mobile-training completion rate of 87%. In linear-mixed models with intent-to-treat data, statistically significant IA improvements were observed over time in both trained tasks and in 2 of the 3 untrained tasks (Cohen’s d’s = 0.5-1.28). Significant improvements were also observed in secondary outcomes of real-world function, positive symptoms, and depression.

CONCLUSIONS: This project provides the first data, to our knowledge, to demonstrate that IA in schizophrenia can be improved. Improving Thinking through Everyday Self-Assessment Training also represents one of just a few blended digital health interventions, including remote cognitive training, and may therefore serve as a blueprint for future intervention development.

PMID:42104799 | DOI:10.1093/schbul/sbag060

Schizophr Bull. 2026 Apr 10;52(3):sbag019. doi: 10.1093/schbul/sbag019.

ABSTRACT

BACKGROUND AND HYPOTHESIS: Schizophrenia treatment in young people involves complex pharmacological decisions, yet sex-specific prescribing patterns and pandemic impacts remain poorly understood. We hypothesized that prescribing trends would differ systematically by sex and show pandemic-related disruptions.

STUDY DESIGN: This population-based cohort study analyzed 8092 individuals aged 15-29 years with schizophrenia-spectrum disorders in Hong Kong (2011-2023) using electronic health records from the Hospital Authority system. We examined temporal trends in 11 medication subclasses using generalized least squares models with autoregressive correlation structures, sex differences using interaction terms, and COVID-19 impacts using interrupted time series (ITS) analysis with adjustment for age and comorbidity.

STUDY RESULTS: After covariate adjustment, all medication subclasses increased over time (0.05-3.71 percentage points annually), indicating universal treatment intensification. Males showed steeper increases than females in 5 subclasses after adjustment, with 18 of 21 specific agents increasing significantly more in males. Period-level pandemic comparisons showed minimal effects, but ITS analysis revealed substantial COVID disruptions in 5 medication subclasses namely oral first-generation antipsychotics, injectable second-generation antipsychotics, serotonin and norepinephrine reuptake inhibitor, Z-hypnotics, and benzodiazepines.

CONCLUSIONS: Young people with schizophrenia experienced universal treatment intensification with males receiving more intensive pharmacotherapy after controlling for confounders. The pandemic produced complex sex-specific disruptions masked by aggregate analyses. Whether these prescribing patterns represent appropriate individualization or systematic care variation remains unknown, highlighting the critical need for studies linking prescribing patterns to functional outcomes and quality of life.

PMID:42104796 | DOI:10.1093/schbul/sbag019

Schizophr Bull. 2026 Apr 10;52(3):sbag066. doi: 10.1093/schbul/sbag066.

ABSTRACT

BACKGROUND AND HYPOTHESIS: Cognitive models of schizophrenia-spectrum disorders (SSD) posit dysfunctional beliefs and cognitive biases as maintenance mechanisms of positive and negative symptoms. Although cognitive behavioral therapy (CBT) targets these processes, its effects on mechanism-level outcomes remain unclear. This review examined whether CBT modifies dysfunctional beliefs and cognitive biases in SSD using rigorous randomized evidence.

STUDY DESIGN: PRISMA 2020-compliant systematic review and meta-analysis (PROSPERO registered). Primary analyses were restricted to intention-to-treat (ITT) randomized controlled trials (RCTs) in SSD samples, using random-effects models and between-group post-treatment estimates. Pre-post and nonrandomized studies were analyzed separately as secondary evidence. Subgroup and meta-regression analyses were conducted.

STUDY RESULTS: Thirty-three studies met inclusion criteria. Fourteen ITT RCTs contributed to the primary pooled analysis of dysfunctional beliefs, yielding a small but statistically significant effect favoring CBT (g = 0.154, 95% CI, 0.049-0.259). Effects were strongest for delusional conviction (g = 0.450) and self-related schemas (positive-self g = 0.278; negative-self g = 0.298). Voice-related beliefs did not reach statistical significance. Too few RCTs assessed cognitive biases to support primary pooled analyses; exploratory findings suggested small effects for belief inflexibility and no reliable effect for jumping-to-conclusions. Greater reductions in dysfunctional beliefs were associated with greater improvements in positive symptoms across trials.

