Tag: pubmed

Beijing Da Xue Xue Bao Yi Xue Ban. 2026 Jun 18;58(3):528-535.

ABSTRACT

OBJECTIVE: To evaluate the genetic nurture effect of parental genotypes on the risk of ischemic stroke (IS) in offspring and to elucidate the parental origin-specific differences in this effect.

METHODS: This study utilized data from the “Family Cohort of Common Chronic Non-communicable Diseases in Rural Areas of Northern China”. A total of 530 core families and sibling pairs were selected, comprising 1 005 offspring. Single nucleotide polymorphisms (SNPs) within the CTNNA gene family (CTNNA1, CTNNA2 and CTNNA3) were detected. Using offspring as the unit of analysis, parental non-transmitted alleles were inferred based on Mendelian inheritance principles. Rigorous quality control was implemented for genotype imputation, ensuring high reliability of the inferred data. Linear mixed-effects models were constructed to estimate the genetic nurture effect of non-transmitted alleles on offspring IS. These models compared differences between genetic nurture effects and individual genetic effects, distinguished between paternal and maternal effects, and calculated the statistic η to assess the relative magnitude of parental effects.

RESULTS: A total of 1 005 offspring from 530 families were included, comprising 308 IS patients (30.6%) with a mean age of 56.3 years. Sixteen independent SNPs associated with IS genetic nurture effects were identified (9 in CTNNA2, 6 in CTNNA3, and 1 in CTNNA1). The effect sizes ranged from -0.282 to 0.480, with rs117741773 (CTNNA2) showing the strongest effect (0.480, 95%CI: 0.278-0.682). Only four of these SNPs exhibited concurrent individual genetic effects, which acted in the opposite direction to the genetic nurture effects. Parent-of-origin specific analysis revealed that 12 SNPs exhibited genetic nurture effects from a single origin: 4 showed exclusively paternal effects (effect size: -0.298 to 0.945; η: 1.21 to 63.83), and 8 showed exclusively maternal effects (effect size: -0.489 to 0.602; η: 0.03 to 0.44).

CONCLUSION: This study provides evidence that multiple IS susceptibility loci within the CTNNA gene family exhibit significant genetic nurture effects. The findings highlight the complex interplay between inherited genetics and the family environment. The heterogeneity of these effects based on parental origin underscores the significant role of parent-specific genetic nurture in the etiology of IS, offering new insights for understanding the missing heritability in stroke genetics.

PMID:42287047

Beijing Da Xue Xue Bao Yi Xue Ban. 2026 Jun 18;58(3):520-527.

ABSTRACT

OBJECTIVE: To investigate the distribution characteristics of myopia among primary and secondary school students in Inner Mongolia Autonomous Region in 2020, and to comprehensively analyze its influencing factors at both school and individual levels, thereby providing scientific evidence for developing targeted myopia prevention and control strategies.

METHODS: A multistage stratified random cluster sampling method was employed to conduct vision examinations and questionnaire surveys among students from fourth grade to senior high school in Inner Mongolia Autonomous Region, collecting information on students’ visual habits, school and family environmental factors. A multilevel regression model was used to analyze the factors influencing myopia detection rates at both school and individual levels.

RESULTS: A total of 130 601 students were included, with a myopia prevalence rate of 68.42%. The prevalence was higher among females (72.75%) than males (64.13%), in urban areas (73.63%) than in suburban counties (66.38%), and overall rates increased with educational level (trend test χ²=4 545.53, P < 0.001). Multilevel analysis revealed that at the individual level, female gender (OR=1.553), higher grade level (junior high OR=2.049, senior high OR=3.061), homework duration ≥1 h after school (≥1 h OR=1.050, ≥2 h OR=1.079), poor close-up vision habits (OR=1.059), prolonged close-up vision activities (0.5 h OR=1.070, ≥1 h OR=1.061), infrequent desk/chair height adjustments based on height (OR=1.006), and parental myopia (one parent OR=1.822, both parents OR=2.412) were risk factors for myopia; while ethnic minority status (Mongolian OR=0.956, other ethnicities OR=0.929), daily outdoor activity exceeding 2 hours (OR=0.986), performing eye exercises (1 session OR=0.891, ≥2 sessions OR=0.920), and adequate sleep (OR=0.925) served as protective factors. At the school level, qualified blackboard reflectance ratio (OR=0.874) and qualified blackboard surface illuminance uniformity (OR=0.973) were associated with reduced myopia risk among students. The model indicated that the included variables collectively explained approximately 31.04% of the variance at the school level.

