Tag: pubmed

JAMA Netw Open. 2025 Jun 2;8(6):e2512681. doi: 10.1001/jamanetworkopen.2025.12681.

ABSTRACT

IMPORTANCE: For breast cancer risk prediction to be clinically useful, it must be accurate and applicable to diverse groups of women across multiple settings.

OBJECTIVE: To examine whether a dynamic risk prediction model incorporating prior mammograms, previously validated in Black and White women, could predict future risk of breast cancer across a racially and ethnically diverse population in a population-based screening program.

DESIGN, SETTING, AND PARTICIPANTS: This prognostic study included women aged 40 to 74 years with 1 or more screening mammograms drawn from the British Columbia Breast Screening Program from January 1, 2013, to December 31, 2019, with follow-up via linkage to the British Columbia Cancer Registry through June 2023. This provincial, organized screening program offers screening mammography with full field digital mammography (FFDM) every 2 years. Data were analyzed from May to August 2024.

EXPOSURE: FFDM-based, artificial intelligence-generated mammogram risk score (MRS), including up to 4 years of prior mammograms.

MAIN OUTCOMES AND MEASURES: The primary outcomes were 5-year risk of breast cancer (measured with the area under the receiver operating characteristic curve [AUROC]) and absolute risk of breast cancer calibrated to the US Surveillance, Epidemiology, and End Results incidence rates.

RESULTS: Among 206 929 women (mean [SD] age, 56.1 [9.7] years; of 118 093 with data on race, there were 34 266 East Asian; 1946 Indigenous; 6116 South Asian; and 66 742 White women), there were 4168 pathology-confirmed incident breast cancers diagnosed through June 2023. Mean (SD) follow-up time was 5.3 (3.0) years. Using up to 4 years of prior mammogram images in addition to the most current mammogram, a 5-year AUROC of 0.78 (95% CI, 0.77-0.80) was obtained based on analysis of images alone. Performance was consistent across subgroups defined by race and ethnicity in East Asian (AUROC, 0.77; 95% CI, 0.75-0.79), Indigenous (AUROC, 0.77; 95% CI 0.71-0.83), and South Asian (AUROC, 0.75; 95% CI 0.71-0.79) women. Stratification by age gave a 5-year AUROC of 0.76 (95% CI, 0.74-0.78) for women aged 50 years or younger and 0.80 (95% CI, 0.78-0.82) for women older than 50 years. There were 18 839 participants (9.0%) with a 5-year risk greater than 3%, and the positive predictive value was 4.9% with an incidence of 11.8 per 1000 person-years.

CONCLUSIONS AND RELEVANCE: A dynamic MRS generated from both current and prior mammograms showed robust performance across diverse racial and ethnic populations in a province-wide screening program starting from age 40 years, reflecting improved accuracy for racially and ethnically diverse populations.

PMID:40478575 | DOI:10.1001/jamanetworkopen.2025.12681

JAMA Netw Open. 2025 Jun 2;8(6):e2514212. doi: 10.1001/jamanetworkopen.2025.14212.

ABSTRACT

IMPORTANCE: Work-related hazards and stress have been shown to be associated with mental health, with suicide rates among adult workers increasing since 2000.

OBJECTIVE: To determine if self-reported lifetime diagnosed depression, frequent mental distress (FMD), extreme distress prevalences, and mean mentally unhealthy days (MUD) varied among current workers by industry or occupation.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used Behavioral Risk Factor Surveillance System (BRFSS) data from 37 states reporting workers’ industry and occupation in 1 or more years between 2015 and 2019. The target population was currently employed civilian adults aged 18 years or older. Analyses were conducted in 2022 and 2023.

EXPOSURES: Workers’ current industry and occupation were the primary exposures of interest. Self-reported sociodemographic covariates included sex, age, race and ethnicity, education, coupled status, and health care coverage.

MAIN OUTCOMES AND MEASURES: Self-reported lifetime diagnosed depression, FMD, extreme distress, and MUD.

