Tag: pubmed

Clin J Pain. 2026 Apr 6. doi: 10.1097/AJP.0000000000001385. Online ahead of print.

ABSTRACT

OBJECTIVES: Dexmedetomidine is a short-term sedative used for peripheral nerve blockade and spinal anesthesia. This meta-analysis evaluated efficacy and safety of dexmedetomidine in TAP block in C-section.

METHODS: A systematic search across online databases comparing dexmedetomidine with local anesthetics to local anesthetics isolated in TAP block for women undergoing spinal anesthesia for cesarean section. Significance was defined at P<0.05 for odds ratios (OR), mean differences (MD), and standard mean differences (SMD). Heterogeneity weas evaluated using I² statistics. Twelve randomized controlled trials (RCTs) encompassing 799 patients were included.

RESULTS: Dexmedetomidine delayed the consumption of first analgesic (MD 3.69; [95% CI 2.93-4.45]; P<0.00001; I²=86%) in the postoperative period; decreased the amount of rescue intravenous tramadol consumption (MD -13.61; [95% CI -24.56–2.67]; P=0.01; I²=85%), the number of patients who required rescue analgesic (OR 0.25; [95% CI 0.13-0.49]; P<0.00001; I²=42%) and the VAS scores at 6h (MD -1.48; [95% CI -1.65–1.30]; P<0.0001; I²=70%), at 12h (MD -0.92; [95% CI -1.60–0.24]; P=0.008; I²=90%) and at 24h (MD -0.50; [95% CI -0.93–0.08]; P=0.02; I²=92%). When patient satisfaction score was analyzed, there was also a significant difference between groups (SMD 1.07; [95% CI 0.76-1.39]; P<0.00001; I²=0%).

DISCUSSION: Dexmedetomidine with local anesthetics was associated with a delay in consumption of the first analgesic in the postoperative period, decrease in the amount of rescue intravenous tramadol and in the VAS scores at 6, 12 and 24 hours. However, the GRADE assessment of the quality of evidence was ‘low’ due to the high risk of bias and heterogeneity.

PMID:41937563 | DOI:10.1097/AJP.0000000000001385

Plant J. 2026 Apr;126(1):e70851. doi: 10.1111/tpj.70851.

ABSTRACT

1-Aminocyclopropane-1-carboxylic acid synthase (ACS) is a central and rate-limiting enzyme in ethylene biosynthesis, but the regulation of ACS in response to endogenous signals and environmental stimuli remains largely unknown, especially in fruit crops such as bananas. In this study, we used various methods, including genome-wide identification, molecular dynamics, comparative genomics, DNase-seq, DAP-seq, RNA-seq, and molecular assays, to elucidate the mechanism by which the transcription factor MaMYB73 regulates the expression of the ethylene biosynthesis-related gene MaACS1. Fourteen MaACS genes were identified in banana, among which MaACS1 plays crucial roles in ethylene biosynthesis. Molecular dynamics showed that MaACS1 binds S-adenosyl-L-methionine (SAM) at residue R220. Comparative genomics revealed that MaACS1 has three orthologs in the tomato genome (SlACS2, SlACS4, and SlACS1B). This orthogroup underwent a statistically significant expansion event along the evolutionary lineage leading to tomato, correlating with its increased ethylene production compared with that of banana. DNase-seq and DAP-seq revealed that MaMYB73 directly binds to the MaACS1 promoter. The overexpression of MaMYB73 in both banana and tomato resulted in reduced expression of MaACS1 and its homologs, respectively, leading to delayed ethylene production. Conversely, silencing MaMYB73 through virus-induced gene silencing (VIGS) significantly increased MaACS1 expression and ethylene production in banana fruit. Furthermore, the RING-H2-type E3 ubiquitin ligase MaRHA2A1, an ethylene accelerator, targets MaMYB73 for ubiquitination and subsequent degradation via the 26S proteasome pathway. Transient overexpression of MaRHA2A1 in banana increased MaACS1 expression and ethylene levels possibly by reducing the accumulation of MaMYB73, whereas silencing of MaRHA2A1 had the opposite effect. These findings provide new insights into the regulatory mechanisms controlling ethylene biosynthesis during banana fruit ripening and establish a new strategy for characterizing the transcriptional regulators of ethylene biosynthesis using various bioinformatics technologies.

PMID:41937552 | DOI:10.1111/tpj.70851

J Physician Assist Educ. 2025 Dec 8. doi: 10.1097/JPA.0000000000000731. Online ahead of print.

