Tag: pubmed

JMIR Ment Health. 2026 Mar 27;13:e89355. doi: 10.2196/89355.

ABSTRACT

BACKGROUND: Since 2020, Medicare Advantage (MA)-related internet searches have tripled, accompanied by increased regional marketing by private insurers. Commercial health insurance dominates the internet during enrollment periods, often outpacing public sources in accessibility. Prior studies suggest that MA advertising significantly shapes enrollment and may fuel choices over traditional Medicare in certain subpopulations. We sought to better understand how health plan marketing strategies affect consumers by using Google Trends data and MA health plan enrollment selection. We applied novel analysis to assess statistical relationships among marketing, internet searches, and enrollment data.

OBJECTIVE: The objectives of this paper are (1) to establish the validity of Google Trends data as a surrogate measure for consumer MA plan selection by demonstrating stable, repeatable seasonality and domain specificity using control terms such as “car insurance” and “life insurance” at national and Designated Market Area levels; (2) to quantify the congruency between MA search interest and Centers for Medicare & Medicaid Services enrollment data by testing whether search peaks coincide with or precede enrollment surges nationally within a year; and (3) to assess whether local search intensity aligns with advertising exposure by evaluating search behavior as a potential proxy for marketing impact and consumer engagement.

METHODS: This study is a retrospective Google Trends analysis of consumer search patterns from January 2004 to December 2024, using relative search volume and conducting correlations with MA enrollment. Search data are accessible via the Google Trends website Explore tool or by applying for Google Trends application programming interface alpha access. MA enrollment data originated from the Centers for Medicare & Medicaid Services MA Dashboard. KFF (formerly the Kaiser Family Foundation) provided the medical advertising marketing data.

RESULTS: A consistent, significant correlation between MA advertising and searches on MA exists across US markets, particularly before and during MA enrollment windows. Findings suggest a linkage in user behavior between volume of searches and subsequent enrollment in an MA plan.

CONCLUSIONS: Internet search data can provide an open, near-real-time means of tracking patterns in MA-related search activity across time and geography, offering insight into how consumer interest fluctuates around enrollment periods. Our analysis reveals repeatable patterns in consumer interest over time that may be useful for contextualizing insurance marketing dynamics of consumers choosing commercial MA over traditional Medicare benefits. We also identified a significant correlation of seasonal trends in searches using terms associated with MA plans that peaked during the annual enrollment period (October-December). Improved accessibility to Medicare resources and directed messaging can bridge information gaps for underserved populations and can lead to more cost-effective decision-making by Medicare-eligible beneficiaries.

PMID:41894677 | DOI:10.2196/89355

JMIR Pediatr Parent. 2026 Mar 27;9:e83867. doi: 10.2196/83867.

ABSTRACT

BACKGROUND: In Saudi Arabia, unintentional injuries among children represent a prevalent and significant public health issue and severe injuries are of the leading indications for hospitalization and impairments.

OBJECTIVE: This study aimed to describe the pattern of unintentional trauma in children admitted to Abha Maternal and Children Hospital, South region of Saudi Arabia.

METHODS: This study was a prospective descriptive, cross-sectional, hospital-based study, which was conducted in the Pediatric Intensive Care Unit, Maternity and Children’s Hospital, Abha, Aseer region, Saudi Arabia. This is the central and main hospital in the region but not the only hospital receiving childhood injuries. The study period was from January 2023 to January 2024. Children’s age groups were from 0 to 12 years old. All children in the study were admitted with a diagnosis of unintentional injuries, like RTAs (road traffic accidents), falls, and other home accidents. The study included 104 children and the data collected were analyzed using SPSS (version 27; IBM Corp). Appropriate statistical tests were used for the analysis and all tests were two tailed and probability P≤.05 is considered significant.

RESULTS: The sample size of the study was 104 children. The gender distribution was 35 females (33.7 %) and 69 males (66.3 %). The patients were recruited from 18 cities in the Aseer region. About half of the patients (49%) were aged 6-12 years. Road traffic accidents (RTA) represent the highest percentage of accidents, with 66 (63.5%) children, followed by falls from height with 38 (36.5%) patients. The most significant types of injuries were head and brain injuries 37 (35.6%), followed by chest and lung injuries 12 (11.5%). Most patients (n=62, 59.6%) remained admitted to the pediatric intensive care unit (PICU) for one to three days. Followed by three to seven days (27), then eight to 14 days (14). Head/brain axonal injury is also the most common injury associated with complications, followed by polytrauma.