RESULTS: Of a total 536 279 workers assessed (unweighted sample, 535 997 workers; 263 007 female [49.1%]; 48 279 Hispanic [9.0%], 40 188 non-Hispanic Black [7.5%], 400 604 non-Hispanic White [74.7%]), 469 129 reported their industry or occupation. Lifetime diagnosed depression was reported by 80 319 of 534 342 workers (14.2% [95% CI, 13.9%-14.4%]). Mean MUD was 9.5 days (95% CI, 9.4-9.7 days) among 530 309 workers, and in all sociodemographic groups the mean MUD was 3 to 5 times higher among workers who reported lifetime diagnosed depression. Higher prevalences than all workers for lifetime diagnosed depression, FMD, and extreme distress were reported by workers who were female (lifetime diagnosed depression, 19.5% [95% 19.1%-19.9%]; FMD, 11.6% [95% CI, 11.3%-11.9%]; extreme distress, 4.8% [95% CI, 4.6%-5.1%]), ages 18 to 34 years (lifetime diagnosed depression, 16.9% [95% CI, 16.4%-17.3%]; FMD, 13.6% [95% CI, 13.1%-14.0%]; extreme distress, 5.5% [95% CI, 5.2%-5.8%]), and no longer or never in a couple (lifetime diagnosed depression, 18.0% [95% CI, 17.6%-18.4%]; FMD, 13.3% [95% CI, 12.9%-13.7%]; extreme distress, 5.7% [95% CI, 5.4%-6.0%]). By industry, retail trade (lifetime diagnosed depression: APR, 1.15 [95% CI, 1.05-1.25]; FMD: APR, 1.23 [95% CI, 1.10-1.39]) and accommodation and food services (lifetime diagnosed depression: APR, 1.13 [95% CI, 1.03-1.25]; FMD: APR, 6.8 [95% CI, 6.0-7.7]) had higher adjusted prevalences of lifetime diagnosed depression and FMD. By occupation, arts, design, entertainment, sports, and media (1.32 [95% CI, 1.09-1.60]); health care support (1.19 [95% CI, 1.03-1.38]); food preparation and serving (1.20 [95% CI, 1.05-1.36]); and sales and related occupations (1.13 [95% CI, 1.01-1.27]) had higher adjusted prevalences of FMD than the comparison group. Health care support (6.6% [95% CI, 5.5%-7.8%]), food preparation and service (6.9% [95% CI, 5.9%-7.8%]), building and grounds cleaning and maintenance (5.2% [95% CI, 4.4%-6.0%]), personal care and service (5.8% [95% CI, 4.9%-6.8%]), and sales and related occupations (4.8% [95% CI, 4.3%-5.3%]) had higher unadjusted extreme distress than all workers.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, poor mental health among workers varied significantly by sociodemographic categories; significant differences among industry and occupation groups remained after adjustment. More research is needed on the effects of work-related factors on mental health, which may inform tailored treatment and prevention strategies.

PMID:40478574 | DOI:10.1001/jamanetworkopen.2025.14212

JAMA Netw Open. 2025 Jun 2;8(6):e2514248. doi: 10.1001/jamanetworkopen.2025.14248.

ABSTRACT

IMPORTANCE: Interactions between race and county-level factors associated with mortality, such as employment, education, income, and population density, are understudied among Asian American and Pacific Islander populations.

OBJECTIVE: To compare all-cause, cancer, and heart disease mortality rates between Pacific Islander and Asian American adults across county-level factors.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study examined National Center for Health Statistics death certificate data on non-Hispanic Asian American and Pacific Islander adults (aged 20-84 years) between January 1, 2018, and December 31, 2020. County-level socioeconomic data were obtained from the American Community Survey, and population density was determined using Rural-Urban Continuum Codes. Analyses were conducted between August 1, 2023, and September 4, 2024.

EXPOSURES: County-level unemployment, educational attainment, median household income, and population density.