CONCLUSIONS: CBT produces small but reliable improvements in dysfunctional beliefs in SSD, although effects vary by domains particularly for delusional conviction and self-schemas, supporting their role as modifiable therapeutic targets and plausible mechanisms of change. Effects on cognitive biases remain limited and understudied.

PMID:42104795 | DOI:10.1093/schbul/sbag066

Schizophr Bull. 2026 Apr 10;52(3):sbag071. doi: 10.1093/schbul/sbag071.

ABSTRACT

BACKGROUND AND HYPOTHESIS: The requirement for hospital admission to initiate clozapine presents a health-systems-related barrier to clozapine prescription and contributes to its underutilization in treatment-resistant schizophrenia (TRS). This study aimed to examine the clinicodemographic characteristics associated with treatment settings for clozapine initiation within a first-episode psychosis (FEP) cohort attending an early intervention in psychosis service.

STUDY DESIGN: Secondary analysis of a retrospective cohort study of 1220 young people presenting with FEP to the Early Psychosis Prevention and Intervention Centre (EPPIC) in Melbourne between 2011 – 2017.

STUDY RESULTS: Ninety-one cases of TRS were identified and included in the analysis, with 70 commencing clozapine, of whom 67 had a commencement setting identified. Over half (n = 36, 53.7%) commenced clozapine in the community. When compared to the hospital initiation group, the community initiation group were less likely to have had a hospital admission at baseline (odds ratio (OR) 0.26, 95%CI, 0.09-0.87) or an involuntary admission during the 2 year episode of care with EPPIC (OR 0.25, 95%CI, 0.09-0.70). The community initiated group had presented with less severe delusion scores on short form Scale for Assessment of Positive Symptoms at baseline (mean 3.08 vs 3.94, P = .031). First generation migrants were less likely to initiate clozapine in the community (OR 0.29, 95%CI, 0.09-0.97). The community initiation group also had reduced odds of clozapine discontinuation until discharge from EPPIC (OR 0.22, 95%CI, 0.06-0.76).

CONCLUSION: Community initiation provides an alternative route to clozapine treatment and may be associated with a reduced rate of clozapine discontinuation.

PMID:42104793 | DOI:10.1093/schbul/sbag071

Health Serv Res. 2026 Jun;61(3):e70126. doi: 10.1111/1475-6773.70126.

ABSTRACT

OBJECTIVE: To examine rural-urban disparities in telehealth utilization during the post-pandemic period and assess whether these disparities persist after adjusting for individual-level characteristics.

STUDY SETTING AND DESIGN: We used multivariable logistic regression and propensity score matching to estimate differences in telehealth use by rurality and examined self-reported reasons for non-use.

DATA SOURCES AND ANALYTIC SAMPLE: We analyzed 2022 and 2024 Health Information National Trends Survey (HINTS) data, a nationally representative survey of noninstitutionalized US adults. The analytic sample included 11,106 respondents after excluding missing observations.

PRINCIPAL FINDINGS: Overall, 38.7% of adults reported telehealth use in the past 12 months. After adjusting for covariates, rural residents were significantly less likely to use telehealth than urban core residents; remote rural residence was associated with a 10-percentage point lower probability (95% CI, -16.2 to -2.8; p < 0.01). Propensity score analyses yielded similar results (-7.7% points; 95% CI, -16.2 to -2.8; p < 0.01). Among non-users, rural respondents were more likely to report not being offered telehealth.

CONCLUSIONS: We observed significant rural-urban disparities in telehealth use in the post-pandemic period. Rural non-users were more likely to report not being offered telehealth, indicating delivery-side barriers.

PMID:42104788 | DOI:10.1111/1475-6773.70126

Gynecol Endocrinol. 2026 Dec 31;42(1):2670809. doi: 10.1080/09513590.2026.2670809. Epub 2026 May 9.