CONCLUSIONS: Road traffic accidents are a significant cause of death and disability in Saudi Arabia for all age groups. A strong association existed between the PICU admission duration and the outcome (P=.02). Health and community institutes and governments should increase community education about the risks and consequences of RTA, strengthen traffic rules and laws, and punish violators.

PMID:41894658 | DOI:10.2196/83867

JCO Clin Cancer Inform. 2026 Mar;10:e2500081. doi: 10.1200/CCI-25-00081. Epub 2026 Mar 27.

ABSTRACT

PURPOSE: Predicting severe adverse events (SAEs) in oncology is challenging because of complex therapies and patient heterogeneity. Traditional pharmacovigilance methods often fail to capture multifactorial risk patterns. Machine learning (ML) offers potential to identify subtle predictors of SAEs within large real-world data sets such as the US Food and Drug Administration Adverse Event Reporting System (FAERS). This study developed and validated an ML model to predict severe oncology-related adverse events and identify key risk factors using FAERS data.

METHODS: We analyzed 3,789,273 unique oncology-related FAERS cases (2012Q4-2024Q3) after extensive preprocessing, including natural language processing-based indication filtering, deduplication, and variable standardization. Severe events were defined by outcomes of death, hospitalization, disability, congenital anomaly, or life-threatening condition. A LightGBM model was trained using Optuna-based hyperparameter optimization and benchmarked against logistic regression. Model performance was evaluated using AUROC, AUPRC, precision, recall, and F1-score. Shapley Additive Explanations (SHAP) analysis assessed the feature influence and interpretability.

RESULTS: LightGBM outperformed logistic regression (AUROC, 0.806 [95% CI, 0.804 to 0.807] v 0.708 [0.706 to 0.709]; AUPRC, 0.615 [0.611 to 0.617] v 0.454 [0.449 to 0.455]; F1 78.1% v 71.6%). Key predictors of severity included advanced age, higher weight, extensive polypharmacy (median 15 drugs; IQR, 9-27), longer therapy duration (median 6.3 days), and greater numbers of reported reactions (mean 5 per case). SHAP analysis revealed that age, polypharmacy, and therapy duration synergistically increased SAE risk.

CONCLUSION: Our gradient boosting model substantially improved prediction and interpretability of severe oncology adverse events compared with logistic regression. SHAP analysis identified clinically meaningful predictors, enabling precision pharmacovigilance and targeted risk mitigation. These findings support ML integration into regulatory and clinical pharmacovigilance workflows to enhance postmarket safety surveillance.

PMID:41894651 | DOI:10.1200/CCI-25-00081

J Urol. 2026 Mar 27:101097JU0000000000005042. doi: 10.1097/JU.0000000000005042. Online ahead of print.

ABSTRACT

PURPOSE: Prior studies have shown that thiazide diuretics’ ability to decrease symptomatic stone events depends on the extent to which they reduce urine calcium. However, it remains unknown whether the calcium change from thiazide diuretics depends on the baseline urine calcium level.

MATERIALS AND METHODS: Among a cohort of Medicare beneficiaries with a 24-hour urine collection for kidney stone disease processed by Labcorp/Litholink between 2011-2018, we identified a subset aged >18 years newly prescribed a thiazide diuretic who performed a second collection between 30 and 180 days after their initial prescription fill. We then fit multivariable linear regression models to estimate the association between dose of thiazide prescribed and change in urine calcium, stratifying by baseline urine calcium. We compared cumulative incidences of clinical stone events stratified by baseline urine calcium groups within a treated and untreated cohort.

RESULTS: From a total of 634 participants, higher baseline urine calcium was associated with greater 24-hour mean absolute (in mg/d) and percentage urine calcium reductions (P_trend<0.001 for both). Higher thiazide dose was associated with greater absolute and percentage urine calcium reduction. No statistically significant differences were seen comparing the adjusted incidences of clinical stone events across baseline calcium groups after thiazide prescription. However, among individuals without thiazide exposure, the unadjusted and adjusted cumulative incidences were higher with greater baseline urine calcium (both P_trend<0.001).