CONCLUSION: The prevalence of myopia among primary and secondary school students in Inner Mongolia Autonomous Region remains high, with influencing factors distributed across multiple levels including individual and school contexts. Comprehensive prevention strategies are recommended, focusing on female students, older grades, and those with genetic predispositions while intensifying interventions on modifiable factors like outdoor activities and visual habits. Improving classroom lighting environments is also crucial to reduce students’ myopia risk.

PMID:42287046

Beijing Da Xue Xue Bao Yi Xue Ban. 2026 Jun 18;58(3):496-502.

ABSTRACT

OBJECTIVE: To identify joint trajectory patterns of direct and indirect maternal mortality ratios (MMR) at the country level from 2000 to 2021, and to compare phase-specific changes during the millennium development goals (MDG, 2000 to 2015) and the sustainable development goals (SDG, 2015 to 2021) periods, as well as differences in health system and policy environments across trajectory groups.

METHODS: Data on maternal mortality among women aged 15-49 years in 204 countries and territories from 2000 to 2021 were obtained from the Global Burden of Disease (GBD) Study. Direct cause MMR and indirect cause MMR at five time points (2000, 2005, 2010, 2015, and 2021) were jointly analyzed using longitudinal K-means clustering (k=2-6). The optimal number of clusters was determined by the Calinski-Harabasz (CH) index. Based on the clustering results, a piecewise linear mixed effects model with random intercepts was fitted with a knot in 2015 to estimate the baseline intercept in 2000 and period-specific slopes for the MDG and SDG phases. For 2021, health system and policy-related indicators, including antenatal care coverage (≥4 visits, ANC4), proportion of women with a demand for contraception that are using a modern method, cesarean section rate, female human immunodeficiency virus (HIV) prevalence, in facility delivery rate, skilled birth attendance, and an abortion legality index were compared across clusters using the Kruskal-Wallis H test. All tests were two-sided, and P < 0.05 was considered statistically significant.

RESULTS: The CH index peaked at k=3 (CH=342.63), classifying the 204 countries and territories into three joint trajectory clusters: high burden (n= 66), medium burden (n=88), and low burden (n=50). In 2021, direct MMR was 334.6 (95%CI: 282.5- 386.7), 65.6 (95%CI: 50.4-80.7), and 5.4 (95%CI: 3.7-7.0) per 100 000 live births in the high, medium, and low burden clusters, respectively; indirect MMR was 33.6 (95%CI: 27.9-39.2), 18.2 (95%CI: 13.5-22.9), and 0.9 (95%CI: 0.6-1.3) per 100 000 live births, respectively. The piecewise mixed effects model showed significant declines in direct MMR during the MDG period in all clusters (slopes: -0.020, -0.016, and -0.036; P < 0.001), whereas declines slowed and became non-significant during the SDG period (-0.011, 0.011, and -0.006; P > 0.05). For indirect MMR, modest increases were observed during the MDG period in the high and medium burden clusters (0.029 and 0.015; P < 0.05), with no significant change in the low burden cluster (P > 0.05). During the SDG period, indirect MMR increased markedly in the medium burden cluster (slope: 0.121; 95%CI: 0.092-0.151; P < 0.001), while remaining broadly stable in the high and low burden clusters (P > 0.05). Health system and policy indicators differed significantly across the clusters (P < 0.001): the high burden cluster showed lower ANC4 coverage, lower in facility delivery and skilled birth attendance, lower demand for contraception satisfied by modern methods, and higher female HIV prevalence; the medium burden cluster achieved near universal in facility delivery and skilled birth attendance but had a higher cesarean section rate; the low-burden cluster generally showed more favorable indicator profiles and a higher abortion legality index.

CONCLUSION: Distinct joint trajectories of direct and indirect maternal mortality were observed globally from 2000 to 2021. While reductions in direct maternal mortality were substantial during the MDG era, progress broadly slowed and plateaued during the SDG era. Meanwhile, the pronounced rise in indirect maternal mortality in medium-burden countries during the SDG period suggests potential structural risk accumulation even when overall MMR appears stable. Incorporating joint direct-indirect trajectories into routine monitoring may facilitate stage and cluster specific prioritization of maternal health interventions.

PMID:42287043

Beijing Da Xue Xue Bao Yi Xue Ban. 2026 Jun 18;58(3):490-495.