MAIN OUTCOMES AND MEASURES: Age-standardized all-cause, cancer, and heart disease mortality rates and mortality rate ratios (MRRs), comparing Pacific Islander with Asian American individuals by sex and age. Interactions between race and county-level factors associated with MRRs were evaluated using P value for trend across county-level factors.

RESULTS: During 2018 to 2020, 43 221 696 Asian American and 1 281 221 Pacific Islander adults resided in the US. A total of 148 939 Asian American individuals (16.7% aged 20-54 years, 17.2% aged 55-64 years, and 66.1% aged ≥65 years; 57.5% male) and 9628 Pacific Islander individuals (29.9% aged 20-54 years, 23.0% aged 55-64 years, and 47.1% aged ≥65 years; 57.2% male) died of any cause. Across all county-level factors, Pacific Islander adults had elevated all-cause, cancer, and heart disease mortality rates compared with Asian American adults (female: MRR range from 1.82 [95% CI, 1.67-1.98] for population <250 000 to 2.93 [95% CI, 2.73-3.14] for lowest unemployment tertile; male: MRR range from 1.64 [95% CI, 1.50-1.78] for lowest income tertile to 2.47 [95% CI, 2.31-2.63] for lowest unemployment tertile). Across all county-level factors, the largest relative all-cause mortality differences between Pacific Islander and Asian American adults occurred in counties with the lowest unemployment (female: MRR, 2.93 [95% CI, 2.73-3.14]; male: MRR, 2.47 [95% CI, 2.31-2.63]), highest educational attainment (female: MRR, 2.71 [95% CI, 2.53-2.90]; male: MRR, 2.39 [95% CI, 2.25-2.54]), highest median household income (female: MRR, 2.67 [95% CI, 2.56-2.79]; male: MRR, 2.25 [95% CI, 2.17-2.33]), and highest population density (female: MRR, 2.79 [95% CI, 2.67-2.92]; male: MRR, 2.37 [95% CI, 2.28-2.47]). No trends in relative cancer mortality differences between Pacific Islander and Asian American adults across county-level factors were observed overall except for greater population density among women (<250 000 population: MRR, 1.49 [95% CI, 1.25-1.76; >1 000 000 population, 2.13 [95% CI, 1.95-2.32]). The largest heart disease MRRs for Pacific Islander compared with Asian American individuals occurred among those younger than 65 years, with the greatest relative mortality among those aged 20 to 54 years in counties with the lowest unemployment (female: MRR, 14.21 [95% CI, 9.89-20.04]; male: MRR, 5.75 [95% CI, 4.58-7.15]) and highest educational attainment (female: MRR, 13.69 [95% CI, 9.68-18.94]; male: MRR, 6.17 [95% CI, 5.00-7.54]), median household income (female: MRR, 11.97 [95% CI, 9.55-14.91]; male: MRR, 5.16 [95% CI, 4.49-5.91]), and population density (female: MRR, 11.77 [95% CI, 9.39-14.62]; male: MRR, 5.48 [95% CI, 4.76-6.29]).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, all-cause mortality disparities between Asian American and Pacific Islander populations worsened in counties with higher socioeconomic status and greater population density. Historical aggregation of Pacific Islander with Asian American individuals may have misled health improvement efforts, especially for Pacific Islander adults who lived in high socioeconomic and more populated areas.

PMID:40478573 | DOI:10.1001/jamanetworkopen.2025.14248

JAMA Netw Open. 2025 Jun 2;8(6):e2514289. doi: 10.1001/jamanetworkopen.2025.14289.

ABSTRACT

IMPORTANCE: Previous studies in low-resource settings have emphasized the risks of childhood weight gain for increased body mass index (BMI) and systolic blood pressure (SBP) in adulthood. However, these studies have not directly compared the risk of extra weight against the benefit of increased adult height.

OBJECTIVE: To test the hypothesis that a continuous 1-SD increase in weight from age 1 to 10 years was associated with taller stature in adulthood but not with increased risk for obesity or hypertension.

DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study, called the Dogon Longitudinal Study, is a 21-year population-based multigenerational cohort study conducted from 1998 to 2019 in 9 Dogon villages on the Bandiagara Escarpment in Mali. A mediation analysis was conducted in 2024 to calculate the estimated total effect on adult SBP of a 1-SD weight increase over the mean throughout the first decade of childhood. This estimated total effect was decomposed into estimated direct and indirect effects. Children aged 5 years or younger on April 15, 1998, as well as all children born from that date to July 2, 2000, were eligible to participate in the F1 generation.

EXPOSURES: Weight and height trajectories from age 1 to 10 years.

MAIN OUTCOMES AND MEASURES: For the mediation analysis, adult SBP was the outcome, and the mediators were height and BMI at age 21 years. The mediation analysis used linear mixed models for SBP, adult height, and adult BMI.

RESULTS: A total of 1348 participants (645 females [47.8%], 703 males [52.2%]) of the F1 generation contributed 10 081 SBP measurements to the analyses. These participants completed the study and had a median (IQR) of 12 (11-14) follow-up visits from enrollment (at median [IQR] age of 1.59 [0.62-3.44] years) to last measurement (at median [IQR] age of 21.14 [19.47-23.14] years). After adjusting for both parents’ height and SBP (F0 generation), analyses included 433 females and 501 males, with 3384 and 3770 SBP measurements, respectively. The total effect on adult SBP of being 1 SD above the mean, instead of at the mean, childhood weight trajectory was 1.9 (95% CI, 0.9-2.8) mm Hg for females and 3.2 (95% CI, 2.3-4.2) mm Hg for males. This total effect was mediated by an indirect effect through adult height of 2.3 (95% CI, 0.9-3.7) mm Hg in females and 3.9 (95% CI, 2.4-5.4) mm Hg in males and by an indirect effect through adult BMI of 2.6 (95% CI, 2.0-3.2) mm Hg in females and 1.4 (95% CI, 0.6-2.2) mm Hg in males. The direct effect on SBP was -3.1 (95% CI, -4.5 to -1.6) mm Hg in females and -2.1 (95% CI, -3.2 to -0.9) mm Hg in males. A 1-SD weight increase in childhood was associated with a 1.6% increase in the prevalence of obesity in females and no increase in the prevalence of obesity in males. The percentage of individuals whose SBP was 130 mm Hg or higher increased by 0.5% in females and 3.7% in males. The mean (SE) height at age 21 years increased by 3.0 (0.5) cm in females and 4.1 (0.6) cm in males.

CONCLUSIONS AND RELEVANCE: The findings of this cohort study of an undernourished population in Mali supported the hypothesis, suggesting that the risks of 1 SD in childhood weight gain for hypertension and obesity in adulthood were small compared with the benefits of taller stature.

PMID:40478571 | DOI:10.1001/jamanetworkopen.2025.14289

JAMA Health Forum. 2025 Jun 7;6(6):e251204. doi: 10.1001/jamahealthforum.2025.1204.

ABSTRACT

IMPORTANCE: Identifying effective and financially viable strategies to meet the care needs of perons with impaired function is a policy challenge for high-income countries with aging populations. The 2022 National Strategy to Support Family Caregivers identified a range of actions to support caregivers, while family-oriented policies to promote the affordability of care were promoted by both candidates in the 2024 presidential election.

OBJECTIVE: To examine public perceptions of federal policies to support older adults, adults living with disabilities, and their family caregivers by political affiliation and caregiving status.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study included adults in the CLIMB study, a nationally representative, longitudinal panel. Data were collected in March and April 2024. Data analyses occurred from September 2024 to February 2025.

EXPOSURES: Self-reported political party affiliation and caregiving responsibility.

MAIN OUTCOMES AND MEASURES: Endorsement of 6 policies. Responses based on a 5-point Likert scale were dichotomized to contrast “strongly” or “somewhat support” with “strongly oppose,” “somewhat oppose,” and “neither support nor oppose.” The probability of support and differences across political affiliations was presented.