CONCLUSIONS: Greater urine calcium reductions after thiazide treatment are observed among those with higher baseline urine calcium, and higher thiazide dose led to a larger reduction. These data are relevant for individualizing thiazide dose for kidney stone prevention.

PMID:41894644 | DOI:10.1097/JU.0000000000005042

Shock. 2026 Mar 26. doi: 10.1097/SHK.0000000000002824. Online ahead of print.

ABSTRACT

BACKGROUND: Sepsis is a life-threatening critical illness characterized by dysregulated host responses, in which excessive neutrophil extracellular trap (NET) formation and sepsis-associated coagulopathy play central roles in organ dysfunction and mortality. Targeting a single pathological pathway has shown limited clinical benefit. Cl-amidine, a peptidylarginine deiminase 4 (PAD4) inhibitor, suppresses NET formation, whereas heparin is widely used in critically ill patients to modulate coagulation and neutralize histone-mediated cytotoxicity. Whether simultaneous targeting of NET-driven inflammation and coagulation dysregulation provides enhanced protection in sepsis remains unclear.

METHODS: Sepsis was induced in C57BL/6J mice using the cecal ligation and puncture (CLP) model. Mice received post-insult treatment with Cl-amidine (50 mg/kg, intraperitoneally) and/or heparin (1000 U/kg, intravenously). Seven-day survival was assessed. Circulating NET-related markers (citrullinated histone H3 and MPO), inflammatory cytokines, coagulation parameters, and histopathological injury of the lung, liver, and kidney were evaluated.

RESULTS: Combined treatment with Cl-amidine and heparin significantly improved 7-day survival compared with untreated septic mice, whereas Cl-amidine monotherapy did not confer a survival benefit despite significantly reducing NET markers. Cl-amidine significantly reduced NET formation, whereas heparin alone did not show a statistically significant effect on NET markers. Combined treatment further enhanced the reduction of MPO levels. Histopathological analysis demonstrated that pulmonary, hepatic, and renal injury was most markedly attenuated in the combination group compared with either monotherapy. Although inflammatory and coagulation parameters were generally improved following treatment, the effects of the combined regimen were comparable to those of the more effective monotherapy for several markers, and no statistically confirmed pharmacological synergy was observed.

CONCLUSION: Combined administration of Cl-amidine and heparin provides a meaningful survival benefit and attenuates multi-organ injury in experimental sepsis. Although no statistically confirmed pharmacological synergy was observed across all parameters, the combined intervention exerted additive protective effects beyond single-agent treatment. Importantly, the additional histological protection could not be explained by further suppression of systemic cytokines or by changes in global coagulation parameters, and the underlying mechanisms therefore remain incompletely defined. Further preclinical studies addressing bleeding risk, optimal dosing strategies, and mechanistic pathways are warranted prior to clinical translation.

PMID:41894635 | DOI:10.1097/SHK.0000000000002824

Int J Mycobacteriol. 2026 Jan 1;15(1):45-53. doi: 10.4103/ijmy.ijmy_217_25. Epub 2026 Mar 27.

ABSTRACT

BACKGROUND: Tuberculosis (TB) remains one of the leading causes of death among children under the age of 5 years. In some resource-limited communities, contact tracing interventions are generally used to curb this problem. We aimed to assess the effect of contact tracing interventions on the management of pediatric TB in the Centre Region of Cameroon.

METHODS: The study was done in 14 diagnostic and treatment centers having a mixed urban-rural population with a high burden of TB. A mixed method including assessment of pediatric TB epidemiological trends, operational data from 2019 to 2024, coupled with healthcare worker perceptions of contact tracing.

RESULTS: Overall, 119 cases of TB were reported. After contact tracing, the number of TB cases rose to 34 in 2021 but dropped in the following years. Zero household investigations and no child under 5 years of age were recorded as TB contacts in 2019-2020, respectively, 779 and 963 in 2021-2024. In 2022, there was about 4.5-fold increase in the number of children identified as TB contacts (387). About 1465 children received TB preventive treatment from 2019 to 2024. After contact tracing, this number peaked at 400 in 2022. About 96% of the personnel responded that the project improved the management of TB.

