Tag: pubmed

J Racial Ethn Health Disparities. 2026 Jul 30. doi: 10.1007/s40615-026-03120-w. Online ahead of print.

ABSTRACT

Racial inequities related to COVID-19 exposure, morbidity, mortality, and access to care in the United States (U.S.) are notable, and COVID-19 vaccine uptake is lower among Black Americans than White Americans. Yet, mechanisms linking healthcare experiences to COVID-19 vaccination behavior among young adults are not well characterized. We analyzed cross-sectional data collected between March and June 2023 from 360 Black young adults (ages 18-29) enrolled in a digital health trial in Georgia, Alabama, and North Carolina (NCT05490329). Discrimination in medical settings and group-based medical mistrust were assessed. COVID-19 vaccination was measured as ever receiving at least one dose. Correlations and a mediation model (PROCESS Model 4; 5,000 bootstrap resamples) tested whether medical mistrust statistically mediated the association between discrimination in medical settings and COVID-19 vaccination, adjusting for age, sex at birth, state, insurance, education, and perceived COVID-19 risk. In mediation analyses, discrimination in medical settings had a significant total effect on COVID-19 vaccination (B=-0.44, SE=0.13, p<.001) and was associated with higher mistrust (B=0.42, SE=0.04, p<.001); higher medical mistrust was associated with lower likelihood of COVID-19 vaccination (B=-0.65, SE=0.24, p=.006). The indirect effect was significant (B=-0.28, SE=0.12, 95% CI [-0.557, – 0.081]). Findings suggest that discriminatory healthcare encounters may reduce COVID-19 vaccination uptake partly through elevated medical mistrust, highlighting the need for trust-building, non-stigmatizing strategies to improve vaccination among Black young adults in the U.S. South.

PMID:42530812 | DOI:10.1007/s40615-026-03120-w

Geroscience. 2026 Jul 30. doi: 10.1007/s11357-026-02399-1. Online ahead of print.

ABSTRACT

Declines in nicotinamide adenine dinucleotide (NAD+) are linked to metabolic stress accompanying aging and disease. While precursor-based approaches elevate systemic NAD, their clinical translation can be constrained by biosynthetic bottlenecks and first-pass metabolism. RENEWAL-NAD+ (ClinicalTrials.gov NCT07336836; retrospectively registered 01/04/2026) was a double-blind, randomized, placebo-controlled Phase 0/1b trial in healthy adults aged 45-75 years (60 randomized; primary analysis n = 50) evaluating 5 days of oral LathMized® NAD+ (LNAD+), a physicochemically modulated formulation that alters the supramolecular organization and solution behavior of NAD+ while preserving its native molecular structure. The primary endpoints were change in intracellular NAD (icNAD), measured in whole blood, and circulating NAD (cirNAD), measured in separated plasma, relative to baseline. LNAD+ produced a rapid and pronounced increase in icNAD, with a 53% elevation versus placebo at Day 6 (p = 5.48e^-14; Hedges’ g = 3.66), while cirNAD was unchanged (p = 0.60), demonstrating compartment-selective augmentation. Plasma NAD catabolites increased substantially (1-methyl-nicotinamide, MeNAM p = 5.39e^-13; N1-methyl-2-pyridone-5-carboxamide, 2PY p = 2.95e^-16), consistent with downstream engagement of NAD metabolic flux. Exploratory analyses identified non-overlapping correlates for the two compartments (cirNAD tracking inflammatory and metabolic markers, icNAD tracking red blood cell indices and NAM). Treatment was very well tolerated: symptom incidence was comparable between groups (p = 0.68), only one mild adverse event (nausea, Grade 1) occurred in the LNAD+ arm, and no secondary clinical, vital-sign, wellbeing, or wearable-derived endpoint survived multiplicity correction. These data demonstrate rapid intracellular NAD augmentation after oral LNAD+ dosing with pharmacodynamic evidence of downstream metabolism, compartment-specific physiological signatures, and a favorable short-term safety profile, with exploratory multi-omic analyses ongoing.

PMID:42530810 | DOI:10.1007/s11357-026-02399-1

Eur Arch Paediatr Dent. 2026 Jul 30. doi: 10.1007/s40368-026-01254-3. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate and compare the 12-month clinical and radiographic success of partial pulpotomy in primary molars using three bioactive materials-MTA, Biodentine, and TheraCal PT-and to assess the influence of final restoration type on treatment outcomes.

