Tag: pubmed

JAMA Intern Med. 2026 Jun 8. doi: 10.1001/jamainternmed.2026.1910. Online ahead of print.

ABSTRACT

IMPORTANCE: Postoperative delirium is associated with long-term cognitive decline in older adults. This might be caused by the delirium itself or because delirium is more common in persons who are ill and frail, and these conditions are also associated with cognitive decline.

OBJECTIVE: To determine whether cognitive decline associated with postoperative delirium is mediated by illness and frailty, as measured by recurrent hospitalizations.

DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study included community-dwelling older adults (age ≥70 years), enrolled from June 2010 to August 2013 with 5 years of follow-up data in the ongoing Successful Aging after Elective Surgery longitudinal study. Data were analyzed from November 2022 to May 2026.

EXPOSURES: Incident delirium following major elective surgery, with and without rehospitalizations, combined and by type (rehospitalization alone, rehospitalization with intensive care unit stay, rehospitalization with postacute care stay).

MAIN OUTCOMES AND MEASURES: The main outcome was long-term cognitive decline, measured as change in General Cognitive Performance (GCP) score, a composite measure of 11 neuropsychological tests, between preoperative baseline and 10 repeated assessments over 5 years.

RESULTS: In the cohort of 560 older adults (mean [SD] age, 76.7 [5.2] years; 326 female [58%]), the mean (SD) GCP score at baseline was 57.6 (7.3). Each rehospitalization was associated with a decline of -0.19 (95% CI, -0.31 to -0.09) GCP units per year. Delirium was associated with more marked cognitive decline of -0.33 (95% CI, -0.67 to -0.06) GCP units per year. Rehospitalizations were more common among patients who developed delirium (adjusted incidence rate ratio, 1.42 [95% CI, 1.17 to 1.72]). However, adjustment for combined rehospitalizations and for each type of rehospitalization resulted in only a minimal percentage change that was not statistically significant (-6% to -9%) in the association of delirium with cognitive decline.

CONCLUSIONS AND RELEVANCE: In this cohort study, contrary to expectations, rehospitalization did not mediate the association between delirium and long-term cognitive decline. Future work will be needed to elucidate the pathways by which delirium is associated with long-term cognitive decline.

PMID:42258189 | DOI:10.1001/jamainternmed.2026.1910

JAMA Pediatr. 2026 Jun 8. doi: 10.1001/jamapediatrics.2026.2118. Online ahead of print.

ABSTRACT

IMPORTANCE: Smartphone acquisition and use under age 13 years is common and has been linked to adverse health implications. Although delaying acquisition until after age 13 years is often recommended, evidence supporting this guideline remains limited.

OBJECTIVE: To quantify the associations of smartphone acquisition around age 13 years and smartphone use with depression, obesity, and insufficient sleep at age 14 years.

DESIGN, SETTING, AND PARTICIPANTS: In this cohort study of youth from the Adolescent Brain Cognitive Development Study, eligible participants were study participants who did not have a smartphone by the 13-year-old assessment. Mixed-effects regression models were applied to quantify associations of past-year smartphone acquisition and use with health outcomes adjusting for pre-exposure depression, obesity and sleep, multiple socioeconomic and parental confounders, and use of other devices. Analyses were conducted between November 2025 and April 2026.

EXPOSURES: Smartphone acquisition and self-reported smartphone use duration (smartphone time).

MAIN OUTCOMES: Odds ratios (ORs) for associations with depression diagnosis (based on a validated computerized diagnostic assessment), obesity (body mass index above 95th percentile), and insufficient sleep (less than 8 hours/night).

