Tag: pubmed

Health Aff (Millwood). 2026 Apr 23:101377hlthaff202501665. doi: 10.1377/hlthaff.2025.01665. Online ahead of print.

ABSTRACT

Extreme heat events have been demonstrated to increase emergency department (ED) visits, hospitalizations, and mortality, but evidence of their impacts on the associated costs and on outpatient use is more limited. We used 2016-23 health insurance claims from a large, national insurer and national temperature and humidity data to conduct a regression analysis on the relationship between extreme heat exposure and ED, inpatient, and outpatient use and cost in the commercial insurance, Medicaid, and Medicare Advantage (MA) populations. One additional day with a heat index of 100°F or hotter within a week was associated with increased ED use and cost across nearly all coverage populations and age groups. Extreme heat was associated with significant increases in inpatient use for children with commercial coverage (1.4 percent), members ages 18-64 with Medicaid coverage (0.47 percent), and MA members (0.5 percent) but was not associated with statistically significant increases in inpatient cost for any population group. It was not associated with increases in outpatient use or cost in any population group. MA members had the highest annual cost due to extreme heat. These findings provide evidence to inform population health management strategies, seasonal preparedness planning, and policy interventions to mitigate heat-related morbidity and health care costs.

PMID:42024824 | DOI:10.1377/hlthaff.2025.01665

Science. 2026 Apr 23;392(6796):395-400. doi: 10.1126/science.aeb0673. Epub 2026 Apr 23.

ABSTRACT

Translating the conductivity of individual carbon nanotubes into practical, macroscopic conductors remains a challenge. We report highly aligned fibers of double-walled carbon nanotubes intercalated with chains of tetrachloroaluminate anions (AlCl₄^–) in the intertube channels. The AlCl₄^– intercalant acts as a noncovalent dopant, accepting 0.65 electrons per anion, mostly from the outer nanotube layer. Combined with a 17% intercalant volume fraction, it produces an increase in room-temperature conductivity to values as high as 24.5 mega-Siemens per meter, which is 41% of that of copper. Specific conductivity values reach 17,345 Siemens-meter squared per kilogram, which is superior to that of metals. These fibers are five times stronger and half the weight of conventional overhead cables while remaining stable in dry conditions and retaining 80% of their conductivity protected from moisture by a cable polymer sheath.

PMID:42024735 | DOI:10.1126/science.aeb0673

J Bone Joint Surg Am. 2026 Apr 23. doi: 10.2106/JBJS.25.00667. Online ahead of print.

ABSTRACT

BACKGROUND: Understanding drivers of supply and labor cost variation in orthopaedic surgery is crucial to provide value-based care. Time-driven activity-based costing (TDABC) is a more accurate methodology for capturing costs of care than traditional methods. Anterior cruciate ligament reconstruction (ACLR) is one of the most performed outpatient procedures within orthopaedic surgery. The purpose of this study was to characterize the cost composition of ACLR and identify factors that drive cost variation.

METHODS: Cost data for supplies and time-based personnel usage were extracted from electronic health records and were used to calculate costs using TDABC. TDABC methodology was applied to calculate the cost of personnel usage by multiplying the duration and associated cost per minute. Descriptive statistics and mixed-effects modeling were used to determine cost drivers.

RESULTS: This study included 861 patients who underwent ACLR at 8 hospitals. The mean patient age (and standard deviation) was 31.1 ± 11.6 years. Of the 861 patients, 350 were male and 511 were female; 85.6% of patients were White, 8.1% were Asian, and 3.4% were Black. There was 3.2-fold variation in supply costs ($2,950) and 1.6-fold variation in labor costs ($940) between the 10th and 90th percentiles. Overall, supply costs accounted for 58.2% of total costs, whereas labor costs comprised the remaining 41.8%. The intraoperative phase was the greatest generator of total cost (89.7%). After adjusting for surgeon and hospital variability, variation in total cost was most effectively explained by graft type, primary surgery status, and meniscal repair (conditional R2 = 0.84; marginal R2 = 0.27). On subanalysis, patients undergoing allograft ACLR had significantly higher total costs, implant costs, and age compared with those undergoing ACLR with any autograft type (all p < 0.01).