ABSTRACT

INTRODUCTION: Identifying predictors of success on the Physician Assistant National Certifying Examination (PANCE) is critical for physician assistant (PA) programs aiming to improve student outcomes. While preadmission metrics are often emphasized, the influence of academic performance during the PA program remains a focus of ongoing investigation. This study examines the relative contributions of preadmission variables, selected demographic factors, and didactic and clinical academic performance in predicting PANCE outcomes.

METHODS: This is a retrospective cohort study of 3 cohorts of PA students (2022-2024), assessing preadmission metrics and performance during the didactic phase and clinical year for associations with PANCE scores using linear regression, Mann-Whitney U, and Kruskal-Wallis tests, with significance set at P < .05.

RESULTS: No statistically significant associations were observed between PANCE scores and preadmission factors, including prematriculation course grades, undergraduate cumulative and science GPAs, patient care hours, or demographic variables such as gender, age, and geographic background. In contrast, didactic and clinical year GPAs, as well as performance on summative I and II exams and the end of curriculum exams, were all strongly and positively correlated with PANCE outcomes (P < .0001).

DISCUSSION: The findings suggest that both the didactic and clinical phases, along with summative assessments, are the strongest predictors of first-time PANCE success. These results underscore the importance of a rigorous curriculum and comprehensive internal assessments to prepare students for certification. Ongoing academic monitoring helps PA programs proactively identify and support students at risk of underperformance on the PANCE.

PMID:41937534 | DOI:10.1097/JPA.0000000000000731

J Appl Gerontol. 2026 Apr 6:7334648261439431. doi: 10.1177/07334648261439431. Online ahead of print.

ABSTRACT

Climate change has intensified environmental conditions that may affect respiratory comfort and overall well-being, particularly among older adults. Empirical evidence on respiratory symptoms and quality of life in later life across diverse climatic contexts remains limited. A rapid online survey was conducted from July to September 2024 among 1,585 adults aged ≥60 years from 14 provinces. Respiratory symptoms were assessed using the WURSS-24, and quality of life using the WHOQOL. Descriptive statistics were applied. Mild to moderate respiratory symptoms were commonly reported in daily life. Higher respiratory symptom burden and lower quality of life were descriptively observed with advancing age, no employment history, and residence in hotter, drier zones. Differences by sex and educational background were minimal, and subgroup patterns in respiratory symptoms were descriptively compared with quality-of-life domain scores. Respiratory symptoms among older adults in Indonesia were commonly reported and descriptively presented alongside perceived quality-of-life scores.

PMID:41937508 | DOI:10.1177/07334648261439431

J Dent Educ. 2026 Apr 6. doi: 10.1002/jdd.70215. Online ahead of print.

ABSTRACT

BACKGROUND: The advent of digital tools impacted all fields, especially dentistry by improving efficiency, the development of an index recording application is warranted to enable better data storage and data safety, reduce workload and streamline the process compared to conventional methods, thus the aim of the study is to evaluate the effectiveness of an application-based dental index recorder on user experience, acceptance, adoption attitude, and perception among dental students 3 months post-intervention.

METHODS: An interventional study was conducted among 150 dental students over a period of 3 months. The development of the application was carried out using the ADDIE model. Evaluation of the application was performed using pre-validated user experience and acceptance questionnaire after 3-month post-intervention and a customized validated attitude and perception questionnaire administered at baseline and 3-month post-intervention. The adoption of the application was evaluated through a customized validated questionnaire administered after 3 months. Descriptive statistics were calculated followed by chi-square and paired t-test were applied.

RESULTS: High user experience scores were recorded for attractiveness (2.7 ± 0.2), efficiency (2.5 ± 0.3), and novelty (2.9 ± 0.3), along with high acceptance and adoption with 85.3% integrating the application into academic practice. After 3 months post-intervention, a statistically significant positive change in attitude and perception was observed, with mean differences of 0.8 ± 0.3 and 0.3 ± 0.3, respectively, towards the application-based dental index recorder (p < 0.001).

CONCLUSION: High user experience, acceptance and adoption score along with positive attitude and perception among dental students towards the application suggest that it could be used in place of conventional index recording methods.

PMID:41937500 | DOI:10.1002/jdd.70215

Health Serv Res. 2026 Apr;61(2):e70112. doi: 10.1111/1475-6773.70112.

ABSTRACT

OBJECTIVE: To create and validate a measure of state-level, average daily Medicaid nursing home spending rates using publicly available data sources.