ABSTRACT

OBJECTIVE: To describe the incidence density of intussusception and its distribution characteristics across different ages, genders, and time periods among resident children aged 0-3 years in Jiangsu Province from 2018 to 2023, providing a scientific basis for health administrative departments in the region to formulate prevention and control strategies and measures for intussusception in children aged 0-3 years.

METHODS: A retrospective cohort study was conducted using data from the Jiangsu Regional Health Information Platform (RHIP). Resident children aged 0-3 years born between January 1, 2018, and December 31, 2023, were included. Suspected cases were identified by retrieving the International Statistical Classification of Diseases and Related Health Problems, 10 revision (ICD-10) code “K56.1” and semantically related keywords for “intussusception” from the original text using a regular expression matching algorithm. An incident case was defined as the first occurrence of the disease during the study period. Follow-up person-years were calculated using the exact person-time method. The Poisson distribution was applied to estimate the overall and subgroup incidence densities and their 95% confidence intervals (CI). Poisson regression models were constructed to calculate incidence rate ratio (IRR) and examine the effects of age (in months) and seasonal differences on incidence density.

RESULTS: A birth cohort comprising 2 252 691 children aged 0-3 years was established, accumulating a total follow-up of 5 316 389.55 person-years. During the study period, 2 650 incident cases of intussusception were identified, including 1 600 boys (60.4%) and 1 050 girls (39.6%). The overall incidence density was 49.8 (95%CI: 47.9-51.7) per 100 000 person-years. The incidence density was 57.8 (95%CI: 54.9-60.6) per 100 000 person-years for boys and 41.2 (95%CI: 38.7-43.7) per 100 000 person-years for girls, with a statistically significant difference between the sexes. Seasonal variations were observed, with peaks occurring in summer and winter. The incidence density exhibited a unimodal pattern, peaking at 8 months (98.5 per 100 000 person-years). The median age of onset was 19.2 months [interquartile range (IQR): 11.4-26.6 months].

CONCLUSION: This large retrospective cohort study based on the Jiangsu RHIP clarified the epidemiological characteristics of intussusception among local children aged 0-3 years from 2018 to 2023. Boys and children aged 8 months to 3 years were identified as high-risk populations for intussusception, with peak incidence occurring in summer and winter. These findings provide evidence-based support for health authorities to formulate targeted strategies for early surveillance, prevention, and healthcare resource allocation.

PMID:42287042

Beijing Da Xue Xue Bao Yi Xue Ban. 2026 Jun 18;58(3):479-489.

ABSTRACT

OBJECTIVE: To systematically investigate the associations between umbilical cord blood protein expression profiles and early infant neurodevelopment using a prospective birth cohort, to identify potential early biomarkers through high-throughput proteomics, and to explore underlying biological mechanisms, thereby providing scientific evidence for early identification of neurodevelopmental risks and understanding the molecular basis of neurodevelopmental deviations in general populations.

METHODS: Based on the Peking University Birth Cohort in Tongzhou, this study enrolled 96 children who completed ages and stages questionnaires, third edition (ASQ-3) assessments at 1 and 3 years of age. Participants were classified into an abnormal group (n=42) and a control group (n=54) according to ASQ-3 screening results. Non-targeted quantitative proteomics was performed on cryopreserved umbilical cord blood plasma samples collected at birth. Differential expression analysis, principal component analysis (PCA), orthogonal partial least squares discriminant analysis (OPLS-DA), and weighted gene co-expression network analysis (WGCNA) were conducted to identify differentially expressed proteins, followed by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) functional enrichment analyses. The fold change (FC) was calculated. Independent samples t-test was used for statistical comparison, with Benjamini-Hochberg method applied to calculate false discovery rate (FDR) for multiple testing correction.

RESULTS: Proteomic analysis identified 8 214 common proteins, among which 385 proteins were differentially expressed (P < 0.05, |log₂FC| >0.585), including 189 proteins upregulated and 196 proteins downregulated in the abnormal group. PCA and OPLS-DA revealed systematic differences in protein expression patterns between the two groups. WGCN A identified 10 co-expression modules, with the yellow module showing significant negative correlation with ASQ-3 abnormal grouping (r=-0.233, P=0.024) and the pink module positively correlating with communication domain scores (r=0.342, P=0.003). Enrichment analyses demonstrated that differential proteins and key modules were primarily enriched in two functional categories: (1) genetic information processing pathways, including ribosome, spliceosome, and mRNA processing; and (2) cytoskeleton organization and Wnt signaling pathways. These pathways held significant biological relevance in the pathogenesis of neurodevelopmental disorders.