METHODS: This randomised controlled trial was conducted in a university postgraduate dental clinic setting and included 120 children aged 4-7 years with cariously exposed, restorable primary molars diagnosed with reversible pulpitis. Teeth were randomised to one of three pulp-capping materials (MTA, Biodentine, or TheraCal PT) and restored with either a preformed metal crown (PMC) or glass ionomer cement (GIC), forming six subgroups. Clinical and radiographic outcomes were assessed at regular intervals using modified Zurn and Seale criteria. Outcome assessment was performed by two blinded evaluators. Cox regression analysis and Kaplan-Meier survival curve were used.

RESULTS: A total of 120 participants (20 per subgroup) were included in the intention-to-treat analysis. No statistically significant differences were observed amongst the groups (p > 0.05). Overall success rates across the six subgroups ranged from 65 to 90% at 12 months. Cox regression showed no significant effect of capping material (Biodentine: HR = 1.06; TheraCal PT: HR = 1.75; overall p > 0.05) or restoration type (GI vs PMC: HR = 1.79; 95% CI 0.82-3.92; p = 0.145) on treatment survival. No material-related adverse events were reported.

CONCLUSIONS: Partial pulpotomy using MTA, Biodentine, or TheraCal PT demonstrated comparable clinical and radiographic outcomes at 12 months. No statistically significant differences were observed between the evaluated materials or final restoration types.

CLINICAL REGISTRY: ClinicalTrials.gov, NCT06227390, submission date: 22 December 2023.

PMID:42530796 | DOI:10.1007/s40368-026-01254-3

Nurs Crit Care. 2026 Sep;31(5):e70611. doi: 10.1111/nicc.70611.

ABSTRACT

BACKGROUND: Hyperglycaemia is common among intensive care unit (ICU) patients and is associated with increased mortality. However, whether intensive or liberal glucose control is more beneficial remains controversial.

AIM: To compare the benefits and risks of intensive versus liberal glucose control in ICU patients.

STUDY DESIGN: A Meta analysis of randomized controlled trials.

METHODS: Systematic review and meta-analysis of randomized controlled trials (RCTs). We systematically searched PubMed, Cochrane Library, Embase and Web of Science from inception to October 30, 2024. The review was conducted according to PRISMA guidelines. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Data were independently screened and extracted by four reviewers. Relative risks (RRs) were pooled using a random effects model, and trial sequential analysis was performed for the primary outcome.

RESULTS: Seventy RCTs were included, comprising 36 502 patients, of which 64 RCTs (32 491 patients, 89%) were conducted in adults and 6 RCTs (4011 patients, 11%) in children. The RR of all-cause mortality after intensive and liberal glucose control was 0.99 (95% CI, 0.93-1.05) in adults. Comparable findings were observed for all-cause mortality in children. Intensive glucose control had a statistically significantly higher risk of severe hypoglycaemia in both children (RR 5.70; 95% CI 2.60-12.51) and adults (RR 3.55; 95% CI 2.49-5.07). However, intensive glucose control had a statistically lower risk of infection in both children (RR 0.83; 95% CI 0.70-0.98) and adults (RR 0.78; 95% CI 0.63-0.97). In the subgroup analysis of adults, a lower risk of infection was observed in all surgical groups, but not in the medical group. There was no statistically significant difference in other complications, including sepsis, acute renal injury, new need for dialysis and need for blood transfusion.

CONCLUSIONS: Intensive and liberal glucose control had similar effects on all-cause mortality in adults and children, though paediatric data are limited and should be interpreted cautiously. Intensive glucose control reduced infection risk, especially in surgical ICUs, but increased the risk of severe hypoglycaemia.

RELEVANCE TO CLINICAL PRACTICE: These findings suggest that routine intensive glucose control does not improve survival and should be applied cautiously due to increased hypoglycaemia risk, although it may reduce infection risk, particularly in surgical ICU patients.

PMID:42529895 | DOI:10.1111/nicc.70611

Pers Soc Psychol Bull. 2026 Jul 30:1461672261468870. doi: 10.1177/01461672261468870. Online ahead of print.

ABSTRACT

It is unclear whether Healthy Neuroticism is beneficial for health, potentially due to mismatches between how Healthy Neuroticism is often conceptualized and operationalized. The present study uses data from 212 to 672 Dutch adults (54.17% female, mean age = 62.46) to examine how 3 operationalizations of Healthy Neuroticism (at the domain, facet, and characteristic adaptation levels) are associated with preventive disease screenings. Using a series of hurdle models, we found that individuals who were higher on Neuroticism domain, facets (Anxiety, Depression), and characteristic adaptations (Disease Concern) were more likely to engage in preventive disease screenings. However, Healthy Neuroticism (operationalized as interactions between domain, facet, and characteristic adaptations with Conscientiousness) was largely not associated with the likelihood or count of disease screenings, though these results should be interpreted with caution until further replication due to limits on statistical power. We discuss the theoretical implications for the Healthy Neuroticism literature and practical implications for improving health.