RESULTS: Participants included 1959 youth (803 girls [41.0%]; 292 Black [14.9%], 314 Hispanic [16.0%], 1661 White [84.8%]) followed up from the 3-year (mean [SD] age, 12.7 [0.6] years) to the 4-year (mean [SD] age, 14.0 [0.7] years) assessment. Between the 3- and 4-year assessments, 1230 participants acquired a smartphone and 729 did not. Smartphone acquisition was not significantly associated with depression (OR, 1.45; 95% CI, 0.98-2.14) or obesity (OR, 1.02; 95% CI, 0.71-1.46), but was associated with insufficient sleep (OR, 1.29; 95% CI, 1.03-1.62) at follow-up. Among those who had acquired a smartphone, total smartphone time (standardized z score) was associated with depression (OR, 1.22; 95% CI, 1.01-1.80), obesity (OR, 1.34; 95% CI, 1.09-1.65), and insufficient sleep (OR, 1.28; 95% CI, 1.12-1.47). Placing smartphones outside the bedroom at bedtime was associated with lower odds of insufficient sleep (OR, 0.64; 95% CI, 0.47-0.87).

CONCLUSIONS AND RELEVANCE: The results of this cohort study suggest that simply smartphone acquisition at age 13 years was not associated with depression or with obesity, but was associated with insufficient sleep at age 14 years; however, the amount of smartphone use was associated with higher odds of all 3 outcomes. Behavioral interventions like limiting smartphone time and keeping smartphones out of bedrooms at night may protect adolescents from potential adverse health outcomes. Findings offer insights to guide caregivers on adolescent smartphone use and inform policies aimed at protecting youth, such as delaying smartphone acquisition until age 13 years.

PMID:42258187 | DOI:10.1001/jamapediatrics.2026.2118

Integr Comp Biol. 2026 Jun 8:icag063. doi: 10.1093/icb/icag063. Online ahead of print.

ABSTRACT

Since the first publication in 2014 reporting that progesterone is detectable in whale baleen, numerous studies have confirmed that patterns of hormones in baleen can provide a multi-year time series of continuous endocrine information from individual whales. The field is poised to expand substantially in the near future, and thus it is an opportune time to review findings and identify current knowledge gaps and pathways for future research. A search of baleen-hormone literature reveals 30 publications that, in total, investigate eight steroid hormones and two thyroid hormones in baleen of ten species of mysticete whale, with the pygmy right whale representing the only mysticete family not yet studied. An early phase of methodological validations optimized the technique, including reduction of sample mass requirement and improvements in hormone yield. Steroid hormones have consistently passed technical and physiological validations; thyroid hormones, however, are still in need of physiological validations. Later literature has entailed a series of descriptive studies, which typically combine endocrine and isotope analyses to elucidate typical hormone ranges and patterns across years in relation to species, sex, age class, and reproductive state. Most descriptive studies have been limited to a small n of individuals (a consequence of the high n of subsamples per whale), yet have been highly informative nonetheless, revealing many unexpected findings (e.g., evidence suggestive of extended gestation, timing and location of breeding, reproductive senescence, early sexual maturity, pregnancy loss, and effects of stressors). Such case-study reports remain of considerable value, but the field is increasingly expanding to include hypothesis-driven research on ecological questions of broad significance, such as influences of oceanographic factors and anthropogenic stressors, and the physiological and behavioral plasticity of individual responses to such environmental drivers. Addressing such questions will require robust statistical frameworks and larger sample sizes of individual whales, a daunting task given that a single baleen specimen can generate > 150 samples requiring months of labor and associated costs. Thus, increased collaborations could be both fruitful and necessary (e.g., a baleen-hormone research consortium wherein datasets can be pooled across research teams). In sum, baleen hormone research has provided unique and invaluable insights into patterns of physiology across time in the great whales and has great promise to continue advancing understanding of the biology of these vulnerable, long-lived, enigmatic species.

PMID:42258149 | DOI:10.1093/icb/icag063

J Clin Monit Comput. 2026 Jun 8. doi: 10.1007/s10877-026-01452-w. Online ahead of print.

