Tag: pubmed

BMC Med Educ. 2025 Dec 15. doi: 10.1186/s12909-025-08457-0. Online ahead of print.

ABSTRACT

BACKGROUND: Anatomy is a cornerstone of medical education, requiring hands-on and interactive learning for effective comprehension. Armed conflicts, however, pose substantial threats to educational continuity. In 2023, Sudan’s ongoing conflict severely disrupted medical education, particularly anatomy instruction, due to displacement, infrastructure damage, and limited access to practical training.

OBJECTIVES: This study aimed to explore the challenges faced by Sudanese medical students in anatomy education during the 2023 armed conflict, including access to practical sessions, use of online learning platforms, and overall satisfaction with alternative educational methods.

METHODS: A descriptive cross-sectional survey was conducted among 109 first- to third-year medical students from 20 institutions affected by the conflict. Data were collected using an online questionnaire distributed via student networks. Descriptive statistics were generated using SPSS version 29.

RESULTS: The majority of students (70.91%) reported no access to practical anatomy sessions, and 56.36% rated educational infrastructure as poor. Technology integration was limited or absent in 94.55% of cases, and 52.73% faced difficulties accessing online platforms. Although 55.45% of students resorted to self-study and 41.82% used online resources, only 10% were satisfied with online anatomy learning, with students outside Sudan reporting higher satisfaction (p-value 0.001). Qualitative feedback emphasized the need for improved internet access, development of virtual anatomy tools, and establishment of safe practical training centers.

CONCLUSION: The 2023 conflict in Sudan has severely disrupted anatomy education, particularly the availability of practical training. While students demonstrated resilience through self-directed learning, significant investment in digital infrastructure, alternative training solutions, and institutional support is critical to preserving educational quality in conflict-affected regions.

PMID:41398249 | DOI:10.1186/s12909-025-08457-0

BMC Public Health. 2025 Dec 15. doi: 10.1186/s12889-025-25823-1. Online ahead of print.

ABSTRACT

Syphilis remains a significant global public health challenge, with over seven million new adult infections each year despite the availability of effective treatment. Its continued persistence, particularly among high-risk and underserved populations, highlights the need for robust analytical models to understand transmission dynamics and inform targeted control strategies. This study presents a novel sex-structured compartmental model that captures the biological and behavioral complexity of syphilis transmission, incorporating multiple infection stages (primary, secondary, and latent), gender-specific progression, treatment, natural recovery, and reinfection. The population is stratified by sex and disease stage, allowing detailed analysis of transmission pathways between males and females. We established the positivity and boundedness of model solutions and derived the basic reproduction number ([Formula: see text]) using the next-generation matrix approach. Stability analysis showed that the disease-free equilibrium is locally asymptotically stable when ([Formula: see text]). Notably, the model exhibits backward bifurcation, indicating that reducing [Formula: see text] below unity may not guarantee disease elimination. Sensitivity analysis using Latin Hypercube Sampling and Partial Rank Correlation Coefficients identified transmission probabilities as the most influential parameters sustaining infection, while treatment and recovery rates substantially reduced transmission. Numerical simulations demonstrated that integrated control strategies combining early diagnosis, treatment coverage above 85%, partner notification, and behavioral interventions can reduce syphilis prevalence by up to 80%. The study presents a comprehensive and biologically realistic modeling framework that enhances understanding of syphilis dynamics. The findings provide actionable insights for public health policy, emphasizing that multifaceted, gender-inclusive interventions are essential for achieving sustained control and eventual elimination of syphilis.

PMID:41398247 | DOI:10.1186/s12889-025-25823-1

BMC Public Health. 2025 Dec 15;25(1):4250. doi: 10.1186/s12889-025-25376-3.

ABSTRACT

BACKGROUND: Smoking is the largest behavioral risk factor for loss of healthy life years. Many smokers intend and try to quit, but have trouble realizing their behavioral health goals. When workplace cessation-support is accompanied by incentives, this can increase its effectiveness. Based on principles from behavioral economics and psychology, regret lotteries have supported the realization of other health behaviors. Regret lotteries capitalize regret aversion by always informing winners at the deadline, but withholding prizes if they smoked. This study builds on previous applications of regret lotteries to test its potential, using a novel combination of incentives, the workplace as a context and smoking as the target behavior.