CONCLUSIONS: Intensification of contact tracing activities and the decrease in TB diagnoses among children under 5 years of age strongly contributed to the prevention and control of the disease within this key population, aligning with the priorities of the World Health Organization End TB Strategy.

PMID:41894628 | DOI:10.4103/ijmy.ijmy_217_25

Int J Mycobacteriol. 2026 Jan 1;15(1):1-5. doi: 10.4103/ijmy.ijmy_129_25. Epub 2026 Mar 27.

ABSTRACT

BACKGROUND: Tuberculosis (TB) remains a significant global health concern, particularly in children. Conventional TB diagnostics, such as culture or sputum-based. The polymerase chain reaction (PCR) is limited in pediatric populations. This study evaluates the molecular diagnostic of Mycobacterium tuberculosis (MTB) 16 small ribosomal RNA (rRNA) plasma in drug-sensitive TB children and household contacts.

METHODS: A cross-sectional study involved children aged 1 month to 18 years who were diagnosed with TB and those with household contact with TB cases. Participants underwent clinical evaluation, tuberculin skin test (TST), and peripheral blood collection for PCR 16S rRNA MTB. Statistical analysis was performed using Fisher’s exact and Mann-Whitney U-tests (P < 0.05). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratio, and area under the curve (AUC) were determined to evaluate the diagnostic efficiency of PCR 16S rRNA.

RESULTS: Among 30 participants, 15 were diagnosed with TB, and 15 were close contacts of TB. Positive PCR 16S rRNA results were found in 66.7% of TB-diagnosed children and 46.7% of household contacts, with no statistically significant difference (P = 0.239). TST was positive in 86.7% of the TB group and 20% of contact TB (P < 0.001). The sensitivity, specificity, PPV, NPV, likelihood ratio, and AUC of the PCR 16S rRNA MTB were 66.7%, 63.3%, 58.82%, 61.53%, 1.817, 0.400 (0.194-0.606).

CONCLUSION: Molecular diagnostic of MTB using PCR 16S rRNA blood is a promising tool for identifying MTB in children. These findings support the potential role of blood-based molecular diagnostics in TB.

PMID:41894621 | DOI:10.4103/ijmy.ijmy_129_25

Nutr Rev. 2026 Mar 27:nuag037. doi: 10.1093/nutrit/nuag037. Online ahead of print.

ABSTRACT

CONTEXT: Dietary protein requirements for older adults with normal kidney function or nondialysis chronic kidney disease (CKD) are still not clearly understood. Low protein intake is often recommended for the management of CKD, although some evidence suggests that higher protein intake may reduce the risk of protein energy malnutrition and sarcopenia among older adults.

OBJECTIVE: To systematically review and synthesize the longitudinal evidence on the association between dietary protein intake and kidney function in community-dwelling older adults (≥65 years) with normal kidney function or nondialysis CKD.

DATA SOURCES: Embase, Medline, and Scopus electronic databases, along with the Web of Science platform, were systematically searched from inception to November 7, 2025.

DATA EXTRACTION: The search yielded 2325 articles. Title and abstract, as well as full-text review, were independently performed by 2 reviewers. A total of 6 studies met our inclusion criteria. Data extraction was completed by 1 reviewer and independently cross-checked by another. The ROBINS-E tool was used to assess the risk of bias and the GRADE approach was used to assess the certainty of evidence.

DATA ANALYSIS AND RESULTS: Due to limitations in available evidence, a meta-analysis could not be performed, and a narrative review approach was adopted instead. Five of the 6 included studies reported no statistically significant association between protein intake and kidney function in older adults with normal kidney function or nondialysis CKD, while, in 1 study, higher plant protein intake was associated with slower estimated glomerular filtration rate (eGFR) decline.

CONCLUSION: There was insufficient evidence that dietary protein intake impacted longitudinal kidney function in community-dwelling older adults not on dialysis; however, research in this area is lacking. Further research may inform the development of more personalized interventions to optimize protein intake and health in later life.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42024567168.

PMID:41894612 | DOI:10.1093/nutrit/nuag037

Int J Periodontics Restorative Dent. 2026 Mar 27;0(0):1-31. doi: 10.11607/prd.7750. Online ahead of print.