RESULTS: Of 2059 respondents (1035 female individuals [50.9%]; mean [SD] age, 49.0 [18.2] years), 394 (20%) reported having caregiving responsibilities, with no significant difference across political affiliation. Endorsement was highest for policies to make care in facilities (1657 [79.0%]) and homes (1600 [75.4%]) more affordable, expand eligibility for financial access to care (1618 [77.3%]), and increase the capacity of the paid caregiving workforce (1649 [78.3%]) and was lower for expansion of paid family leave (1342 [65.4%]) and payment of family caregivers (1223 [61.2%]). Endorsement by political affiliation was most similar for policies to make care at home more affordable (13.7-percentage point difference; 95% CI, -20.4 to -7.1) and least similar for paid family leave (33.4-percentage point difference; 95% CI, -39.0 to -27.7). While respondents with caregiving responsibilities were more likely to support paying family caregivers, political affiliation was associated with the endorsement of policies to support the care economy that was stronger in magnitude than sociodemographic characteristics (eg, sex) or caregiving experiences.

CONCLUSIONS AND RELEVANCE: The results of this cohort study suggest that, despite some differences by political affiliation, there is high support of policies to support the adult care economy, suggesting a policy window to advance legislation and executive action to address the care needs of aging populations and populations with disabilities.

PMID:40478556 | DOI:10.1001/jamahealthforum.2025.1204

JAMA Health Forum. 2025 Jun 7;6(6):e251215. doi: 10.1001/jamahealthforum.2025.1215.

ABSTRACT

IMPORTANCE: In Medicare Advantage (MA), the private component of the Medicare program that enrolls more than half of beneficiaries, an increasing share of plans are offering Part B premium givebacks to pay for part or all of the at least $174.70 Part B monthly premium. Millions of dollars of Medicare expenditures are attributable to this benefit, yet little is known about its association with member enrollment or other plan characteristics.

OBJECTIVE: To document trends and expenditures in MA Part B premium givebacks and examine their association with plan enrollment.

DESIGN, SETTING, AND PARTICIPANTS: This longitudinal difference-in-differences analysis compared MA plan enrollment before and after the offer of a Part B giveback among plans that offered the giveback vs plans that did not. January MA plan enrollment and characteristics data from 2018 through 2024 were included. Data were analyzed from May 2024 to February 2025.

EXPOSURE: Adoption of a Part B giveback.

MAIN OUTCOMES AND MEASURES: Total plan enrollment.

RESULTS: A sample of 18 627 plan-years representing more than 130 million enrollee-years was included in the analysis. The percentage of MA plans offering a Part B premium giveback increased from 4.3% (93 of 2187) in 2018 to 18.7% (737 of 3940) in 2024. Plans offering Part B premium givebacks had lower median enrollment, belonged to newer, higher rated contracts, had higher cost-sharing, and had lower enrollee risk scores compared with plans that did not offer givebacks. In 2024, the 3.4 million enrollees in plans with Part B givebacks received a mean (SD) of $77 ($42), amounting to as much as approximately $261 million in total monthly expenditures across the MA program. Adoption of a Part B giveback was associated with a 33.3% (95% CI, 9.3-56.9) increase in enrollment, robust to all model specifications. There was a dose-response association between the size of the giveback and enrollment.

CONCLUSIONS AND RELEVANCE: In this study, the adoption of Part B premium givebacks among MA plans was associated with a substantial increase in plan enrollment. Further research will be needed to understand the total value to enrollees of Part B givebacks, which confers hundreds of millions of dollars monthly to Medicare beneficiaries.

PMID:40478555 | DOI:10.1001/jamahealthforum.2025.1215

JAMA Health Forum. 2025 Jun 7;6(6):e251430. doi: 10.1001/jamahealthforum.2025.1430.

ABSTRACT

IMPORTANCE: Evidence is limited regarding the physician characteristics associated with the provision of low-value services in primary care, especially outside of the US.

