Tag: pubmed

Obstet Gynecol. 2025 Jun 26. doi: 10.1097/AOG.0000000000005986. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the effectiveness of influenza vaccination during pregnancy against influenza in infants during their first 6 months of life.

METHODS: We conducted a cohort study among pregnant individuals enrolled in Kaiser Permanente Northern California (KPNC) and their infants. We followed all infants from birth until the first occurrence of a polymerase chain reaction test result positive for influenza, the infant reached age 6 months, death, disenrollment from KPNC, or the end of the study on December 31, 2022. We used Cox regression to compare the hazard of influenza in infants whose mothers were vaccinated against influenza during pregnancy with those whose mothers were unvaccinated. Hazard ratios (HRs) were adjusted for calendar time, maternal sociodemographic and comorbidities. Vaccine effectiveness was calculated as 100% (1-adjusted HR). We evaluated the association between vaccination and infant influenza outcomes any time during pregnancy and by trimester of vaccination.

RESULTS: Of the 245,498 infants included in the study, 46.0% were born to vaccinated mothers. The incidence of influenza was lower among infants of vaccinated mothers than unvaccinated mothers (0.12% vs 0.30%). After adjusting for covariates, vaccination during pregnancy was associated with a reduction in infant influenza in any clinical setting by 44.4% (95% CI, 31.4-54.9%). Vaccination during the first trimester was associated with a reduction in infant influenza by 11.3%, a reduction of 51.5% during the second trimester, and a reduction of 59.3% during the third trimester. The differences in vaccine effectiveness estimates that compared the first and second trimesters (P=.02) and compared the first and third trimesters (P<.001 were statistically significant.

CONCLUSION: Influenza vaccination during pregnancy was associated with a reduction in infant influenza infection by 44.4%. The reduction in infant influenza infection was greater when vaccination occurred in the second or third trimester, compared with the first trimester.

PMID:40570349 | DOI:10.1097/AOG.0000000000005986

N Z Med J. 2025 Jun 27;138(1617):100-112. doi: 10.26635/6965.6909.

ABSTRACT

AIM: To characterise the appropriateness of community referrer-rated urgency among dermatology referrals.

METHOD: Using e-referral data from a month representative of volume and service provision in a tertiary dermatology service, referrer-rated urgency and triage priority assigned by two specialist dermatologists were compared to determine appropriateness. Descriptive analysis was conducted to quantify the proportion of appropriately and inappropriately assigned urgency in priority populations of women, Māori and Pacific peoples and paediatric patients.

RESULTS: One-third of general dermatology referrals, and nearly one in six referrals of suspected skin cancers, had an inappropriately assigned urgency. A quarter of general dermatology and most melanoma referrals had urgency lower than triage priority. Māori and Pacific patients were under-represented in the proportion of referrals received by ethnicity when comparing to national and provincial population estimates. However, no significant disparities in appropriateness of urgency across ethnicity were observed, and the same was seen for female and paediatric patients.

CONCLUSION: Our study adds to the limited research on the appropriateness of referrer-rated urgency. We have pointed out that artificial intelligence (AI) has significant potential to improve the prioritisation of referrals by identifying melanoma and severe skin diseases.

PMID:40570338 | DOI:10.26635/6965.6909

N Z Med J. 2025 Jun 27;138(1617):85-99. doi: 10.26635/6965.6905.

ABSTRACT

AIM: Community-acquired pneumonia (CAP) is inequitably experienced in populations globally, with multiple social and environmental factors contributing to the risk of CAP; thus, predicting communities at increased risk is difficult. The aims of this study were to determine the geographical distribution of adults with CAP requiring hospitalisation in Christchurch, and to examine the associations between CAP and socio-economic and area deprivation.

METHODS: A retrospective clinical records review was conducted of all adult patients hospitalised with CAP at Christchurch Hospital over a 12-month period. Geocoding residential addresses allowed for geospatial hotspot analysis using the Getis-Ord Gi* method. Comparison of the relative rates of CAP in different socio-economic deprivation deciles was assessed using New Zealand census data and the Index of Multiple Deprivation (IMD).

RESULTS: The dataset comprised 924 hospitalisations. CAP hotspots were located in the northeast and southwest of the city. CAP was not equally distributed across the deprivation quantiles (p <0.001); compared with the least deprived quintile, quintiles four and five had rate ratios (95% confidence interval [CI]) of 1.5 (1.3 to 1.8) and 1.6 (1.3 to 2.0), respectively. Patients with CAP who identified as Māori or Pacific peoples were significantly younger, and a higher proportion were resident in areas of highest socio-economic deprivation relative to patients who identified as NZ European.

CONCLUSION: This study identified hotspots within Christchurch with higher rates of CAP requiring hospitalisation and has contributed further New Zealand-based evidence on the influence of socio-economic disparities on health inequity.

PMID:40570337 | DOI:10.26635/6965.6905

N Z Med J. 2025 Jun 27;138(1617):76-84. doi: 10.26635/6965.6788.