CONCLUSION: Perturbations in proteins associated with genetic information processing and cytoskeleton/Wnt signaling pathways in umbilical cord blood may represent important molecular characteristics of early neurodevelopmental screening abnormalities in infants. This study provides potential peripheral blood biomarker combinations for early identification of neurodevelopmental risks in general populations and offers novel insights into the biological mechanisms underlying neurodevelopmental deviations. Future research should validate these findings in larger-scale cohorts and elucidate specific functional mechanisms of key proteins through experimental studies.

PMID:42287041

Beijing Da Xue Xue Bao Yi Xue Ban. 2026 Jun 18;58(3):472-478.

ABSTRACT

OBJECTIVE: To assess the spatial accessibility of pediatric healthcare resources in Beijing and to develop an optimization model for resource allocation under a fixed additional resource constraint, with the aim of exploring optimal allocation strategies for 2025 and 2030.

METHODS: Using communities as the unit of analysis, this study integrated data on Beijing ‘ s child population in 2020 and pediatric healthcare resources in 2022. An improved two-step floating catchment area (2SFCA) method was applied to measure spatial accessibility. Based on projected child population data for 2025 and 2030, an optimization model was constructed to minimize regional disparities in accessibility. Under the constraint of a fixed total number of additional resources, optimal spatial allocation schemes were derived and compared with a conventional population-based allocation approach.

RESULTS: In 2022, Beijing had 4 704 pediatric beds and 4 011 pediatric physicians. The mean spatial accessibility for pediatric beds and pediatric physicians was 1.17 and 0.97, respectively, with a standard deviation of 2.78 for bed accessibility, exhibiting a clear spatial pattern of higher accessibility in central districts and lower accessibility in suburban districts. In the same year, the number of pediatric physicians per 1 000 children in Beijing reached 1.52, already exceeding the targets for 2025 and 2030; therefore, no additional increase in total physician numbers was required. Under the 2025 optimization scenario, the mean accessibility of pediatric beds increased to 1.68, with the standard deviation declining to 2.45, indicating a reduction in regional disparities. Under the 2030 scenario, the mean accessibility further increased to 2. 31, with a standard deviation of 2.56, reflecting continued improvement in accessibility. The optimization model identified Daxing District, Tongzhou District, and Mentougou District as priority districts for additional bed allocation, whereas the conventional population-based approach allocated more resources to Daxing District, Haidian District, and Tongzhou District. While the two approaches showed general consistency in overall spatial allocation, the optimization model more effectively addressed inter-district disparities in accessibility.

CONCLUSION: Significant spatial disparities were identified in the distribution of pediatric healthcare resources in Beijing. The accessibility-oriented optimization approach, under a fixed resource constraint, improved the alignment between supply and demand and reduced regional inequities. It served as a useful complement to conventional population-based allocation methods and provided quantitative evidence to support refined planning and dynamic adjustment of pediatric healthcare resources. Given that the total number of pediatric physicians has already met national targets, leveraging integrated medical consortium and multi-site practice policies to promote the mobility of qualified pediatric physicians toward underserved areas represents a promising pathway toward structural optimization of spatial resource distribution.

PMID:42287040

Beijing Da Xue Xue Bao Yi Xue Ban. 2026 Jun 18;58(3):437-445.

ABSTRACT

OBJECTIVE: To evaluate the impact of international pooled procurement mechanisms, which are primarily represented by the United Nations Children ‘ s Fund (UNICEF) and the Pan American Health Organization (PAHO), on the procurement prices of vaccines.

METHODS: Based on 14 497 vaccine procurement transaction records collected from 188 different countries spanning the period from 2013 to 2024, this research employed a high-dimensional fixed effects model along with an event study metho-dology to accurately identify the price effects and dynamic temporal trends, while simultaneously conducting a multidimensional heterogeneity analysis.