ABSTRACT

This study aimed to achieve two primary objectives: (1) to evaluate the opioid-sparing effect of Surgical Pleth Index (SPI)-directed analgesia during surgery via a randomized controlled trial (RCT), and (2) to propose and preliminarily assess a novel dynamic metric, Threshold-based Time-Weighted SPI (Tb-TW-SPI), which integrates stimulus intensity and duration, for its predictive efficacy regarding postoperative moderate-to-severe pain. Employing an RCT combined with exploratory analysis, 61 patients undergoing elective laparoscopic gynecologic surgery were randomized into an SPI-directed analgesia group or a conventional analgesia group. The primary outcome was total intraoperative remifentanil consumption. Postoperatively, an exploratory analysis of the control group data evaluated the correlation between Tb-TW-SPI and Numeric Rating Scale (NRS) pain scores in the post-anesthesia care unit (PACU), calculating its predictive value for moderate-to-severe pain (NRS ≥ 4). Results: The SPI-directed group required significantly less intraoperative remifentanil than the conventional group [median (IQR): 5.84(5.02,6.62)vs. 6.96(5.81,8.19)µg/kg/h; P = 0.016]. Postoperative pain scores did not differ significantly between groups (P > 0.05). Exploratory analysis of the conventional analgesia group revealed that Tb-TW-SPI values were significantly higher in patients with moderate-to-severe postoperative pain (NRS ≥ 4) compared to those without (P = 0.0417).The area under the ROC curve for Tb-TW-SPI predicting this pain was 0.74 (95% CI: 0.52-0.96), with 67% sensitivity and 76% specificity at an optimal cutoff of 1210. This RCT suggests that SPI-directed analgesia can safely and moderately reduce intraoperative remifentanil consumption. Furthermore, the proposed Tb-TW-SPI metric, in this exploratory analysis, suggests potential for predicting postoperative pain, though this finding requires validation in larger cohorts with higher-frequency SPI sampling, offering a new direction for SPI interpretation. Large-scale, multicenter trials are warranted to validate the predictive utility of Tb-TW-SPI. Clinical Trial Registration, China Clinical Trial Registry: ChiCTR2400088444.

PMID:42258123 | DOI:10.1007/s10877-026-01452-w

J Cancer Surviv. 2026 Jun 8. doi: 10.1007/s11764-026-02054-w. Online ahead of print.

ABSTRACT

PURPOSE: Prospective evidence on the role of pre-chemotherapy psychosocial factors in symptom burden across the first chemotherapy cycle remains limited among patients with cancer. This prospective multicenter observational cohort study aimed to comprehensively evaluate clinical and pre-chemotherapy psychosocial predictors of chemotherapy-induced nausea and vomiting (CINV) across the entire first chemotherapy cycle.

METHODS: Chemotherapy-naive adult cancer patients scheduled to receive their first cycle of highly or moderately emetogenic chemotherapy (HEC or MEC) were enrolled. Pre-chemotherapy psychosocial variables were assessed using the Distress Thermometer (DT), selected Mini-Mental Adjustment to Cancer (Mini-MAC) subscales, and an investigator-developed behavioral/cognitive risk factor questionnaire. CINV was assessed through a 21-day patient diary after chemotherapy. Correlation and multicollinearity diagnostics were performed to assess relationships among psychosocial variables. Univariable and multivariable logistic regression analyses were applied to identify factors associated with CINV across the acute, delayed, and beyond-risk phases. Moderation analyses examined whether clinical variables modified psychosocial effects. A sensitivity analysis restricted to patients receiving guideline-adherent prophylaxis assessed psychosocial associations with CINV using reduced models adjusted for established CINV risk factors.

RESULTS: Among 1168 patients screened, 1031 chemotherapy-naive individuals were eligible and included in the final analysis. Acute-phase CINV occurred in 72.8% of patients, while delayed-phase CINV was reported by 73.0%. Notably, 25.6% of patients experienced CINV beyond the risk phase, predominantly nausea (25.5%) rather than vomiting (3.8%). Patients who developed CINV had higher levels of pre-treatment psychological distress and maladaptive coping, including helplessness/hopelessness and anxious preoccupation (all P < 0.001). In univariable analyses, clinical factors, including HEC, advanced disease stage, and non-adherence to guideline-recommended prophylaxis, as well as patient-related and psychosocial factors, were associated with CINV. After adjustment, motion sickness history, short sleep duration, and clinically significant distress remained independently associated with CINV across multiple phases. In the beyond-risk phase, multiple psychosocial and behavioral factors, including vomiting expectancy, perceived nausea susceptibility, motion sickness history, short sleep duration, clinically significant distress, helplessness/hopelessness, and anxious preoccupation, remained independently associated with CINV, whereas most clinical determinants lost statistical significance, except chemotherapy emetogenicity. Moderation analyses indicated that these psychosocial associations were not significantly modified by chemotherapy emetogenicity or antiemetic guideline adherence. In sensitivity analyses restricted to patients receiving guideline-adherent prophylaxis, Mini-MAC/H, Mini-MAC/AP, and short sleep duration remained associated with overall CINV.

