Tag: pubmed

Diabetologia. 2026 Apr 22. doi: 10.1007/s00125-026-06740-3. Online ahead of print.

ABSTRACT

AIMS/HYPOTHESIS: Ethnic disparities in the incidence of type 2 diabetes mellitus are well documented in multiethnic urban populations, but the contributions of migration status and mental health are less well understood. This study used a large dataset from primary care centres in South London that is unique in that it includes migration-related information together with information on mental and physical health comorbidities. We aimed to assess how migration status and mental health contribute to longitudinal associations of ethnicity and type 2 diabetes risk in a multiethnic urban population.

METHODS: We conducted a longitudinal cohort study (2012-2019) of approximately 340,000 adults without baseline type 2 diabetes. Cox proportional hazards models were applied with sequential adjustments: first for age and sex; second, adding migration status (country of birth being UK or not); and third, further adding mental health conditions (depression, anxiety, severe mental illness), physical health factors (BMI, hypertension and other macrovascular diseases) and area-level deprivation. This approach allowed us to examine whether ethnic differences in the incidence of type 2 diabetes persist after accounting for additional factors.

RESULTS: South Asian, Black African and Black Caribbean groups had 2-3-fold higher type 2 diabetes risks compared with White British individuals, which were only partially explained by socioeconomic and clinical factors. Being born outside the UK increased type 2 diabetes risk by 29% across all ethnic groups. Depression/anxiety and severe mental illness were associated with a higher risk of type 2 diabetes. No statistical evidence of strong interactions between these factors was obtained.

CONCLUSIONS/INTERPRETATION: Ethnicity, migration status and mental health conditions were each independently associated with type 2 diabetes risk, and ethnic disparities persisted after adjustment. The lack of evidence for interactions suggests that migration- and mental health-related mechanisms may operate similarly across ethnic groups rather than amplifying or mitigating existing disparities in type 2 diabetes rates. Efforts to reduce diabetes inequalities will require both support for post‑migration challenges and addressing of the broader structural and environmental determinants underlying persistent ethnic disparities.

PMID:42018145 | DOI:10.1007/s00125-026-06740-3

Equine Vet J. 2026 Apr 22. doi: 10.1002/evj.70170. Online ahead of print.

ABSTRACT

BACKGROUND: Misconceptions can be defined as ‘false, persistent beliefs’ or ‘inaccurate, prior knowledge’ and can influence decision-making.

OBJECTIVES: To investigate the impact of evidence-based information on UK horse owners’ decision-making for colic.

STUDY DESIGN: Mixed-methods cross-sectional study.

METHODS: An online survey was distributed to UK horse owners, with four sections: owner demographics; views on decision-making and referral to an equine hospital facility for colic; current knowledge and approach to colic; impact of evidence-based information (including evidence on recognising and responding to colic, and colic surgery survival and outcome data) on decision-making. Statistical analysis was performed using Kendall’s tau for continuous variables and Chi-squared testing for categorical variables. Multivariable analysis was performed using a generalised linear model with binomial distribution (logistic regression), with p < 0.05 for model fit. Content analysis was used for free-text answers.

RESULTS: In total, 1544 participants met inclusion criteria. Owners were more likely to agree to referral if their horse was insured (p < 0.001, 95% confidence interval [CI]: 1.86-2.93), and less likely if their horse was older (p < 0.001, CI: 0.90-0.94) or they felt pressure (p < 0.001, CI: 0.44-0.70). Pressure to refer was mainly from veterinary professionals (66%, 367/549) or peers (20%, 110/549). Many participants were unaware of how quickly irreversible intestinal damage could occur (58%, 903/1544), costs of colic surgery and UK insurance cover limits (63%, 966/1544), post-operative survival rates for geriatric vs. non-geriatric horses (65%; 996/1544), or prognosis for return to work following colic surgery (68%, 1052/1544). Sharing evidence-based information had limited impact on decision-making. Free text response analysis identified previous experience of colic, anecdotal information, finances and peer pressures as barriers to change.

MAIN LIMITATIONS: Potential for response bias, UK participants only.

CONCLUSIONS: Misconceptions around colic were common, with many horse owners reluctant to change their approach after evidence-based information. Intent to pursue referral was less likely with increasing horse age and perceived pressure to refer.

PMID:42018127 | DOI:10.1002/evj.70170

Eur J Health Econ. 2026 Apr 22. doi: 10.1007/s10198-026-01923-6. Online ahead of print.