METHODS: We compared a workplace group cessation training (control arm) to the same training plus regret lotteries (intervention arm). To test its effect on smoking cessation, we performed a cluster randomized trial with 13 organizations and 111 participants, followed for 52 weeks. Participants in the intervention arm additionally participated in 13 weekly lotteries, followed by a long-term lottery after 26 weeks. In each lottery, winners were drawn from all participants in a group. Winners were promised to always learn the outcome of the lotteries. However, the winners could only claim their prize if they did not smoke. The primary outcome of interest was continuous smoking abstinence at 52 weeks from the quit date, self-reported and biochemically validated with a carbon monoxide measurement and a cut-off point of ≤ 9 parts per million. A multi-level logistic regression analysis was performed to estimate the treatment effects after 52 weeks, while accounting for the clustered data pattern within organizations. We adjusted for Fagerström nicotine dependence score, education level, income, age and gender. Secondary outcomes were abstinence at weeks 13 and 26 after the quit-date.

RESULTS: At the 52-week primary outcome point of this trial, in the control arm, 23.9% of participants were continuously abstinent opposed to 43.2% in the intervention arm (OR = 3.25; 95% CI, 0.99-10.70). Thirteen weeks after the quit date, in the control arm, 35.8% of participants were continuously abstinent opposed to 68.2% in the intervention arm (OR = 3.66; 95% CI, 1.47-9.16). After 26 weeks, in the control arm, 25.4% of participants were continuously abstinent opposed to 54.6% in the intervention arm (OR = 3.24; 95% CI, 1.27-8.22).

CONCLUSIONS: Although differences were only statistically significant up to 26 weeks, we found meaningful and practically relevant increases in smoking cessation due to the lottery intervention at the main outcome point. The intervention design was rooted in behavioral economics and builds on previous successful applications. Therefore, the results show enough potential to theorize and further apply this method in a field setting, that can benefit from the theoretical, methodological and practical lessons learned in this trial.

TRIAL REGISTRATION: The trial protocol and materials were reviewed and approved by the Radboud University Ethical Review Board (ECSW-2019-114). The study was registered in the Dutch Trial Register (trial registration number: NTR NL84632, 17 March 2020) and lottery drawings were performed by an independent notary.

PMID:41398243 | DOI:10.1186/s12889-025-25376-3

J Exp Psychol Hum Percept Perform. 2025 Dec 15. doi: 10.1037/xhp0001396. Online ahead of print.

ABSTRACT

Previous studies have demonstrated that attentional selection is biased toward locations likely to contain a target and away from those likely to contain a distractor. These biases are thought to arise from statistical learning, which adjusts weights within a spatial priority map to optimize attentional selection. While prior work has shown statistical learning based on across-trial probabilities, it remains unclear whether individuals can learn associations between distractor and target locations within a given trial. To investigate this, two experiments employed the additional singleton paradigm, in which, sometimes, the location of the distractor predicted the location of the target. Results from Experiment 1 revealed that participants responded faster when the distractor appeared at a location predictive of the target, suggesting successful learning of the within-trial association. Experiment 2, which incorporated eye-tracking, showed that this benefit was not because of proactive suppression, but instead driven by faster disengagement from the distractor, as reflected in reduced dwell times. These findings demonstrate a novel form of statistical learning based on within-trial spatial associations. They also indicate that the spatial priority map can be dynamically updated following attentional selection, a process potentially reinforced by the execution of a motor response. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

PMID:41396642 | DOI:10.1037/xhp0001396

Stat Methods Med Res. 2025 Dec 15:9622802251404064. doi: 10.1177/09622802251404064. Online ahead of print.

ABSTRACT

As routinely collected longitudinal data becomes more available in many settings, policy makers are increasingly interested in the effect of time-varying treatments (sustained treatment strategies). In settings such as this, many commonly used statistical approaches for estimating treatment effects, such as g-methods, often adopt the ‘no unmeasured confounding’ assumption. Instrumental variable (IV) methods aim to reduce biases due to unmeasured confounding, but have received limited attention in settings with time-varying treatments. This paper extends and critically evaluates a commonly used IV estimating approach, Two Stage Least Squares (2SLS), for evaluating time-varying treatments. Using a simulation study, we found that, unlike standard 2SLS, the extended 2SLS performs relatively well across a wide range of circumstances, including certain model misspecifications. We illustrate the methods in an evaluation of treatment intensification for Type-2 Diabetes Mellitus, exploring the exogeneity in prescribing preferences to operationalise a time-varying instrument.

PMID:41396640 | DOI:10.1177/09622802251404064

Health Psychol. 2026 Jan;45(1):14-24. doi: 10.1037/hea0001504.