CONCLUSIONS: Pre-chemotherapy psychosocial and behavioral susceptibility factors were independently associated with CINV throughout the first chemotherapy cycle, with particularly persistent associations beyond the conventional risk window. These findings support integrating routine pre-chemotherapy psychosocial screening into standard antiemetic and survivorship-oriented supportive care.

IMPLICATIONS FOR CANCER SURVIVORS: Incorporating psychosocial risk assessment before chemotherapy may help identify patients vulnerable to persistent CINV and inform individualized supportive care across the survivorship continuum.

PMID:42258111 | DOI:10.1007/s11764-026-02054-w

Phys Eng Sci Med. 2026 Jun 8. doi: 10.1007/s13246-026-01750-2. Online ahead of print.

ABSTRACT

The complex dose delivery mechanisms of TomoTherapy (TOMO) demand rigorous patient-specific quality assurance (PSQA). This study systematically evaluates the relationship between ArcCHECK measurements and GPU-accelerated Monte Carlo (GPU-MC) calculations for nasopharyngeal carcinoma (NPC) TOMO plans across multiple gamma criteria, aiming to delineate their respective strengths and inform an optimized verification strategy. A retrospective analysis was conducted on 317 TOMO plans for NPC, each optimized using the Accuray Precision Treatment Planning System. Patient-specific dose verification was performed using ArcCHECK measurements and independent MC calculations implemented through PlanQA. Gamma passing rates (GPRs) were evaluated under nine different conditions, including both same-criterion and cross-criterion comparisons. To assess differences, agreement, and correlations between methods, statistical analyses were conducted using the Wilcoxon signed-rank test, Bland-Altman analysis, and Spearman correlation. Under identical Gamma criteria, there was no statistically significant difference in GPR between ArcCHECK and MC. However, cross-criterion comparisons revealed marked discrepancies, highlighting the criterion-dependent nature of GPR outcomes. Lenient standards typically exhibit good consistency and relatively minor deviations. Furthermore, the correlations among all combinations of these standards can be considered negligible. The comparable performance of GPU-MC and ArcCHECK under conventional criteria (3%/3 mm, 3%/2 mm) validates ArcCHECK’s established role in verifying delivery fidelity. Crucially, under the stringent 2%/2 mm criterion where ArcCHECK passing rates decline, MC provides critical diagnostic power to differentiate between discrepancies originating from the dose calculation algorithm and those arising from the physical delivery process. For TOMO PSQA, GPU-MC and ArcCHECK are complementary. An integrated approach leveraging both methods is therefore recommended.

PMID:42258104 | DOI:10.1007/s13246-026-01750-2

Carbon Balance Manag. 2026 Jun 8. doi: 10.1186/s13021-026-00464-y. Online ahead of print.

ABSTRACT

BACKGROUND: Carbon stocks and stock changes in harvested wood products (HWPs) are an important part of land sector greenhouse gas (GHG) estimation and reporting. HWPs broadly categorized as products in-use (e.g., solid wood and paper products) and in solid waste disposal sites (SWDS; e.g., landfills), store carbon transferred from harvested trees. In the United States (US), estimates of carbon in HWPs have historically been reported in the US GHG Inventory and included in submissions to the United Nations Framework Convention on Climate Change. These data have been obtained from national and international statistics on production and consumption of forest products and incorporated into a compilation system to estimate carbon in products in-use and in SWDS. In contrast, estimates of carbon in forest ecosystems have been obtained from nationwide forest inventory (NFI) data collected and maintained by the US Forest Service, Forest Inventory and Analysis (FIA) program. Here we describe a case study for the northern Lake States region of the US (Michigan, Minnesota, Wisconsin) where harvest data from the FIA program were integrated into HWP compilation systems. This advance improves consistency and continuity with forest ecosystem from NFI plots with estimates of HWPs.