OBJECTIVE: To measure physician-level use of 10 low-value care services that provide no net clinical benefit and to investigate the characteristics of primary care physicians who frequently provide low-value care in Japan.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional analysis used a nationwide electronic health record database linked with claims data in Japan to assess visits by adult patients (age ≥18 years) to a solo-practice primary care physician from October 1, 2022, through September 30, 2023. Data analysis was performed from June 2024 to February 2025.

MAIN OUTCOMES AND MEASURES: Multivariable-adjusted composite rate of low-value care services delivered per 100 patients per year, aggregated across 10 low-value measures, after accounting for case mix and other characteristics.

RESULTS: Among 2 542 630 patients (mean [SD] age, 51.6 [19.8] years; 58.2% female) treated by 1019 primary care physicians (mean [SD] age 56.4 [10.2] years; 90.4% male), 436 317 low-value care services were identified (17.2 cases per 100 patients overall). Nearly half of these low-value care services were provided by 10% of physicians. After accounting for patient case mix, older physicians (age ≥60 years) delivered 2.1 per 100 patients (95% CI, 1.0-3.3) more low-value care services than those younger than 40 years; not board-certified physicians delivered 0.8 per 100 patients (95% CI, 0.2-1.5) more than general internal medicine board-certified physicians; physicians with higher patient volumes delivered 2.3 per 100 patients (95% CI, 1.5-3.2) more than those with low patient volumes; and physicians practicing in Western Japan delivered 1.0 per 100 patients (95% CI, 0.5-1.5) more than those in Eastern Japan.

CONCLUSIONS AND RELEVANCE: The findings of this cross-sectional analysis suggest that low-value care services were common and concentrated among a small number of primary care physicians in Japan, with older physicians and not board-certified physicians being more likely to provide low-value care. Policy interventions targeting at a small number of certain types of physicians providing large quantities of low-value care may be more effective and efficient than those targeting all physicians uniformly.

PMID:40478554 | DOI:10.1001/jamahealthforum.2025.1430

Mil Med. 2025 Jun 6:usaf262. doi: 10.1093/milmed/usaf262. Online ahead of print.

ABSTRACT

INTRODUCTION: Most mortality studies among Norwegian military veterans from international peacekeeping missions were conducted among men, as the number of women participants in each mission has been too small to give statistically robust results. However, women have served in every peacekeeping operation since 1978. As the number of military women increases, knowledge about the causes of death among female military peacekeepers is increasingly important to ensure the Armed Forces’ military operability and preventive initiatives. Hence, we aimed to study mortality in a cohort comprising all military women who participated in such service back to 1978.

MATERIALS AND METHODS: The cohort was established by the Norwegian Armed Forces Health Registry and included 2,365 women eligible for follow-up from their first day of peacekeeping service through 2023. We calculated standardized mortality ratios (SMRs) with 95% confidence intervals (CIs) by comparing the observed numbers of deaths with the expected numbers calculated from national population rates in Norway.

RESULTS: A total of 65 deaths observed during follow-up gave a lower-than-expected all-cause SMR of 0.79 bordering on statistical significance (95% CI, 0.61-1.01). This was because of to low mortality from diseases. Mortality from (nonmalignant) respiratory diseases was lower than expected (SMR = 0.18, 95% CI, 0.00-0.99), on the other hand, the risk of dying from cerebrovascular diseases (stroke) was elevated (SMR = 2.64, 95% CI, 1.21-5.01). Mortality from all external causes combined, as well as from accidents and suicide, did not differ from that of the national rates, the same was true for breast cancer and lung cancer mortality.

CONCLUSION: Generally, military women peacekeepers did not have an increased risk of mortality overall, but the risk of death from stroke was increased. Most of the stroke deaths were haemorrhagic, for which parity and old age at menopause are known risk factors.

PMID:40478536 | DOI:10.1093/milmed/usaf262

Mil Med. 2025 Jun 6:usaf254. doi: 10.1093/milmed/usaf254. Online ahead of print.