CONCLUSIONS: The most notable drivers of labor and supply cost variation were graft type, surgeon, surgery center, primary surgery status, and concomitant meniscal repair. Understanding modifiable cost drivers may aid health systems in designing value-based pathways, implant formularies, and surgeon education programs. Future studies may integrate cost with outcome measures for a more holistic view of value.

LEVEL OF EVIDENCE: Economic and Decision Analysis Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:42024715 | DOI:10.2106/JBJS.25.00667

Int Health. 2026 Apr 23:ihag039. doi: 10.1093/inthealth/ihag039. Online ahead of print.

ABSTRACT

BACKGROUND: Despite increased facility-based childbirth in Nepal, stagnant neonatal and high maternal mortality highlight a critical ‘know-do’ gap in care quality. To address this, a modular, competency-based learning resource package (LRP) was developed for maternal and newborn health providers.

METHODS: A mixed-methods exploratory pilot study involved curriculum alignment with international standards, multidisciplinary co-design and a single-group pre-post evaluation among 24 nursing professionals in Gandaki Province. Feasibility and acceptability were evaluated utilizing objective structured clinical examinations (OSCEs) and qualitative interviews.

RESULTS: Non-parametric analyses revealed significant educational gains. Median knowledge scores increased from 64.0 to 88.0. Statistically significant median improvements (p<0.001) were documented across all OSCE clinical domains: antenatal care (30.0 to 92.1), postnatal care (53.8 to 90.4), infection prevention (31.8 to 90.0) and respectful maternity care (30.0 to 92.9). Qualitative data indicated high acceptability; however, heavy clinical workloads and linguistic diversity constrained programmatic sustainability.

CONCLUSIONS: The LRP is a feasible intervention to bridge clinical competency gaps. Definitive national scale-up requires larger controlled trials assessing patient-level outcomes along with essential systemic investments in supply chains, healthcare infrastructure and continuous post-training mentorship.

PMID:42023467 | DOI:10.1093/inthealth/ihag039

Actas Esp Psiquiatr. 2026 Apr 15;54(2):287-300. doi: 10.62641/aep.v54i2.2043.

ABSTRACT

BACKGROUND: Non-suicidal self-injury (NSSI) in adolescents and young adults is a serious public health concern. The COVID-19 pandemic significantly impacted mental health worldwide. This longitudinal study aimed to investigate the differential impacts of COVID-19 on psychological health, social support, and academic performance among young adults with and without previous history of NSSI.

METHODS: From an initial sample of 603 college students, 241 (40%) completed this 2.5-year follow-up study. The first assessment was in January-February/2020 (pre-pandemic) and the second in June-July/2022 (post-pandemic). Participants were grouped based on the pres-ence or absence of NSSI at baseline. Variables assessed included sociodemographic data, academic performance, COVID-19-related experiences, clinical characteristics, and perceived social support.

RESULTS: A significant reduction in the prevalence of NSSI behaviors was observed over the follow-up period, decreasing from 35% to 8.7%. The NSSI group endorsed worse academic performance post-pandemic. While they maintained stable clinical severity with no observed worsening, during pandemic period they experienced an improvement in perceived social support. In contrast, the Non-NSSI group experienced a decline in perceived social support during the same period.

CONCLUSIONS: Contrary to previous studies, our findings indicate that young adults with NSSI significantly reduced self-harm behaviors after the COVID-19 pandemic. Although their academic performance was negatively affected, their clinical severity and social support did not worsen compared to those without NSSI. Findings indicate that the COVID-19 outbreak did not increase NSSI behaviors or exacerbate psychopathology in individuals with NSSI.

PMID:42023465 | DOI:10.62641/aep.v54i2.2043

Actas Esp Psiquiatr. 2026 Apr 15;54(2):335-347. doi: 10.62641/aep.v54i2.2066.

ABSTRACT

BACKGROUND: The Scale of Externalizing Problem Behaviors in Adults (SEPBA) was developed as a hybrid psychometric instrument designed to assess both dimensional traits and categorical diagnoses associated with externalizing psychopathology. Based on an integrative operational framework drawing on Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the Hierarchical Taxonomy of Psychopathology (HiTOP) model, the SEPBA assesses 15 traits/facets and 6 disorders within the domains of antagonism and disinhibition.