RESULTS: Over the 1900-2024 time period, total estimated net accumulation (i.e., balance of additions from transfers of harvested wood from forest ecosystems and losses from decay of wood harvested in the past) of carbon stored in products in-use was 277.0 ± 17.5 Million Metric Tons (MMT) Carbon (C) and in SWDS was 155.2 ± 9.8 MMT C. We estimate that HWPs from the region represent a carbon sink of 4.9 ± 0.1 MMT C in 2024. These estimates include HWPs produced in the region and exported domestically or internationally, as well as any HWPs produced and retained in the region, but not imports.

CONCLUSIONS: The proposed methodology enables disaggregation with coarse national and state-level FIA data, and allows for integration of more specific, entity-level data to improve precision and reduce uncertainty in HWPs estimates in the US and improves consistency and continuity with forest ecosystem estimates across spatial and temporal scales.

PMID:42258097 | DOI:10.1186/s13021-026-00464-y

J Patient Rep Outcomes. 2026 Jun 8. doi: 10.1186/s41687-026-01094-1. Online ahead of print.

ABSTRACT

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is often performed under conscious sedation, which may increase pain and dissatisfaction. Mental health conditions may influence patient-reported experience measures (PREMs), including tolerability. This study explores the association between pre-existing anxiety and/or depression and ERCP tolerability using the validated Patient-Reported Scale for Tolerability of Endoscopic Procedure (PRO-STEP) to address this.

METHODOLOGY: We performed a retrospective analysis of prospectively maintained data from an international observational cohort of adult patients undergoing ERCP. Pre-existing anxiety/depression were identified prior to the index procedure and the PRO-STEP questionnaire was used to evaluate peri- and post-procedure outcomes. Univariable and multivariable logistic regressions examined the associations between pre-operative anxiety/depression and peri- and post-operative tolerability and patient-reported health outcomes.

RESULTS: Among 3,714 participants, 13% had anxiety and/or depression. The mean age of participants in the control group was 62.3 ± 17.4 years, and 49.9% were female, while in the group with depression and/or anxiety, the mean age was 60.0 ± 16.4 years and 68.3% were female (p < 0.001). Common bile duct stones were the most common indications for ERCP in both groups (41.6% of controls and 42.4% of the depression/anxiety group, p = 0.10). Patients in the depression/anxiety group reported higher rates of opioid use (23.4% vs. 13.8%, p < 0.001), cannabis use (22.8% vs. 10.5%, p < 0.001), and heavy alcohol consumption (5.0% vs. 3.6%, p < 0.001). There were no statistically significant differences between groups in terms of disposition, comorbidities, or procedural parameters. Underlying anxiety and/or depression was significantly associated with increased intra-procedural awareness score > 3 (odds ratio, OR, 1.55, 95% CI 1.23-1.95) and discomfort score > 6 (OR 1.73, 95% CI 1.23-2.43) and with post-procedural scores > 3 for abdominal pain (OR 1.44, 95% CI 1.08-1.93), nausea (OR 2.03, 95% CI 1.43-2.89), and distension (OR 2.12, 95% CI 1.29-3.50).

CONCLUSIONS: Patients with pre-existing anxiety and/or depression reported significantly worse tolerability of ERCP under conscious sedation. Although further research is needed in this area, staff in gastrointestinal endoscopy units should consider strategies aimed at improving tolerability and, consequently, satisfaction among vulnerable populations.

PMID:42258080 | DOI:10.1186/s41687-026-01094-1

Clin Rheumatol. 2026 Jun 8. doi: 10.1007/s10067-026-08213-9. Online ahead of print.