ABSTRACT

OBJECTIVE: Transgender and gender diverse (TGD) youth have significantly worse mental health compared to cisgender youth because of the influence of gender minority stressors in society and consequent symptoms of gender dysphoria. Studies find that some TGD youth experience chronic pain, but research is lacking and the relationship is not well understood. The present study aims to better understand the relationship between gender and pain among TGD youth using mixed methods.

METHOD: In total, 16 adolescents (Mage = 16.2 years; 37.5% transgender male) aged 13-18 with chronic pain and eight caregivers were recruited from pain, adolescent medicine, and gender clinics and completed self-report measures of pain burden, functional disability, gender minority stressors, and caregiver support. Subsequently, 12 adolescents and five caregivers completed focus groups discussing the relationship between gender and pain. Descriptive statistics were used for quantitative data and qualitative descriptive analysis for focus group data.

RESULTS: Adolescents reported moderate levels of pain burden and functional disability, high levels of gender minority stress, and high levels of caregiver support. Two core themes emerged from focus group discussions: the influence of (a) one’s gender experience and (b) the overlap between gender and pain experiences.

CONCLUSIONS: The findings indicate a link between gender and pain experiences through factors related to gender minority stress, gender affirmation, social support, and gender dysphoria. The results provide support to existing research showing that TGD youth identify gender minority stressors as contributing to their challenges managing their health and pain. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

PMID:41396627 | DOI:10.1037/hea0001504

JAMA Netw Open. 2025 Dec 1;8(12):e2548036. doi: 10.1001/jamanetworkopen.2025.48036.

ABSTRACT

IMPORTANCE: A better understanding of how health-related social needs (HRSNs) are associated with health care utilization may help health systems prioritize efforts to address HRSNs.

OBJECTIVES: To examine the association of HRSNs with inpatient (IP) and emergency department (ED) utilization and whether resolution of HRSNs is associated with a reduction in utilization.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included 166 682 Medicare and Medicaid recipients in a single health system who were screened for HRSNs under the Accountable Health Communities (AHC) program from June 5, 2018, to January 31, 2022. A follow-up sample included the subset of patients with multiple screenings in the study period. Statistical analysis was performed from June 2024 to September 2025.

EXPOSURES: Health-related social needs assessed under the AHC program included housing stability, housing quality, food security, transportation, utilities, and interpersonal safety. Measures included the presence of individual HRSNs, number of needs, and resolution of need at follow-up.

MAIN OUTCOMES AND MEASURES: IP admissions and ED visits were ascertained for 6 months before baseline screening and 6 months after follow-up. Models assessed the association of baseline HRSNs and IP and ED admissions in the 6 months prior to screening, and resolution of HRSNs with IP and ED admissions in the 6 months after follow-up. Models were mutually adjusted for HRSNs as well as demographic characteristics and comorbidities.

RESULTS: There were 166 682 patients (43.4% aged ≥65 years; 60.3% women) with baseline screening in the sample. All 6 baseline HRSNs were associated with ED use after adjustment for all covariates: 5 with higher odds of ED visits and 1 (housing quality) with lower odds of ED use; point estimates were largest for housing stability (odds ratio [OR], 1.25; 95% CI, 1.18-1.33) and transportation (OR, 1.31; 95% CI, 1.25-1.38). Emergency department visits occurred for 26.9% of patients with housing stability needs and 25.6% of those with transportation needs. After adjustment for other HRSNs, demographic characteristics, and health conditions, only 2 HRSNs retained an association with an increase in IP admissions: housing stability (OR, 1.34; 95% CI, 1.23-1.47) and transportation (OR, 1.16; 95% CI, 1.08-1.24). In the subsample with follow-up screening (n = 15 139), resolution of HRSNs was not associated with utilization after adjustment for other HRSNs, demographic characteristics, and comorbidities.

CONCLUSIONS AND RELEVANCE: In this cohort study, most HRSNs were associated with ED visits, with strongest associations for housing instability and transportation. Associations were not present for adjusted models for resolution of HRSNs. Further research on the fluctuation of individual HRSNs over time is warranted to better understand if resolution of needs is associated with reduced health care utilization.

PMID:41396605 | DOI:10.1001/jamanetworkopen.2025.48036

JAMA Netw Open. 2025 Dec 1;8(12):e2548060. doi: 10.1001/jamanetworkopen.2025.48060.

ABSTRACT

IMPORTANCE: The choice of induction agent during rapid sequence intubation (RSI) of critically ill adults may affect clinical outcomes. Although ketamine and etomidate are frequently used for RSI, their comparative effectiveness remains controversial.