ABSTRACT

BACKGROUND: Female infertility is multifactorial, with adiposity and regional fat distribution hypothesized as contributors, though evidence using detailed fat measures is limited. This study aims to examine the association between fat distribution indicators and female infertility in a nationally representative sample.

METHODS: This retrospective cross-sectional study analyzed NHANES 2013-2018 data from 2,531 women aged 20-45. Infertility was defined by self-reported difficulty conceiving ≥ 12 months or seeking fertility care. Exposures included body mass index (BMI) and DXA-based measures: total percent fat (TPF), android percent fat (APF), gynoid percent fat (GPF), android fat/gynoid fat ratio (AGR), visceral fat/total fat (VPF), subcutaneous fat/total fat (SPF), and visceral fat/subcutaneous fat ratio (VSR). Multivariable logistic regression was used to assess associations, and sensitivity analyses were performed to evaluate robustness.

RESULTS: In multivariable-adjusted models, TPF, APF, AGR, and BMI were modestly associated with higher odds of infertility (TPF: OR = 1.02, 95%CI: 1.00-1.05; APF: OR = 1.03, 95%CI: 1.01-1.04; AGR: OR = 1.02, 95%CI: 1.01-1.03; BMI: OR = 1.02, 95%CI: 1.01-1.04). Smooth curve fitting suggested a generally monotonic positive pattern for these associations. Associations were broadly similar across subgroups, although some subgroup interactions were observed.

CONCLUSION: In this analysis, TPF, APF, AGR, and BMI showed modest associations with infertility, which should not be interpreted causally. Although associations were generally consistent across subgroups, subgroup-specific heterogeneity cannot be excluded.

PMID:42104773 | DOI:10.1080/09513590.2026.2670809

Acta Anaesthesiol Scand. 2026 Jul;70(6):e70246. doi: 10.1111/aas.70246.

ABSTRACT

BACKGROUND: Closed reduction of distal radius fractures is painful, and current analgesic strategies may be inadequate. Ultrasound-guided lateral infraclavicular brachial plexus block may offer complete analgesia and muscle relaxation, potentially improving patient comfort and reduction quality. However, benefits and challenges regarding anesthetic agents for this procedure remain unclear.

METHODS: In this randomized, controlled, blinded, noninferiority trial, 63 adults with distal radius fractures requiring closed reduction received a lateral infraclavicular block with either 30 mL of ropivacaine 0.5%, lidocaine 1% with epinephrine, or ropivacaine 0.2%. The primary outcome was block success at 45 min, defined as complete sensory and extensive motor block of the radial, musculocutaneous, ulnar, and median nerves. Noninferiority was assessed using a margin of 20%. Exploratory outcomes included sensory and motor block assessments, time to pain relief, block duration, pain during reduction, patient satisfaction, quality of closed reduction, fracture treatments, and safety.

RESULTS: Ropivacaine 0.2% was statistically inferior to ropivacaine 0.5% in achieving block success at 45 min (risk ratio (RR) 0.63, 97.5% CI 0.40-0.99). Lidocaine 1% with epinephrine did not meet the predefined noninferiority criteria for block success (RR 0.95, 97.5% CI 0.73-1.22) but did provide comparable analgesia with a shorter block duration. Pain scores during reduction were low across all groups, with a significant decrease in pain from baseline. Patient satisfaction was high in all groups. No significant differences were found in the quality of closed reduction, safety, or fracture treatments.

CONCLUSION: Lateral infraclavicular block with ropivacaine 0.2% failed to demonstrate noninferiority for block success and was statistically inferior to ropivacaine 0.5%. Inferiority testing should be interpreted cautiously within the context of a noninferiority design, although the results suggest reduced effectiveness for distal radius fracture reduction. Lidocaine 1% with epinephrine yielded inconclusive results for noninferiority on block success, but provided a shorter block duration without compromising analgesia, patient satisfaction, or quality of reduction.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT06379490 (released April 23, 2024); https://clinicaltrials.gov/study/NCT06379490; EUCT Identifier 2024-510,572-20-00; https://euclinicaltrials.eu/ctis-public/view/2024-510572-20-00.