ABSTRACT

BACKGROUND: Humans are concurrently exposed to a variety of environmental endocrine-disrupting chemicals (EDCs), which include such widespread substances like urinary perchlorates, nitrates, thiocyanates, and serum per- and polyfluoroalkyl substances (PFAS). The vast majority of the previous studies were devoted to individual chemicals or certain groups of chemicals, but the impact of co-exposure to mixtures of EDCs was also not thoroughly studied. The objective of this study is to identify the relationship between these EDC mixtures and prevalence of rheumatoid arthritis (RA) based on NHANES database.

METHODS: We used three types of regression models with individual chemical effects, weighted quantile sum (WQS) regression, and Bayesian kernel machine regression (BKMR) in 2005-2012 to analyze results of individuals aged ≥ 20 years. Age and gender subgroup analyses were also done.

RESULTS: A total of 4219 patients were analyzed, and 215 (5.10%) of them had RA. Multivariate logistic regression demonstrated that there was a significant relationship between thiocyanate (as a continuous variable) and the prevalence of RA. The upper quartile of perchlorate, nitrate as well as thiocyanate and MPAH showed correlation with elevated prevalence of RA. The effects of specific chemicals were stronger among the older subjects and females. WQS and BKMR models showed a positive association between co-exposure to these chemicals and RA, with thiocyanate as the primary contributor. These associations were especially strong in young adults and females.

CONCLUSION: This study provides the first evidence that co-exposure to a mixture of EDCs is positively correlated with RA, with a stronger effect in young adults and females. Thiocyanate is identified as a key contributor. Limiting exposure to EDCs may be beneficial for potentially reducing RA risk. Key Points • We assessed the association between a mixture of ten chemicals and the risk of incidence of RA. • The co-exposure of chemical mixtures were positively associated with RA by WQS and BKMR models. • Thiocyanate was the key contributor in these mixtures. • The associations were more pronounced among young adults and females.

PMID:42258069 | DOI:10.1007/s10067-026-08213-9

Saudi Dent J. 2026 Jun 8;38(6):82. doi: 10.1007/s44445-026-00191-7.

ABSTRACT

PURPOSE: To examine the associations between oral microbiome diversity and genus composition with the Zhejiang University Index (ZJU Index) and clinical biomarkers.

METHODS: We included 2,490 eligible participants from the U.S. National Health and Nutrition Examination Survey (NHANES). Oral microbiome diversity was assessed using alpha and beta diversity, and genus-level analyses were based on abundance transformed using the centered log-ratio (CLR) method to account for compositionality. Weighted logistic regression models were used to assess the corresponding associations. Beta diversity disparities were evaluated through Principal Coordinate Analysis (PCoA) and Permutational Multivariate Analysis of Variance (PERMANOVA).

RESULTS: Alpha diversity metrics were positively correlated with the ZJU Index in males aged 30-44 years (Faith’s Phylogenetic Diversity: unadjusted: β = 0.05, 95% CI: 0.006 to 0.094, p = 0.033; Model 1: β = 0.058, 95% CI: 0.011 to 0.104, p = 0.026; Model 2: β = 0.076, 95% CI: 0.032 to 0.120, p = 0.005; Model 3: β = 0.081, 95% CI: 0.035 to 0.128, p = 0.008) and in females aged 60-69 years (Observed ASVs: β = 1.242, 95% CI: 0.345 to 2.139, p = 0.042; Faith’s Phylogenetic Diversity: β = 0.097, 95% CI: 0.025 to 0.168, p = 0.045). Significant differences in beta diversity metrics were observed among ZJU Index-defined subgroups (p < 0.05), confirmed with age- and sex-stratified analyses. Genera including Bulleidia, Senegalimassilia, Fretibacterium, and Hungatella exhibited significant associations with the ZJU Index and with clinical biomarkers (triglycerides, low-density lipoproteins (LDL), high-density lipoproteins (HDL), insulin, and testosterone).

CONCLUSIONS: Higher oral microbiome alpha diversity was associated with higher ZJU Index in certain populations. Beta diversity demonstrated that ZJU Index-defined subgroups differed in oral microbial composition. Specific genera were identified to be significantly associated with the ZJU Index and clinical biomarkers.

PMID:42258061 | DOI:10.1007/s44445-026-00191-7