OBJECTIVE: To compare the safety of etomidate vs ketamine for emergency RSI in critically ill adults.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used a target trial emulation with observational data collected between March 1, 2022, and April 30, 2024, from 18 emergency departments across Brazil, with data from the Brazilian Airway Registry Cooperation. Adults who underwent RSI and received either etomidate or ketamine as a sole hypnotic agent were included; those with preintubation cardiac arrest or immediate postintubation transfer were excluded.

EXPOSURE: Administration of etomidate or ketamine as the induction agent for RSI.

MAIN OUTCOMES AND MEASURES: The primary outcome was 28-day in-hospital mortality. Secondary outcomes included 7-day in-hospital mortality, first-attempt intubation success, and major adverse events (new hemodynamic instability, severe hypoxemia, and cardiac arrest) within 30 minutes after intubation. Inverse probability of treatment weighting was used to adjust for confounding. Risk ratios (RRs) and risk differences (RDs) with 95% CIs were used to compare outcomes between groups.

RESULTS: Among 1810 patients (median age, 64 years [IQR, 50-74 years]; 1048 men [57.9%]), 514 received ketamine and 1296 received etomidate. The median shock index was higher in the ketamine group than the etomidate group (0.81 [IQR, 0.65-1.01] vs 0.76 [IQR, 0.59-0.99]), and preintubation vasopressor use was more common in the ketamine group than the etomidate group (191 of 514 [37.2%] vs 391 of 1296 [30.2%]). Weighted 28-day mortality was higher with etomidate than ketamine (60.5% [95% CI, 57.2%-63.8%] vs 54.4% [95% CI, 45.0%-63.9%]; RR, 1.14 [95% CI, 1.03-1.27]; RD, 7.6% [95% CI, 2.0%-13.3%]). Seven-day mortality was also higher with etomidate than ketamine (35.2% [95% CI, 32.0%-38.3%] vs 30.1% [95% CI, 23.5%-36.7%]; RR, 1.19 [95% CI, 1.04-1.35]). New hemodynamic instability within 30 minutes after intubation was more frequent with ketamine (24.2% [95% CI, 20.4%-28.0%] vs 18.9% [95% CI, 16.7%-21.0%]; RR, 0.78 [0.64-0.95]). There were no statistically significant differences in the other secondary outcomes.

CONCLUSIONS AND RELEVANCE: In this cohort study of critically ill adults undergoing RSI, etomidate use was associated with higher in-hospital mortality at 7 and 28 days compared with ketamine. These findings highlight the need for definitive randomized clinical trials to compare both agents.

PMID:41396604 | DOI:10.1001/jamanetworkopen.2025.48060

JAMA Netw Open. 2025 Dec 1;8(12):e2548869. doi: 10.1001/jamanetworkopen.2025.48869.

ABSTRACT

IMPORTANCE: The potential utility of real-time digital therapeutics that identify impending behavioral outbursts to proactively apply evidence-based interventions for managing children with disruptive behavior disorder has not been tested.

OBJECTIVES: To evaluate feasibility and adherence of a digitally augmented, real-time, proactive behavioral intervention (smartwatch) for children with disruptive behaviors.

DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial was conducted between March 1, 2022, and December 31, 2023, at Mayo Clinic in Rochester, Minnesota. The study enrolled children aged 3 to 7 years with externalizing behavior problems rated above the clinically significant range (I score ≥120; T score ≥60) on the Eyberg Child Behavior Inventory (ECBI).

INTERVENTIONS: Twelve weekly sessions of parent-child interaction therapy (PCIT) (treatment as usual [TAU] arm) vs artificial intelligence (AI)-enhanced PCIT augmented with real-time behavioral outburst alerts (PCIT-AI arm).

MAIN OUTCOMES AND MEASURES: The primary outcome was achieving the a priori feasibility benchmark set at greater than 70% for both completion of PCIT sessions and daily smartwatch wear. Parental reaction time to behavior prompts was measured in seconds. Secondary outcomes were percentage changes in ECBI and Pediatric Sleep Questionnaire scores. Behavioral outburst duration was examined based on parental logs of start and end times of observed tantrums using a smartphone application.