PMID:42104772 | DOI:10.1111/aas.70246

Cleft Palate Craniofac J. 2026 May 9:10556656261449340. doi: 10.1177/10556656261449340. Online ahead of print.

ABSTRACT

ObjectiveTo study the effect of nutrition care process (NCP) on cleft repair timing.DesignQuasi-experimental design.SettingTertiary care hospital with an operational cleft unit.Participants47 mothers of infants aged 0-6 months with cleft lip and palate who fulfilled the eligibility criteria.InterventionsDuring the baseline visit, anthropometric measurements of the infant were recorded, and World Health Organization (WHO) Z scores were plotted to identify their nutritional status. Nutritional education according to NCP was imparted to the mothers. In subsequent visits, growth of infants was monitored by anthropometry, education was reiterated and errors rectified. Right surgical timing was classified as on time or delayed according to age in months at surgery. Data collected were analyzed in SPSS software.Main Outcome Measure(s)Nutritional status, timely surgical readiness, educational level regarding nutrition, and feeding techniques.ResultsAmong the 47 infants, malnutrition improved from 55.3% mild, 29.8% moderate, and 14.9% severe at the first visit to 66% mild at lip surgery and 70.2% mild at palate surgery, with 68.1% and 70.2% infants respectively achieving timely surgical readiness. Infants with cleft showed consistently lower mean weights than the WHO standards at birth, lip, and palate surgery which was statistically significant (p = .001) indicating persistent growth faltering that was more pronounced among males. Mother’s education level was significantly associated with timely surgery (χ2 = 7.964, p = .047).ConclusionNutrition education effectively assisted infants in attaining the weight necessary for corrective surgery.

PMID:42104755 | DOI:10.1177/10556656261449340

Health Technol Assess. 2026 May;30(32):1-50. doi: 10.3310/GJIC1716.

ABSTRACT

BACKGROUND: Surgical wounds healing by secondary intention occur if a surgical wound is not closed or dehisces following primary closure. Surgical wounds healing by secondary intention are common and adversely affect patients’ quality of life. Treatment is often prolonged, complex and expensive. Negative pressure wound therapy applies a controlled vacuum to the wound and is increasingly used to promote surgical wound healing by secondary intention despite limited rigorous evidence for the clinical and cost-effectiveness of negative pressure wound therapy to augment surgical wound healing by secondary intention.

OBJECTIVE: Assess the clinical and cost-effectiveness of negative pressure wound therapy versus usual care (no negative pressure wound therapy) in treating surgical wounds healing by secondary intention.

DESIGN AND METHODS: A pragmatic, two-arm, parallel-group, randomised controlled superiority trial. Twenty-eight UK NHS Trusts randomised adult patients with a surgical wounds healing by secondary intention to receive negative pressure wound therapy or usual care (no negative pressure wound therapy). The planned sample size was 696 participants. Participants were followed up for 12 months via weekly telephone contact to collect the primary outcome (time to healing: full cover with no scab in days since randomisation) and clinical secondary outcomes: wound healing, surgical site infection, pain, hospital re-admission, current treatment and reasons for treatment change (if applicable), reoperation, amputation, antibiotic use, death. Patient-reported outcomes (pain, health-related quality of life and resource use) were collected by postal questionnaire at 3, 6 and 12 months. Validation of the Bluebelle Wound Healing Questionnaire, a patient-reported measure of surgical site infection, was also undertaken. A cost-effectiveness decision model considering all available evidence, and a within-trial cost-utility analysis, was also undertaken to evaluate the cost-effectiveness of negative pressure wound therapy against usual care. Neither participants nor the investigators were blind to treatment allocation.