METHODS: The present study analyzed the psychometric properties of the SEPBA in a combined community and prisoner sample (n = 922). The final version of the SEPBA included 144 items rated on a 4-point Likert scale. Reliability (α, ω), item discrimination, convergent/discriminant validity, confirmatory factor analyses, and gender measurement invariance were examined.

RESULTS: The results indicated adequate item discrimination and internal consistency across all scales. Confirmatory factor analyses supported the unidimensionality of the individual scales and the hypothesized hierarchical organization of traits and facets. Gender invariance of the measure was demonstrated. In addition, evidence of convergent and discriminant validity was provided through correlations with external measures.

CONCLUSION: The findings support the SEPBA as a suitable assessment instrument. Its hybrid structure offers an integrative approach to transdiagnostic assessment, enhancing both the clinical utility of categorical diagnoses and the empirical applicability of dimensional profiles for assessing externalizing behaviors in adults.

PMID:42023463 | DOI:10.62641/aep.v54i2.2066

Actas Esp Psiquiatr. 2026 Apr 15;54(2):545-555. doi: 10.62641/aep.v54i2.2089.

ABSTRACT

BACKGROUND: Suicide is a leading cause of death among adolescents worldwide. Suicide is a complex multifactorial issue and, in 2025, became the third-leading cause of death among individuals aged 15-29. We sought to evaluate the effectiveness of technology-assisted interventions (TIs) in reducing both suicidal behaviour and non-suicidal self-injury among adolescents.

METHODS: For this meta-analysis, we searched the EBSCO (APA PsycArticles, APA PsycInfo, MEDLINE, APA PsycTherapy, Psychology and Behavioral Sciences Collection), PubMed and Cochrane databases from inception until May 2025, seeking out articles featuring data (quantitative outcomes related to suicidal ideation or behaviour) on evaluated suicide or self-harm interventions among children and adolescents (aged 13-18) that incorporated digital technologies in some manner. We used random effects meta-analysis to estimate the effect size for suicidal ideation reduction. We assessed heterogeneity using the I² statistic, and, due to the small number of considered studies, publication bias was assessed using an adaptation of Cochrane’s guidelines for the assessment of bias risk. The review was registered with INPLASY, with the code INPLASY202570073.

RESULTS: After applying the eligibility criteria, six studies were selected for the analysis. Although the initial conceptual aim pertained to suicidal risk and self-harm more broadly, suicidal ideation was the only outcome consistently reported across the eligible studies; therefore, it served as the primary meta-analytic outcome.

CONCLUSIONS: The results highlight that technology-assisted interventions yield an overall statistically significant moderate reduction in suicidal ideation, providing valuable support for the implementation of such interventions during adolescence, although further rigorous research is needed to strengthen the evidence base.

PMID:42023461 | DOI:10.62641/aep.v54i2.2089

Actas Esp Psiquiatr. 2026 Apr 15;54(2):443-454. doi: 10.62641/aep.v54i2.2115.

ABSTRACT

BACKGROUND: Psychometric screening tools for persons in penitentiary centers (PPC) are key to assessing their mental health needs, given the shortage of both time and mental health personnel. Depression and anxiety are among the most prevalent mental health problems in PPC. Inadequate diagnosis can lead to increased symptom severity and even suicide. Therefore, validating instruments to assess depression and anxiety in PPC populations is essential to reduce the risk of misdiagnosis and its consequences.

METHODS: A cross-sectional study was conducted to evaluate the reliability and validity of the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) in 272 men (>18 years old) deprived of liberty in a penitentiary center in Mexico. Both exploratory and confirmatory factor analyses were performed. Concurrent and discriminant validity were assessed using the depression and anxiety scales of the International Statistical Classification of Diseases and Related Health Problems, Eleventh Revision (ICD-11) Primary Health Care (PHC). Receiver Operating Characteristic curves were plotted to determine the best cut-off points in both instruments.

RESULTS: Both the PHQ-9 and GAD-7 showed items that were representative of their underlying constructs and supported the original one-factor structure, with satisfactory goodness-of-fit indices in both exploratory and confirmatory analyses. Both instruments exhibited good internal consistency in the sample of Mexican men incarcerated in penitentiary centers (α = 0.87 and α = 0.89, respectively). Furthermore, both scales showed strong correlations with the ICD-11 PHC depression and anxiety scales, along with adequate sensitivity, specificity, false positive, and false negative rates, resulting in a low misclassification rate.