PMID:42529892 | DOI:10.1177/01461672261468870

Disaster Med Public Health Prep. 2026 Jul 30;20:e138. doi: 10.1017/dmp.2026.10414.

ABSTRACT

OBJECTIVES: Children are disproportionately affected by disasters and represent a vulnerable population in such settings. However, no internationally recognized core competencies exist to guide health care providers in caring for children impacted by disasters (particularly non-pediatricians). This study aimed to establish consensus-based core competencies for pediatric disaster response through international expert agreement across disciplines.

METHODS: A three-round modified Delphi study was conducted following CREDES criteria, using competency statements generated via a comprehensive scoping review of pediatric disaster literature. International disaster medicine experts rated competency statements on a 7-point linear scale (1 = disagree, 7 = agree). Consensus was defined a priori as standard deviation (SD) ≤ 1.0. Data were collected and analyzed using the STAT59 online platform.

RESULTS: 57 competencies met consensus criteria across three Delphi rounds, with mean scores ranging from 5.4 to 6.6. The highest-ranked competencies (mean = 6.6) were pediatric vulnerabilities recognition, pediatric transport management, child identification and tracking, and child-parent reunification. Decontamination initiation was also highly ranked (mean = 6.5).

CONCLUSIONS: The 57 consensus-based core competencies for pediatric disaster medicine response, spanning 16 practice domains, provide a foundation to further develop standardized curricula, guide preparedness and response efforts, and define minimum training expectations for health care providers caring for children impacted by disasters.

PMID:42529878 | DOI:10.1017/dmp.2026.10414

Prim Health Care Res Dev. 2026 Jul 30;27:e81. doi: 10.1017/S146342362610142X.

ABSTRACT

BACKGROUND: Out-of-hours primary care (OOH-PC) has been introduced in many health systems to reduce non-urgent emergency department (ED) use. While prior studies suggest potential efficiency gains, economic evaluations rarely stratify outcomes by patient risk, limiting policy relevance. This study assesses the cost-effectiveness of diverting low-risk patients from ED to OOH-PC.

AIM: Compare direct medical costs, time spent at the facility, and hospitalization probability across risk and care setting subgroups from a societal perspective.

METHODS: We analysed data from a cluster-randomized trial conducted in Belgium that examined a nurse-led triage system. Under the study trial’s extended Manchester Triage System (eMTS) protocol, patients eligible for primary care were assigned to OOH-PC and are referred to in our study as low-risk, while those assigned to the ED are defined as high-risk. To complement previous work, we stratified costs and effects by risk group. Mixed-effects regression models estimated costs, time at the facility, and hospitalization, with bootstrap confidence intervals. We also calculated the incremental net monetary benefit (INMB).

RESULTS: Treating low-risk patients at the OOH-PC instead of at the ED reduced costs by €24 (€14-€39) per patient, shortened the time spent at the facility by 69 (52-94) minutes. From a societal perspective, the average INMB was €49.5 per low-risk patient. Aggregately, we estimated that the 37 intervention weekends in 2019 led to an average saving of €14,136 in direct medical costs and cumulative time savings of 28 days.

CONCLUSION: Diverting low-risk patients from the ED to OOH-PC resulted in cost- and time-savings for low-risk patients at the study site. These findings highlight the potential to improve out-of-hours healthcare delivery to maximize benefits for patients and healthcare systems, although confirmation in other healthcare settings is required before wider implementation.

PMID:42529876 | DOI:10.1017/S146342362610142X

Br J Math Stat Psychol. 2026 Jul 30. doi: 10.1111/bmsp.70065. Online ahead of print.

ABSTRACT

Bayesian statistics has gained popularity in psychological research due to its intuitive uncertainty quantification and convenient information-updating rules. In many applications, however, prior distributions are introduced merely as instruments to facilitate computation, rather than as representations of genuine subjective belief. Consequently, relying on standard Bayesian justifications for inferential procedures becomes conceptually ungrounded. In this paper, we recommend evaluating finite-sample performance over repeated sampling of data and parameters as an alternative justification for “pragmatic Bayes.” We demonstrate a key vulnerability in the usual posterior-based inference: when analysts’ chosen prior distribution mismatches the true parameter-generating process, Bayesian inference can be misleading in the long run. Given that this true process is rarely known in practice, we propose a safer alternative: calibrating Bayesian credible regions to achieve frequentist validity. This latter criterion is stronger and guarantees validity of Bayesian inference regardless of the underlying parameter-generating mechanism. To solve the calibration problem in practice, we propose a novel stochastic approximation algorithm. Monte Carlo experiments are conducted and reported, in which we observe that uncalibrated Bayesian inference can be liberal under certain parameter-generating scenarios, whereas our calibrated solution consistently maintain validity. We also illustrate the proposed calibration procedure using a real-data example involving location-scale regression.