STUDY DESIGN: We created a new state-level measure of average daily Medicaid nursing home payment rates, calculating Medicaid spending per day divided by estimated Medicaid days. We compared this new measure to existing benchmarks in 2004 and 2019 and estimated correlations (Pearson and Spearman rank coefficients).

DATA SOURCES AND ANALYTIC SAMPLE: To create the new measure, we used data from Brown University’s Long-Term Care Focus website and the Medicaid Long-Term Services and Supports Annual Expenditure Report, covering nursing home spending and characteristics from most states.

PRINCIPLE FINDINGS: The measure of state-level average daily Medicaid nursing home spending demonstrated strong positive correlations with both historical data (Pearson [r] = 0.70, Spearman rank [ρ] = 0.80) and government-published estimates (r = 0.68, ρ = 0.63).

CONCLUSIONS: The new, validated measure offers a reliable and transparent method for comparing Medicaid nursing home payment rates across states using only publicly available data. Importantly, this approach enables timely, cross-state comparisons without the need for restricted or proprietary data, improving transparency and removing barriers to policy evaluation.

PMID:41937205 | DOI:10.1111/1475-6773.70112

Confl Health. 2026 Apr 5. doi: 10.1186/s13031-026-00789-y. Online ahead of print.

ABSTRACT

BACKGROUND: Civilians suffer greatly from mortality as a result of armed conflicts.The magnitude of family members’ deaths and their perceived causes in households in war-affected settings of Tigray region of Ethiopia has not been investigated.

METHODS: This study was part of a large integrated cross-sectional survey conducted in selected 13,915 households from 19 districts.The data analysis was done using STATA 17 versions software packages.We have fitted all the possible count regression models to discover the best fitted model. Log-likelihood, Akaike Information Criteria (AIC), and Bayesian Information Criteria (BIC) were also used to compare various candidate models. We found that the robust Poisson regression model better fits the mortality data. Adjusted Incidence Rate Ratio (AIRR) with 95% confidence intervals (CI) at P < 0.05 was used to establish the statistical significance in multivariable robust Poisson regression to assess the association between independent variables and the out come variable.

RESULTS: In this study, from the total 13,915 participants, 5% (n = 699) of them experienced civilian family members’ war-associated death.Households with a disabled member (AIRR = 2.46; 95%CI: 1.80, 3.39), displaced from home (AIRR = 0.60; 95%CI: 0.50, 0.74,five and more family size (AIRR = 1.09; 95%CI: 1.04-1.14) and widowed marital status (AIRR = 3.72; 95%CI: 2.89-4.81),, and semi-urban place of residence (AIRR = 0.49; 95CI: 0.30, 0.82) were associated with the outcome variable .

CONCLUSION: Civilian family members’ death report in this study is high. Large family size, widowed marital status, not displacing from home, having a disabled member of the family, and rural residences were the identified factors associated with civilian’s death. In the context of the cessation of hostilities following the Pretoria Peace Agreement, sustained efforts from the government, humanitarian organizations, and the international community are essential .

PMID:41937193 | DOI:10.1186/s13031-026-00789-y

Health Serv Res. 2026 Apr;61(2):e70111. doi: 10.1111/1475-6773.70111.

ABSTRACT

OBJECTIVE: To examine whether the November 2022 Massachusetts Dental Loss Ratio ballot initiative was associated with an increase in dental service prices.

DATA SOURCES AND ANALYTIC SAMPLE: We used quarterly price data from the Fluent DentaBase commercial claims dental database. Data was aggregated by state and quarter. We extracted data for Massachusetts and five comparison states: Connecticut, Maryland, New Jersey, New York, and Rhode Island from Quarter 1, 2022 through Quarter 2, 2025.

STUDY DESIGN: To account for the small number of states in our study, we used a pre-intervention unit-demeaning difference-in-differences estimator. We estimated cross-sectional regressions to estimate the average treatment effect on the treated over the entire post-intervention period after Quarter 4, 2022 and quarter-specific treatment effects. Exact inference was used to ascertain statistical significance of policy effects.

PRINCIPAL FINDINGS: Allowed prices for dental procedures increased 5.2% (95% CI: 2.3%-8.0%), and the insurer discount applied to submitted charges declined 2.8 percentage points (95% CI: -5.3 to -0.19 percentage points) relative to the comparison states.

CONCLUSIONS: Prior to full implementation of the dental loss ratio requirement in 2025, dental insurers in Massachusetts increased reimbursement to dentists to possibly meet the required dental loss ratio threshold.