CONCLUSIONS: The PHQ-9 and GAD-7 can be used to briefly and reliably assess depression and anxiety among male PPC in Mexico City and in populations with similar institutional and sociodemographic conditions Given the specific characteristics of PPC populations across different countries, it remains necessary to continue testing these instruments in underrepresented populations to ensure the development of reliable and valid tools that help identify potentially confusing items and minimize diagnostic errors.

PMID:42023458 | DOI:10.62641/aep.v54i2.2115

Actas Esp Psiquiatr. 2026 Apr 15;54(2):362-368. doi: 10.62641/aep.v54i2.2161.

ABSTRACT

OBJECTIVE: This study aims to identify predictive factors for significant cognitive improvement following transcranial direct current stimulation (tDCS) in patients with post-stroke cognitive impairment (PSCI), thereby providing evidence for individualized clinical intervention.

METHODS: A total of 123 patients with PSCI who received tDCS treatment were retrospectively enrolled. Based on changes in Mini-Mental State Examination (MMSE) scores, patients were classified into a cognitive improvement group (n = 61) and a non-improvement group (n = 62). Baseline clinical characteristics were collected, and activities of daily living were using the Modified Barthel Index (MBI). Univariate analyses were performed to compare differences between the two groups, and variables with statistical significance in univariate analysis were further entered into a multivariate logistic regression model to identify independent predictors of significant cognitive improvement following tDCS treatment.

RESULTS: The proportion of patients with a university education or above was significantly in the cognitive improvement group higher than in the non-improvement group (p < 0.001); whereas the proportion of patients with a history of stroke in the non-improvement group was significantly higher (p < 0.05). Patients in the cognitive improvement group had a significantly shorter disease duration compared to those in the non-improvement group (p < 0.05); meanwhile, a higher proportion of patients with Fazekas grade 0-1 was observed in the improvement group (p < 0.05). Results of the multivariate Logistic regression analysis indicated that educational level and disease duration were independent predictive factorsforsignificant cognitive improvement after tDCS treatment (p < 0.05).

CONCLUSION: PSCI patients with higher educational level and shorter disease duration have a better cognitive improvement effect following tDCS treatment.

PMID:42023448 | DOI:10.62641/aep.v54i2.2161

Actas Esp Psiquiatr. 2026 Apr 15;54(2):398-408. doi: 10.62641/aep.v54i2.2174.

ABSTRACT

BACKGROUND: This research aimed to examine the effects of multi-role collaborative palliative care on anxiety, cancer-related fatigue (CRF), psychological status, and quality of life in patients with advanced lung cancer, and to explore potential mechanisms using correlation analysis and structural equation modelling.

METHODS: We conducted a retrospective study of the medical records of 200 patients with advanced lung cancer. Based on the care they received, patients were divided into two groups: a control group (n = 100) that received standard nursing care, and a combined nursing group (n = 100) that received multi-role collaborative palliative care. Anxiety, CRF, psychological status, and overall quality of life were compared between the two groups based on the record documented before and after nursing care. Adverse events recorded during the nursing period were also reviewed and analysed. Path analysis of variables was conducted using the AMOS module of SPSS.

RESULTS: Following nursing care, the combined group showed significantly lower CRF and anxiety scores, and significantly higher psychological state and quality of life scores compared with both pre-nursing scores and the control group (all p < 0.05). There was no statistically significant difference in the rate of adverse event between the two groups (36.00% vs. 28.00%, p > 0.05). Path analysis indicates that multi-role collaborative palliative care is associated with lower levels of anxiety. This association has a direct relationship and indirect relationships through its connection with the reduction of CRF and the improvement of psychological condition. Path analysis shows that multirole collaborative palliative care not only directly alleviates patients’ inner anxiety, but also may indirectly reduce inner anxiety by lowering CRF and improving psychological conditions.

CONCLUSIONS: Implementing multi-role collaborative palliative care for patients with advanced lung cancer can help alleviate CRF, relieve anxiety, improve psychological state and enhance quality of life. Exploratory path analysis suggests that this nursing model has a significant direct statistical association with lower anxiety. This association may also involve indirect interrelations with lower CRF and a better psychological state.

PMID:42023445 | DOI:10.62641/aep.v54i2.2174