RESULTS: (1) The baseline model demonstrated that, when compared to the independent self-procurement conducted by individual nations, utilizing pooled procurement through the UNICEF significantly reduced the average vaccine prices by 27.6% (β=-0.323, P < 0.01). The PAHO mechanism similarly exhibited an initial price reduction potential of approximately 30.9% (β=-0.370, P=0.052). (2) The event study method strictly validated the parallel trend assumption (joint significance test of pre-treatment coefficients: F=0.27, P=0.845). Dynamic tracking revealed that a price reduction of approximately 30.0% (β=-0.356, P < 0.01) was achieved exactly in the year of transitioning from self-procurement to pooled procurement, and this reduction effect remained persistently stable in subsequent years. (3) Heterogeneity tests revealed a significant “pro-poor” effect of pooled procurement: the price reduction margin obtained by small-scale buyers (38.5%, β=-0.487, P < 0.01) was significantly higher than that of large-scale buyers (22.5%, β=-0.255, P < 0.01). The marginal price reduction coefficient for non-Global Alliance for Vaccines and Immunization (GAVI) eligible countries (β=-0.418, P < 0.01) was substantially larger than that for GAVI eligible countries (β=-0.118, P < 0.05). The high-income country group experienced the most substantial price drop (β=-0.475, P < 0.01). (4) The supply-side moderating effect analysis indicated that UNICEF’ s collective bargaining power maintained robustness across diverse market structures, showing no statistically significant attenuation despite increases in market concentration (interaction term β=0.095, P>0.10).

CONCLUSION: Institutionalized pooled procurement mechanisms are capable of significantly reducing vaccine prices. For those countries that are currently in the immunization financing transition period, as well as those facing high self-procurement benchmark prices, participating in an efficient international pooled procurement platform serves as a critical institutional arrangement to replace external financial aid and to effectively maintain the long-term affordability of vaccines.

PMID:42287036

Biomed Res Int. 2026;2026(1):e1619093. doi: 10.1155/bmri/1619093.

ABSTRACT

BACKGROUND: Systemic inflammation links periodontal disease (PD) and nephrolithiasis. Proinflammatory cytokines like IL-6, IL-8, TNF-α, IL-1β, and MMP-8 are implicated in both conditions. This study investigates salivary levels of these biomarkers in young adult males with kidney stones and their association with periodontal status (CPITN) and body mass index (BMI).

METHODS: This case-control study enrolled 109 males (25-35 years): 52 with kidney stones and 57 healthy controls. Unstimulated whole saliva was analyzed for IL-6, IL-8, TNF-α, IL-1β, and MMP-8 via ELISA. Periodontal health was assessed using the community periodontal index of treatment needs (CPITN). Serum C-reactive protein (CRP) and BMI were also measured.

RESULTS: The kidney stone group had significantly higher salivary IL-6 (3.95 [2.0-5.2] pg/mL vs. 2.7 [1.5-4.0] pg/mL; adj. p = 0.042) and TNF-α (11.99 [8.5-13.8] pg/mL vs. 9.5 [7.0-11.6] pg/mL; adj. p = 0.021) than controls. Differences in IL-1β (adj. p = 0.051) and MMP-8 (adj. p = 0.058) showed a consistent trend toward elevation but did not retain statistical significance after FDR correction. No significant difference was observed in salivary IL-8 levels (adj. p = 0.120). Patients also showed elevated CRP (p = 0.010) and worse CPITN scores (p = 0.002). In the kidney stone group, salivary IL-6, TNF-α, and MMP-8 positively correlated with CPITN scores (p < 0.01), whereas TNF-α also correlated with BMI (p = 0.048).

CONCLUSION: Elevated salivary inflammatory biomarkers (IL-6 and TNF-α) are significantly associated with kidney stones and periodontal status (CPITN) in young males, whereas IL-1β and MMP-8 showed a trend toward elevation. Salivary analysis may be a noninvasive tool for assessing systemic inflammation and identifying at-risk individuals.

PMID:42287034 | DOI:10.1155/bmri/1619093

Addiction. 2026 Jun 12. doi: 10.1111/add.70502. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Naltrexone is a pharmacotherapeutic option for relapse prevention in opioid use disorder (OUD); however, studies highlight low rates of initiation and high rates of discontinuation as limiting its effectiveness. We aimed to (1) estimate the percentage of individuals with OUD who (having undergone withdrawal and wish to remain abstinent) initiate and discontinue naltrexone and (2) examine participant- and study-level factors that contribute to variation in initiation and discontinuation rates.