ABSTRACT

PURPOSE: Regulatory T cells (Tregs) are well-known to play an essential role in neuroinflammatory conditions. However, their role in visual deficits after military-relevant neurotrauma is not known. This study aims to decipher the role of CD4 + Foxp3 + Tregs in the development of visual deficits in a mild traumatic brain injury (mTBI) mouse model.

MATERIALS AND METHODS: Seventeen-week-old genetically modified mice [C57BL/6-Tg(Foxp3-HBEGF/EGFP)23.2 Spar/Mmjax] in which Foxp3 + Tregs are fluorescently labeled were used in the study. Mice were subjected to a 50-psi air pulse on the left side of the head overlying the forebrain, resulting in an mTBI. A low-dose diphtheria toxin (DTx, ip, 0.05 mg/g body weight) allowed for specific ablation of Foxp3 + Treg cells. DTx treatment began 3 days before causing a blast injury and continued every 3 days to keep Tregs depleted for 30 days after the injury. Mice receiving no DTx served as Treg control, with sham-blast mice serving as additional controls for blast injury. One month following the injury, vision function was assessed by opto kinetic nystagmus and electroretinography (ERG), followed by molecular and immunohistological analysis for neuroinflammatory markers.

RESULTS: Intraperitoneal administration of DTx effectively depleted Foxp3 + Treg cells in the spleen, both in sham and blast-injured mice. The blast injury resulted in a significant reduction in visual acuity and increased contrast sensitivity requirements, with these effects being exacerbated by DTx treatment. Electroretinography revealed a decrease in “b” wave amplitude post-blast injury, which was further reduced with DTx, though not significantly. Neuroinflammatory gene expression, including IL1β, CD86, TNFα, and CXCL10, was elevated in blast-injured mice, with DTx alone also inducing similar increases. Immunohistological analysis showed increased macroglia positive for GFAP and microglia/macrophages positive for IBA1 expression in the retina of blast-injured mice, with further increases observed in the DTx-treated group, although these changes did not reach statistical significance.

CONCLUSIONS: Our studies suggest that depletion of Treg cells followed by blast injury leads to increased retinal degeneration and neuroinflammation. This highlights the continuous requirement of Foxp3 + Treg cell activity to prevent neurodegeneration in mTBI. Future studies should fully explore the relationship of immunomodulatory Treg cells with neurodegeneration in blast-associated visual deficits. Therapeutics aiming to modulate Treg cells could be tested in DEREG transgenic mice after blast injury.

PMID:40478534 | DOI:10.1093/milmed/usaf254

Eur J Public Health. 2025 Jun 6:ckaf066. doi: 10.1093/eurpub/ckaf066. Online ahead of print.

ABSTRACT

Prostate cancer (PCa) poses a significant global health threat, with high incidence and mortality rates. In 2022, the Council of the European Union (EU) updated its screening recommendations, prioritizing PCa screening. This signals a crucial step towards establishing new early detection programmes in EU member states. This study investigates the role of policy makers and governance in cancer screening to inform the development of PCa screening. We had a mixed-method study design. First, a rapid review was conducted on policy making and governance in EU-funded cancer screening initiatives. Second, a focus group discussion reviewed study concepts and methods. Third, a systematic literature review was performed and, fourth, a series of in-depth interviews with actors involved in PCa screening pilots was conducted. Data were analysed thematically and the findings are used to propose 10 recommendations for policy makers. The results of the rapid review and focus group discussion framed the study in the context of existing cancer screening programmes across the EU, and highlighted what already exists in terms of governance tools and methodology. The literature review and in-depth interviews presented key learnings from the literature and real-life settings. These findings are reported using a pre-existing conceptional framework for effective health system governance. The study underscores the critical importance of governance in effective cancer screening programmes. Ten recommendations are proposed, including: defining cancer screening governance, allocating budgets and defining common approaches and key performance indicators for evaluation, establishing methods to enhance citizen participation, and reinforcing network governance.

PMID:40478531 | DOI:10.1093/eurpub/ckaf066