NO ABSTRACT

PMID:42018119 | DOI:10.1007/s10198-026-01923-6

J Am Heart Assoc. 2026 Apr 22:e042044. doi: 10.1161/JAHA.125.042044. Online ahead of print.

ABSTRACT

BACKGROUND: Although large studies and pooled analyses of individual patient data have demonstrated the safety of deferring coronary revascularization based on a nonischemic intracoronary pressure index result, conflicting findings have emerged in specific patient subsets and with varying follow-up. Thus, we conducted an updated comprehensive systematic review and meta-analysis to investigate the cardiovascular outcomes associated with deferred or performed coronary revascularization based on intracoronary physiology.

METHODS: Available studies were identified through a systematic search of PubMed, EMBASE, and CENTRAL. Efficacy outcomes investigated were major adverse cardiovascular events, all-cause death, cardiovascular death, noncardiovascular death, myocardial infarction, and unplanned revascularization.

RESULTS: A total of 24 studies enrolling 24 285 patients were included in the meta-analysis. After a mean±SD follow-up of 2.6±1.6 years, patients undergoing physiology-guided deferred revascularization show consistently better outcomes than patients who underwent revascularization, including all-cause death (incidence rate ratio [IRR], 1.14 [95% CI, 1.00-1.30]; P=0.05), cardiovascular death (IRR, 1.53 [95% CI, 1.17-2.00]; P=0.002), and unplanned revascularization (IRR, 1.38 [95% CI, 1.06-1.79]; P=0.01). For major adverse cardiovascular events (IRR, 1.15 [95% CI, 0.99-1.34]; P=0.07) and myocardial infarction (IRR, 1.24 [95% CI, 0.95-1.61]; P=0.11), the associations did not reach statistical significance.

CONCLUSIONS: Patients in whom revascularization was deferred based on intracoronary physiology show lower risk of adverse cardiovascular events compared with those who underwent revascularization. These findings suggest that pressure wire assessment has prognostic implications besides the indication for revascularization.

PMID:42017344 | DOI:10.1161/JAHA.125.042044

Stress Health. 2026 Apr;42(2):e70178. doi: 10.1002/smi.70178.

ABSTRACT

Childhood maltreatment has been associated with an increased risk of irritable bowel syndrome (IBS) in adulthood, but the longitudinal relationship and underlying mechanisms remain underexplored. Using data from the UK Biobank, this cohort study investigated the association between childhood maltreatment and the onset of IBS in adulthood and explored potential mediating pathways. A total of 108,365 participants (mean age: 34.57 [SD: 4.81] years; 57.2% were female) were followed up from age 30 onwards (or January 1, 1985, whichever was later) until the first IBS diagnosis, death, or the end of follow-up, whichever occurred first. Childhood maltreatment was assessed through self-reported data, and incident IBS cases were identified using ICD-10 codes, with subtypes classified by Rome III criteria. Cox proportional hazards, sequential mediation analyses, and multinomial logistic regression were performed. Over a mean follow-up of 35.6 years, 5806 incident IBS cases were recorded. A positive association was observed between cumulative childhood maltreatment and incident IBS (HR: 1.10; 95% CI: 1.07-1.12). Among individual maltreatment types, emotional neglect showed the strongest association with IBS (HR: 1.27; 95% CI: 1.20-1.35). Sequential mediation analyses indicated that psychological adversity accounted for the largest proportion of the indirect effect (15.3%-17.0%), followed by socioeconomic status, lifestyle behaviours, and biological alterations. These findings emphasise the need for prevention strategies to reduce childhood maltreatment and mitigate its long-term health impacts. Tailored interventions focussing on psychosocial support, addressing socioeconomic disparities, and promoting healthy lifestyle changes may further reduce IBS risk in affected individuals.

PMID:42017339 | DOI:10.1002/smi.70178

J Am Heart Assoc. 2026 Apr 22:e048080. doi: 10.1161/JAHA.125.048080. Online ahead of print.

ABSTRACT

BACKGROUND: Although public access defibrillation programs have expanded, real-world bystander automated external defibrillator (AED) use remains limited. The concept of functional accessibility, the realistic ability of bystanders to retrieve and use an AED within a time window that affects survival, has not yet been systematically evaluated. This study aimed to evaluate the functional accessibility of publicly installed AEDs by integrating factors influencing their usability in out-of-hospital cardiac arrest events.