METHODS: We undertook a systematic review, random-effects meta-analysis and meta-regression searching Medline, Embase, PsychINFO and CENTRAL from database inception to 19 February 2025 for studies of any design from any geographical region involving individuals with OUD eligible to receive naltrexone as a relapse prevention pharmacotherapy (i.e. those completing opioid withdrawal and wishing to remain abstinent). Measurements included the percentage of individuals who initiate or discontinue oral, long-acting injectable depot or implantable formulations of naltrexone at 1, 3 or 6 months. Certainty was assessed using the GRADE framework.

RESULTS: Twenty-two studies, including 124 016 individuals, reported initiation and 95 studies, including 16 969 individuals, reported discontinuation. The pooled percentage initiating oral naltrexone among those eligible was 60.3% [95% confidence interval (CI) = 38.9%-80.0%, 2014 participants, 15 studies] and depot was 18.2% (95% CI = 2.7%-42.5%, 57 383 participants, 4 studies). The pooled percentage discontinuing oral was 50.0% (95% CI = 41.9%-58.1%, 7340 participants, 34 studies) at 1 month, 61.3% (95% CI = 50.9%-71.2%, 2347 participants, 29 studies) at 3 months and 71.0% (95% CI = 57.3%-83.0%, 1889 participants, 19 studies) at 6 months. The pooled percentage discontinuing depot was 26.1% (95% CI = 19.5%-33.3%, 3589 participants, 33 studies) at 1 month, 46.7% (95% CI = 38.4%-55.1%, 3302 participants, 33 studies) at 3 months and 60.0% (95% CI = 43.2%-75.8%, 3071 participants, 22 studies) at 6 months. Statistically significantly higher percentages initiated oral naltrexone if it was the only offered pharmacotherapy (meta-regression coefficient 33.6%, 95% CI = 8.1%-59.2%, P = 0.014) and statistically significantly lower percentages discontinued oral naltrexone at 3 and 6 months if administration was supervised (meta-regression coefficient -18.6%, 95% CI = -36.6% to -1.0%, P = 0.043 and -27.3%, 95% CI = -50.1% to -4.4%, P = 0.022, respectively). There was no clear evidence that study setting (i.e. if the study was conducted in routine clinical care or an investigational setting) substantially explained or contributed to the variation in any estimates. All outcomes were very low certainty.

CONCLUSIONS: Very low certainty evidence suggests that, among people with opioid use disorder who have undergone withdrawal and wish to remain abstinent, a substantial percentage are willing to initiate naltrexone with marked early discontinuation.

PMID:42286437 | DOI:10.1111/add.70502

Addiction. 2026 Jun 12. doi: 10.1111/add.70503. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Individuals with opioid use disorder (OUD) frequently present with co-occurring mental health conditions such as depression and posttraumatic stress disorder (PTSD), along with other mental health substance use disorders, physical health conditions and social determinants that together comprise ‘clinical complexity.’ Collaborative care (CC), a primary care-based behavioral health integration model, aims to improve outcomes through coordinated, patient-centered treatment. This study examined heterogeneity in baseline clinical complexity among participants in the CLARO (Collaboration Leading to Addiction Treatment and Recovery from Other Stresses) trial and assessed whether the effects of CC versus enhanced usual care (EUC) differed across clinical complexity groups.

METHODS: Secondary analysis of CLARO, a pragmatic randomized clinical trial (n = 797) of CC versus EUC for adults with OUD and depression and/or PTSD, conducted in 18 low-resourced primary care clinics in New Mexico and California, USA. Latent class analysis of baseline data identified subgroups defined by mental health and substance use as the main characteristics along with physical health and social challenges. Six-month treatment effects were estimated using one-step models that jointly estimated latent class membership and class-specific outcomes, incorporating class × treatment interactions. Outcomes included depression symptom severity, PTSD symptom severity, and buprenorphine utilization and prescribing duration.

RESULTS: Three subgroups were identified: (1) low complexity (43%), with relative clinical and social stability; (2) mental health complexity (34%), with high psychiatric symptoms but lower substance use and moderate social adversity; and (3) high dual complexity (23%). Compared with EUC, CC was associated with lower depression severity at follow-up for the low-complexity class, but not for other classes. CC and EUC did not differ statistically significantly with respect to PTSD outcomes in any class. Buprenorphine utilization and prescribing duration outcomes were similar across CC and EUC treatment arms.

CONCLUSIONS: The effects of collaborative care may vary according to patients’ baseline clinical complexity. Collaborative care appears to be associated with more favorable depression outcomes than enhanced usual care among participants with lower clinical complexity but not among those with higher clinical complexity.

PMID:42286436 | DOI:10.1111/add.70503