RESULTS: Between 15 May 2019 and 13 January 2023, 686 participants were recruited, randomised and included in the analysis (negative pressure wound therapy n = 349; usual care n = 337). Most participants had a single surgical wound healing by secondary intention (n = 622, 90.7%), located on the foot (n = 551, 80.3%) or leg (n = 69, 10.1%) arising following vascular surgery (n = 619, 90.2%). Most participants had comorbidities; diabetes (n = 549, 80.0%), cardiovascular disease (n = 446, 65.0%) and/or peripheral vascular disease (n = 349, 50.9%). Median time to healing was 187 days (negative pressure wound therapy) versus 195 days (usual care), with no evidence that negative pressure wound therapy reduced the time to wound healing compared to usual care (hazard ratio 1.08, 95% CI 0.88 to 1.32; p = 0.47). Odds of re-admission, reoperation, surgical site infection and antibiotic use were slightly higher, and odds of amputation or death slightly lower for negative pressure wound therapy participants. These results were not clinically or statistically significant. Bluebelle Wound Healing Questionnaire, quality of life and wound pain scores were not statistically significantly different at any time point. Serious adverse events were rare (nine negative pressure wound therapy vs. five usual-care participants). Both cost-effectiveness analyses concluded that negative pressure wound therapy generates higher costs and marginally higher quality-adjusted life-years than usual care, although findings were statistically insignificant. The probability of negative pressure wound therapy being cost-effective was under the recommended National Institute for Health and Care Excellence cost-effectiveness thresholds. The Bluebelle Wound Healing Questionnaire was acceptable to participants, had low levels of missing data and demonstrated good levels of sensitivity and specificity in the detection of surgical site infection in surgical wounds healing by secondary intention.

LIMITATIONS: The trial included a high proportion of diabetic participants with foot wounds, which may affect study generalisability. Negative pressure wound therapy use for ‘wound management’, common in certain surgical specialties, was not assessed in this study.

CONCLUSIONS: Negative pressure wound therapy is not clinically or cost-effective in augmenting healing in patients with surgical wounds healing by secondary intention, particularly those with comorbidities.

FUTURE WORK: Evaluation of methods to treat or prevent infection of surgical wounds healing by secondary intention and evaluation of negative pressure wound therapy for ‘wound management’ are recommended.

FUNDING: This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 17/42/94.

PMID:42104753 | DOI:10.3310/GJIC1716

Pharmacoepidemiol Drug Saf. 2026 May;35(5):e70384. doi: 10.1002/pds.70384.

ABSTRACT

PURPOSE: The length of the time window used to assess “current drug use” or “number of medications used” will influence the estimates hereof; however, no consensus exists on the optimal width of such time windows. We aimed to explore how the estimated prevalence of drug use in general, and of polypharmacy in particular, is affected by definitions used.

METHODS: We conducted a drug-utilization study divided into two parts. In the first part, we focused on current drug use. Using population-based registries from Denmark, we identified adults (i.e., individuals aged ≥ 18) during 2020-2022, and among them, current use of different drugs, including those with typically chronic or episodic patterns of use. The second part of the study focused on polypharmacy. We estimated its prevalence, based on different definitions, using population-based registries from Denmark in a cohort of older adults (i.e., individuals aged ≥ 65) in 2022. We also evaluated the accuracy of different criteria for predicting polypharmacy using simulations.

RESULTS: Evaluating current drug use, the proportion of individuals classified as exposed increased with the length of the time window for all drugs, reaching a plateau considering a 120-150-day window for statins, glucose-lowering drugs, and selective serotonin reuptake inhibitors, and a 180-300-day window for opioids, whereas no plateau was reached for non-steroidal anti-inflammatory drugs within 360 days. The prevalence of polypharmacy ranged from 21% (10 different 4th level Anatomical Therapeutic Chemical (ATC) groups in 1 year) to 92% (two different 4th level ATC groups in 1 year) depending on the applied definition. In the simulation, the best criterion for identifying polypharmacy required at least two dispensations during the one-year study period for each of at least five drugs, with sensitivity ranging between 0.93 and 1.0, and specificity between 0.72 and 1.0.

CONCLUSIONS: Time windows up to 120 days are too short to identify baseline drug use in the Danish setting. How polypharmacy is defined significantly influences its estimate, suggesting a need to use multiple definitions in each study.

PMID:42104746 | DOI:10.1002/pds.70384