ABSTRACT

The aim of this retrospective case series is to provide evidence of the performance of a surgical concept, the ‘Compensatory Alveolar Socket Seal’ (CASS) by sealing not only the coronal part of the alveolar socket but also its buccal aspect using a subepithelial connective tissue graft to enhance soft tissue volume and adequately restore a proper emergence profile.

MATERIAL AND METHODS: In this retrospective case series, 389 patients underwent treatment with this modified surgical technique (CASS). This treatment includes minimally traumatic extraction, immediate implant placement and a connective tissue sealing the buccal aspect of the socket. Radiographic bone level (RBL) was stablished as the main outcome variable. Other variables such as implant osteointegration or need for secondary subepithelial connective tissue graft surgery were also recorded. Additionally, Pink Esthetic Score (PES) was also evaluated.

RESULTS: Although no statistical differences in RBL were observed, a trend was seen for increased bone level changes in the upper first left premolar (0.97 mm (SD=0.89)) while the least was observed in the upper left canine (0.07 mm (SD=0.88)). Bone level changes varied according to implant site and type of connection. Implants with an external connection had a deeper bone remodeling compared with an internal connection (0.65 mm SD=1.12 vs 0.47 mm SD=1.34 respectively. PES levels improved during the follow up period. The highest increase (1.61) was found between baseline (V1) and 12 weeks postoperatively (V2) (p < 0.001).

CONCLUSIONS: The CASS technique appears to be a reliable technique for preserving the alveolar process without requiring hard tissue replacement strategies, with excellent aesthetic results.

PMID:41894611 | DOI:10.11607/prd.7750

Mil Med. 2026 Mar 27:usag142. doi: 10.1093/milmed/usag142. Online ahead of print.

ABSTRACT

INTRODUCTION: Obesity poses an increasing threat to U.S. military readiness, with over half of active-duty service members classified as overweight and up to 27% with obesity. Within the Military Health System (MHS), obesity contributes to service disqualification, musculoskeletal injury, and cardiometabolic disease, accounting for an estimated $2 billion annually in combined costs. Although TRICARE began covering obesity medications (OMs) in 2018, prior analyses demonstrated limited utilization. With policy changes in September 2024 that streamlined access and the introduction of newer agents such as semaglutide (Wegovy) and tirzepatide (Zepbound), this study examined updated prescribing trends and predictors of OM use from fiscal years (FY) 2023-2024.

MATERIALS AND METHODS: This cross-sectional study analyzed demographic, clinical, and pharmacy claims data from the MHS Data Repository for adult TRICARE Prime and Plus beneficiaries ages 18-64, without type 1 or type 2 diabetes, and with a body mass index (BMI) of 27 or higher. The primary outcome was receipt of one or more TRICARE-approved OMs, excluding formulations approved for diabetes. Descriptive statistics and multivariable logistic regression identified predictors of OM use by sex, age, race/ethnicity, beneficiary category, rank, comorbidity status (prediabetes, metabolic syndrome, coronary artery disease, obstructive sleep apnea), and care setting.

RESULTS: Among 568,232 BMI-eligible adult beneficiaries, 31,176 (5.5%) received at least one OM. OM users were predominantly female (81%), ages 30-59 years, and dependents (71%). Half had a primary care manager in direct care and half in the private sector. Most prescribed agents were phentermine (41%), semaglutide (Wegovy, 28%), naltrexone/bupropion (20%), phentermine/topiramate (16%), and tirzepatide (Zepbound, 15%). Female sex (OR = 4.07) and senior enlisted rank (OR = 1.13) were associated with significantly (P < .05) higher odds of use; Asian/Pacific Islander (OR = 0.59), Hispanic (OR = 0.81), Black (OR = 0.82), and active-duty (OR = 0.64) beneficiaries had significantly (P < .05) lower odds.

CONCLUSIONS: Obesity medication utilization in the MHS increased modestly since 2018 but remains low relative to disease prevalence, particularly among active-duty and minority beneficiaries. Recent TRICARE coverage changes may further shape access and prescribing patterns, though their downstream effects on health outcomes, readiness, and costs remain uncertain. These findings highlight ongoing knowledge gaps regarding the optimal, sustainable use of OM in the MHS and underscore the need for MHS-specific effectiveness, safety, and cost-effectiveness data to inform evidence-based, readiness-aligned obesity care strategies.

PMID:41894608 | DOI:10.1093/milmed/usag142