PMID:41937189 | DOI:10.1111/1475-6773.70111

BMC Health Serv Res. 2026 Apr 6. doi: 10.1186/s12913-026-14470-w. Online ahead of print.

ABSTRACT

BACKGROUND: Strengthening health systems to accommodate the growing need for palliative care is a global priority. Currently, one in eight older adults in India requires palliative care with complex healthcare needs. The interaction of older adults with these needs with public and private healthcare providers is unknown. This study aims to determine the patterns of public and private healthcare utilisation and their disparities among older adults with palliative care needs.

METHODOLOGY: A cross-sectional study design was employed using the Wave-1 data of the LASI. Using the SPICT-LIS, 2903 older adults with palliative care needs were identified for the analysis. The primary outcome variable, i.e. the utilisation of the type of health facilities for outpatient visits and hospitalisation, was summarised as descriptive statistics. The Chi-square and Kruskal-Wallis tests were employed to identify the association between background characteristics and the utilisation of different facilities. Additionally, multivariate logistic regression (Odds Ratio) was performed to determine the factors associated with utilisation of private facilities.

RESULTS: The utilisation of private facilities (60.3%) was higher than that of public facilities (23%) and other facilities (16.6%) for outpatient care. Similarly, hospitalisation in private health facilities was the highest (58.3%), followed by public (39.7%) and other facilities (1.9%). Disparities in the utilisation of private facilities based on wealth status, caste, food insecurities and geographical regions were observed for both outpatient care and hospitalisation. A higher level of satisfaction with private facilities compared to public health facilities was observed in terms of waiting time, being treated respectfully, providing clear explanations, maintaining privacy during conversations, and cleanliness.

CONCLUSION: Older adults with palliative care needs used private healthcare facilities significantly more than public ones for outpatient care and hospitalisation. Their use of private facilities was also linked to disparities based on socio-economic status. Addressing gaps in public health service provisions is crucial to achieving universal health coverage for older adults with palliative care needs. Public-private partnerships, social welfare schemes, and expanded health insurance could help reduce these disparities.

PMID:41937173 | DOI:10.1186/s12913-026-14470-w

BMC Med. 2026 Apr 6. doi: 10.1186/s12916-026-04841-9. Online ahead of print.

ABSTRACT

BACKGROUND: Evidence regarding a preventive impact of antiviral medication for influenza on hospitalization or mortality among non-severe cases is scarce. The objective of this study was to assess the association between the use of antiviral medications in non-hospitalized patients with influenza and their subsequent hospitalization and mortality.

METHODS: This multi-center retrospective cohort study used TriNetX, a global database to assess the clinical impact of antiviral medications (oseltamivir, laninamivir, zanamivir, peramivir, and baloxavir) for influenza among non-hospitalized patients. The outcomes included hospitalization, emergency department visit, intensive care unit (ICU) admission, and mortality between 3 and 30 days following influenza diagnosis with the 2-day window period between diagnosis and antiviral administration. Propensity score matching with a 1:1 ratio was conducted to estimate the risk ratio (RR).

RESULTS: A total of 1,016,581 patients with influenza were identified. After matching, 426,275 patients from each cohort were compared. The antiviral-treated group was associated with lower risks of hospitalization (RR 0.91; 95% confidence interval 0.85-0.95; p < 0.001); emergency department visits (RR 0.80; 95% CI 0.79-0.82; p < 0.001), ICU admission (RR 0.84; 95% CI 0.73-0.97; p = 0.016); and mortality (RR 0.60; 95% CI 0.47-0.77; p < 0.001). The sensitivity analysis revealed that the statistical significance in hospitalization was maintained by replacing the 2-day window period with 0 days (RR 0.82; 95% CI 0.79-0.84; p < 0.001). The sensitivity analysis limited to those aged 2 to 64 years without any high-risk comorbidities in the antiviral-treated group compared to the antiviral-untreated group showed fewer outcome events for hospitalization (RR 0.76; 95% CI 0.68-0.85; p < 0.001); ED visit (RR 0.68; 95% CI 0.65-0.71; p < 0.001); and ICU admission (RR 0.48; 95% CI 0.30-0.78; p = 0.002).

CONCLUSIONS: Antiviral treatment was negatively associated with hospitalization, ICU admission, and mortality. The results need to be interpreted with caution, given limitations.

PMID:41937170 | DOI:10.1186/s12916-026-04841-9