RESULT: This study enrolled 50 children (median [IQR] age, 5.0 [4.0-6.0] years; 34 [68%] male and 16 [32%] female; 28 randomized to the PCIT-AI arm and 22 to the PCIT-TAU arm). Of these children, 37 (74%; 21 in the PCIT-AI arm and 16 in the PCIT-TAU arm) completed PCIT, with children wearing the watch a median (IQR) 75.7% (67.8%-82.9%) of the time, thus achieving the feasibility benchmark (primary outcome). Median (IQR) response time to behavior prompts in the PCIT-AI arm was 3.65 (2.07-7.08) seconds. Assessing between-group differences, there was no statistically significantly greater numerical improvement in ECBI-intensity percentage change (13.86%; 95% CI, -1.41% to 29.14%), ECBI-problem percentage change subscale scores (38.59%; 95% CI, -1.22% to 78.40%), or absolute change in Pediatric Sleep Questionnaire scores (-0.16; 95% CI, -1.85 to 1.53) with the PCIT-AI arm than with the PCIT-TAU arm. Children in the PCIT-AI arm had significantly shorter mean (SD) tantrum durations (10.4 [20.8] minutes vs 22.1 [30.0] minutes; P < .001) and lower odds of tantrums lasting for 15 minutes or more (odds ratio, 3.66; 95% CI, 2.72-4.95).

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, both recruitment and technology feasibility benchmarks were achieved. The findings inform the design of fully powered efficacy study of wearable, digitally augmented PCIT for children with disruptive behaviors.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05077722.

PMID:41396603 | DOI:10.1001/jamanetworkopen.2025.48869

JAMA Netw Open. 2025 Dec 1;8(12):e2549730. doi: 10.1001/jamanetworkopen.2025.49730.

ABSTRACT

IMPORTANCE: There is clear evidence that deleterious germline variants in CHEK2 increase risk for breast and prostate cancers; there is limited or conflicting evidence for other cancers.

OBJECTIVE: To quantify the prevalence of as well as cancer risk and survival associated with CHEK2 germline pathogenic and likely pathogenic variants using genomic ascertainment.

DESIGN, SETTING, AND PARTICIPANTS: This case-control study used 2 electronic health record-linked and exome-sequenced biobanks: UK Biobank (n = 469 765) and Geisinger MyCode (adults only; n = 167 050). Variants were classified according to American College of Medical Genetics and Genomics and the Association for Molecular Pathology criteria. Cases were defined as individuals with heterozygous CHEK2, harboring pathogenic or likely pathogenic variants; controls as individuals with a benign or likely benign CHEK2 variation or wildtype CHEK2. Cancer registry (MyCode since approximately 1943; UK Biobank since approximately 1970) and demographic data were retrieved; to adjust for relatedness, association analysis was performed with SAIGE-GENE+ with Bonferroni correction.

MAIN OUTCOMES AND MEASURES: Prevalence of as well as cancer risk and survival in adults with CHEK2 germline variants.

RESULTS: Of 469 765 individuals in the UK Biobank, there were 3232 case participants (mean [SD] age, 70.8 [8.0] years; 3139 [97.1%] White; 1744 [54.0%] women); of 167 050 individuals with MyCode, there were 3153 case participants (mean [SD] age, 60.5 [17.8] years; 3123 [98.8%] White; 1935 [61.5%] women). In case participants in both MyCode and UKBB, there was a significant excess risk of all cancers (odds ratio [OR], 1.33 [95% CI, 1.18-1.49]; OR, 1.41 [95% CI, 1.26-1.59], respectively), breast (OR, 1.54 [95% CI, 1.18-2.00]; OR, 1.84 [95% CI, 1.49-2.27], respectively), prostate (OR, 1.62 [95% CI, 1.27-2.07]; OR, 1.78 [95% CI, 1.48-2.16], respectively), kidney (OR, 1.58 [95% CI, 1.03-2.41]; OR, 1.84 [95% CI, 1.22-2.77], respectively), and bladder (OR, 1.50 [95% CI, 1.01-2.23]; OR, 1.64 [95% CI, 1.17-2.31], respectively) cancers as well as lymphoid leukemia (OR, 2.08 [95% CI, 1.17-3.69]; OR, 2.21 [95% CI, 1.19-4.08], respectively). Compared with control participants, time to cancer in case participants was significantly shorter in both cohorts; no significant difference was observed between the age-dependent penetrance of truncating and missense variants for cancer in either cohort. Overall survival was significantly decreased in case participants in UK Biobank; however, the primary consequence was seen after 75 years. There was no statistical difference in survival in MyCode. There were no differences in survival between case participants with cancer and control participants with cancer.

CONCLUSIONS AND RELEVANCE: In this case-control study of genomic ascertainment of individuals with heterozygous CHEK2 pathogenic or likely pathogenic variants in 2 population-scale cohorts, there was a significant excess risk of breast, prostate, kidney, bladder, and lymphoid leukemia cancer. The conferred excess mortality and cancer risk was low (ORs <2). This has clinical implications for individuals ascertained this way (vs with a family history of cancer).

PMID:41396600 | DOI:10.1001/jamanetworkopen.2025.49730