METHODS: We conducted a population-based geospatial analysis of 39 563 out-of-hospital cardiac arrests in Gyeonggi-do, Korea (2021-2023). Each incident was matched to the nearest public AED using network-based walking routes. Functional accessibility was measured by walking time and distance, stratified by urbanization, time of day, and location of arrest. Multivariable logistic regression was used to assess the association of AED accessibility with bystander AED use and prehospital return of spontaneous circulation.

RESULTS: The median walking time to the nearest AED was 1.9 minutes; only 25.4% of rural arrests were within 3 minutes. Among 17 285 resuscitation-attempted cases, bystander AED use occurred in 2.9%. Shorter walking time was a statistically significant predictor of AED use and prehospital return of spontaneous circulation. Nighttime and residential arrests showed markedly reduced AED use irrespective of proximity. Moreover, although home arrests accounted for 70% of cases, bystander defibrillation occurred in <2%.

CONCLUSIONS: Functional accessibility determines both device use and survival outcomes. Policies should prioritize 24/7 external AED availability, integration of dispatcher-assisted public access defibrillation programs, and novel delivery systems, such as drones, to bridge the spatial and temporal gaps in access.

PMID:42017328 | DOI:10.1161/JAHA.125.048080

Phlebology. 2026 Apr 22:2683555261446155. doi: 10.1177/02683555261446155. Online ahead of print.

ABSTRACT

BackgroundEffective management of lower extremity lymphedema requires its recognition as a distinct clinical entity. This study aimed to evaluate the validity and reliability of the Turkish version of the Lymphedema Symptom Intensity and Distress Survey-Lower Limb (LSIDS-L), a tool designed to assess both the severity and distress of symptoms in patients with lower limb lymphedema.AimsTo evaluate the validity and reliability of the Turkish version of the Lymphedema Symptom Intensity and Distress Survey-Lower Limb (LSIDS-L) in patients with lower extremity lymphedema.Study designDiagnostic Accuracy Study.MethodsThe LSIDS-L was translated and culturally adapted into Turkish using the forward-backward translation method. The final version was administered to 155 patients alongside the Lymphoedema Quality of Life Questionnaire-Leg (LYMQOL-Leg). Reliability was assessed using a 7-days test-retest approach. Descriptive statistics were used for demographic data. Construct validity was evaluated using Spearman’s rank correlation coefficient, while internal consistency and test-retest reliability were assessed via Cronbach’s alpha and the intraclass correlation coefficient (ICC), respectively.ResultsThe questionnaire demonstrated excellent test-retest reliability with ICC_1k = 0.9989 and r = 0.9970. Internal consistency was also high, with a Cronbach’s alpha of 0.9180 and a standardized alpha of 0.9145, indicating strong coherence among items.ConclusionThe Turkish version of the LSIDS-L (LSIDS-L-TR) is a valid and reliable instrument for assessing symptom intensity and distress in patients with lower extremity lymphedema. It offers a comprehensive tool for use in both clinical practice and research settings.

PMID:42017324 | DOI:10.1177/02683555261446155

J Am Heart Assoc. 2026 Apr 22:e047923. doi: 10.1161/JAHA.125.047923. Online ahead of print.

ABSTRACT

BACKGROUND: Combining PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitors with statins significantly lowers low-density lipoprotein cholesterol and reduces cardiovascular events in patients with coronary heart disease versus statins alone. However, it remains unclear which monotherapy offers greater cardiovascular benefit.

METHODS: This prospective non-randomized real-world observational cohort study enrolled coronary heart disease inpatients from July 2020 to March 2024. Patients received either alirocumab (75 mg/2 weeks) or statins (atorvastatin 20 mg/day or rosuvastatin 10 mg/day). The primary outcome was a composite of cardiovascular death, myocardial infarction, stroke, heart failure hospitalization, or coronary revascularization. Cox proportional hazards models and restricted mean survival time analyses were used.

RESULTS: Among 1165 analyzed patients, 215 received PCSK9 inhibitors and 950 received statins. After 1 month, low-density lipoprotein cholesterol reduction was greater in the PCSK9 inhibitor group (from 2.57 to 0.75 mmol/L) than in the statin group (from 2.29 to 1.40 mmol/L; P<0.001). However, this difference was not significant at 12 months (1.44 versus 1.52 mmol/L; P=0.058). Multivariate Cox regression analysis revealed an adjusted hazard ratio of 0.74 (95% confidence interval, 0.49-1.12; P=0.152) for the primary outcome with statins versus PCSK9 inhibitors. The restricted mean survival time was 26.11 months for the PCSK9 inhibitor group and 26.48 months for the statin group. The results were consistent across key subgroups. No serious adverse events occurred during the follow-up.