PMID:42529865 | DOI:10.1111/bmsp.70065

CNS Neurosci Ther. 2026 Aug;32(8):e71066. doi: 10.1002/cns.71066.

ABSTRACT

BACKGROUND: Insomnia disorder (ID) is characterized by hyperarousal, yet the relationship between cortical excitability and large-scale network dynamics remains incompletely understood. While fMRI studies indicate network alterations in ID, high-temporal-resolution characterization of these dynamics across the sleep-wake cycle is lacking.

METHODS: Twenty-six patients with ID and 29 healthy controls underwent eyes-closed resting-state OPM-MEG recordings during evening (pre-sleep) and morning (post-awakening) sessions. We analyzed the aperiodic spectral exponent to index cortical excitability and employed microstate analysis to quantify fast network dynamics. A mediation analysis was conducted to explore the associations between electrophysiological features and sleep quality.

RESULTS: Compared to controls, patients with ID exhibited a significantly flatter aperiodic power spectrum in the evening, suggesting elevated cortical excitability. Microstate analysis revealed distinct spatiotemporal alterations: (1) an evening-specific increase in the coverage of a putative temporal-limbic microstate, and (2) a sustained elevation of a putative sensorimotor microstate observed in both evening and morning sessions. Mediation analysis indicated that the altered evening limbic microstate dynamics statistically mediated the association between the aperiodic exponent and subjective sleep disturbance measures.

CONCLUSIONS: These findings indicate that ID involves concurrent disruptions in aperiodic neural activity and microstate temporal organization. The study highlights distinct diurnal profiles for putative sensorimotor and limbic network alterations, suggesting that OPM-MEG can effectively capture the multifaceted electrophysiological signatures of the insomnia phenotype.

PMID:42529863 | DOI:10.1002/cns.71066

Knee Surg Sports Traumatol Arthrosc. 2026 Jul 30. doi: 10.1002/ksa.70553. Online ahead of print.

ABSTRACT

PURPOSE: Robotic-assisted total knee arthroplasty (TKA) is increasingly adopted worldwide, yet comparative data on the rotational accuracy of image-based and imageless platforms remain limited. The aim of this study was to compare the accuracy of image-based and imageless robotic platforms in achieving planned femoral rotation in primary TKA. We hypothesized that the two platforms would be equivalent, with any difference within ±1°.

METHODS: This single-surgeon retrospective cohort study included patients undergoing image-based and imageless robotic-assisted TKA for primary osteoarthritis. All patients underwent pre- and postoperative computed tomography (CT) scans. Native femoral rotation was defined using the transepicondylar axis (TEA)-posterior condylar axis (PCA) angle. Femoral rotation was planned intraoperatively relative to the PCA, and postoperative TEA-PCA was measured on CT. Accuracy was defined as the absolute difference between achieved and intended rotation. Measurements were independently performed by two blinded fellowship-trained knee surgeons. Statistical analysis included two one-sided tests (TOST) equivalence testing and analysis of covariance (ANCOVA). Significance was set at p < 0.05.

RESULTS: A total of 150 TKAs were included (imageless 79, image-based 71). Patients in the image-based group were younger (67.7 vs. 71.3 years, p = 0.007), with no other baseline differences. The mean rotational error was 1.3 ± 1.0° for imageless and 1.2 ± 1.2° for image-based TKA (p = 0.346; effect size -0.09). Equivalence testing confirmed statistical equivalence, with the 90% confidence interval (-0.23 to 0.31) lying within the predefined ±1° margin (p < 0.01). ANCOVA demonstrated a small adjusted difference of 0.51° (p = 0.045), with minimal explained variance (adjusted R² = 0.01). Intra-observer reliability was excellent (intraclass correlation coefficient [ICC] 0.91), while inter-observer reliability was good (ICC 0.82). No differences were observed in patient-reported outcomes, except lower pain scores in the image-based group at 12 months.

CONCLUSION: Image-based and imageless robotic platforms demonstrated equivalent accuracy in achieving planned femoral rotation in primary TKA. Any observed differences were not clinically meaningful.

LEVEL OF EVIDENCE: Level III, retrospective comparative cohort study.

PMID:42529843 | DOI:10.1002/ksa.70553