CONCLUSIONS: PCSK9 inhibitor monotherapy showed no statistically significant difference from statin monotherapy in long-term lipid-lowering efficacy or cardiovascular risk reduction, suggesting it may be an effective alternative for secondary prevention in coronary heart disease.

PMID:42017316 | DOI:10.1161/JAHA.125.047923

Invest Ophthalmol Vis Sci. 2026 Apr 1;67(4):53. doi: 10.1167/iovs.67.4.53.

ABSTRACT

PURPOSE: To provide insight into rod pathway dysfunction in early-stage diabetic retinopathy (DR) by measuring dark-adapted ERGs and pupillary light reflexes (PLRs) across a broad range of stimulus luminance.

METHODS: Seventeen diabetics with no clinically apparent DR (NDR), 17 with mild nonproliferative DR (MDR), and 15 nondiabetic controls participated. Dark-adapted, full-field ERGs and PLRs were obtained. Achromatic (-4 to 1 log cd-s-m-2) and long-wavelength (-4.0 to 2.6 log cd/m2) flashes were used for ERG and pupillometry, respectively. The b-wave amplitudes and pupil diameters were fit with Naka-Rushton functions to obtain (1) maximum b-wave amplitude (Vmax), (2) maximum PLR (Pmax), (3) b-wave sensitivity (kb), and (4) PLR sensitivity (kp).

RESULTS: ERG a-wave amplitude was reduced (0.13 log µV averaged across stimulus luminance) in DR compared with the controls, but this was not statistically significant (F = 1.41; P = 0.25). ERG Vmax did not significantly differ among groups (F = 2.20, P = 0.12), whereas kb was elevated (reduced sensitivity) for both groups (both t > 2.40; P < 0.02). Pupil Pmax was reduced in MDR (t = 2.83, P = 0.01), but not NDR (t = 0.99, P = 0.33). Pupil kb was significantly elevated in NDR and MDR (both t > 2.1; P < 0.04).

CONCLUSIONS: Reduced b-wave amplitude may largely be accounted for by the reduced a-wave amplitude. By contrast, pupil sensitivity loss greatly exceeded the b-wave sensitivity loss, suggesting sites of abnormality beyond the bipolar cells contribute to pupil response deficits in diabetics.

PMID:42017306 | DOI:10.1167/iovs.67.4.53

Physiother Res Int. 2026 Apr;31(2):e70223. doi: 10.1002/pri.70223.

ABSTRACT

BACKGROUND AND PURPOSE: Obesity is a widespread global health problem linked to an elevated risk of falls, detrimental effects on both static and dynamic balance, and diminished quality of life (QOL). Despite these adverse effects of obesity, research on the effectiveness of Brain Gym exercises has been conducted in various populations, but their impact has never been studied among individuals with obesity.

METHODS: A pre-post randomized controlled trial aimed to examine the influence of Brain Gym exercises on fall risk, balance, as well as quality of life among obese individuals. Thirty-two subjects (15 males and 17 females) aged 18-50 years, with a Body Mass Index (BMI) of ≥ 30 kg/m² were randomly assigned to two equal groups, Group A (experimental): engaged in Brain Gym exercises for 30 min daily, three times weekly, for eight successive weeks, in addition to conventional balance training for 45 min throughout three sessions per week for eight weeks. Group B (control): received conventional balancing training. Outcome measures included: risk of falling assessed using the Modified Arabic version of the Activities-Specific Balance Confidence Scale (ABC); static balance evaluated via the Berg Balance Scale (BBS); dynamic balance assessed with the Balance Check 636 Stability Tester (Dr. Wolff, Arnsberg, Germany); as well as health-related quality of life determined through the Arabic version of the World Health Organization Quality of Life-BREF questionnaire (WHOQOL-BREF).

RESULTS: The results indicated substantial enhancements in all assessed outcomes, including risk of falling, static balance, dynamic balance, and quality of life domains, in both groups following treatment (p < 0.001). The experimental group demonstrated statistically and clinically significant improvements in all parameters relative to the control group (p < 0.001).

DISCUSSION: Brain Gym exercises combined with conventional training could have a further impact on the risk of fall, balance as well as quality of life among obese subjects than conventional balance training alone.

TRIAL REGISTRATION: NCT06587932.

PMID:42017295 | DOI:10.1002/pri.70223