ABSTRACT

BACKGROUND: Metabolic bariatric surgery (MBS) is an effective treatment for obesity and its related comorbidities.1 Publicly funded MBS in New Zealand is regionally limited with variable case volumes, potentially limiting surgical training.2 This retrospective study aims to evaluate if MBS safety and effectiveness are impacted by teaching within a low-volume unit.

METHODS: A retrospective outcomes analysis was carried out for all MBS cases of a single surgeon (public and private). Cases were compared based on primary operator status: consultant (COP) and trainee/fellow (TOF). Primary outcomes included multiple safety and effectiveness parameters including leaks, haemorrhage, 30-day morbidity and total weight loss (TWL).

RESULTS: Two-hundred and fifty patients satisfied inclusion criteria. Results are reported as COP and TOF. Primary operator: 87 (34.8%) and 163 (65.2%). There were no leaks, strictures or 30-day mortalities. Perioperative haemorrhage: 1 and 4. Thirty-day morbidity: 1 and 5. One-year TWL: 36.0% and 35.0%. Sleeve stenosis: 0 and 1. Thirty-day readmissions: 1 and 4. One-year readmissions: 4 and 9. Length of stay: 3 and 4 (p=<0.001).

CONCLUSION: MBS safety and effectiveness outcomes in low-volume practice performed by TOF were no different to COP within our study setting.

PMID:40570336 | DOI:10.26635/6965.6788

N Z Med J. 2025 Jun 27;138(1617):50-61. doi: 10.26635/6965.6807.

ABSTRACT

AIM: We examined equity in the provision of cochlear implant services for New Zealand Māori compared with other New Zealanders.

METHODS: The client databases of both Aotearoa New Zealand cochlear implant programmes were searched and an anonymised dataset was provided to the audit team. Ethics committee approval was not required. Ethnicity was categorised as Māori or non-Māori.

RESULTS: There is no significant difference between Māori and non-Māori with respect to acceptance for surgery rates and time from acceptance to surgery. Māori children and adults have a higher rate of proceeding to surgery than non-Māori ethnic groups. Average days to surgery for adult clients reduced over the period studied. Time to surgery was low for both child ethnic groups. When a measure of prioritisation (clinical priority access criteria [CPAC]) was incorporated into the evaluation, we found that Māori clients waited slightly, but not significantly less time per unit of CPAC scored.

CONCLUSION: We were able to demonstrate that once Māori clients accessed the cochlear implant programmes, they were implanted at a similar rate as non-Māori, and adult clients experienced equivalent waiting times even when adjusted for CPAC score. These favourable results suggest that our internal systems and pathways are promoting equity.

PMID:40570334 | DOI:10.26635/6965.6807

N Z Med J. 2025 Jun 27;138(1617):12-49. doi: 10.26635/6965.6926.

ABSTRACT

AIM: A rib fracture guideline was implemented at Whangārei Hospital with the aim of improving the care of patients and mitigating the risk of preventable additional morbidity. The aim of this study was to assess the impact of this guideline on the management and outcomes of patients.

METHODS: A single centre retrospective audit was performed comparing patients with rib fractures pre and post the implementation of the RIB-IMPROVE guideline. The primary outcome of interest was pneumonia. Patients with an abbreviated injury score (AIS) head or abdomen >2 were excluded. Binomial logistic regression was conducted for the primary outcome with adjustments for clinically plausible variables.

RESULTS: There were 418 patients identified, 241 in the pre-guideline and 177 in the post-guideline group. There was no difference in age, sex, ethnicity, number of rib fractures, injury severity score (ISS) or local anaesthetic block placement. The pneumonia rate was 13% vs 7% comparing the pre- and post-guideline groups, respectively. After adjustment for age, sex and ISS, the relative risk of developing pneumonia was 0.52 comparing the post- with the pre-guideline group (p=0.04). No statistical difference in secondary outcomes was seen, including the length of stay, 30-day readmission rate or 30-day mortality rate.

CONCLUSION: This study found that the risk of pneumonia was decreased by almost half after implementation of the RIB-IMPROVE guideline at Whangārei Hospital. This study highlights the effectiveness of a multidisciplinary guideline in the management of patients with rib fractures.

PMID:40570333 | DOI:10.26635/6965.6926

JMIR Infodemiology. 2025 Jun 26;5:e58302. doi: 10.2196/58302.

ABSTRACT

BACKGROUND: The outbreak of SARS-CoV-2 in 2019 was accompanied by a rise in the popularity of conspiracy theories. These theories often undermined vaccination efforts. There is evidence that the spread of misinformation about COVID-19 is associated with online social media use. Online social media enables network effects that influence the dissemination of information. It is important to distinguish between the effects of using social media and the network effects that occur within the platform.

OBJECTIVE: This study aims to investigate the association between the modularity of online social networks and the spread of, as well as attitudes toward, information and misinformation about COVID-19.

METHODS: This study used data from the social network structure of the online social media platform Vkontakte (VK) to construct an adjusted modularity index (fragmentation index) for 166 Russian towns. VK is a widely used Russian social media platform. The study combined town-level network indices with data from the poll “Research on COVID-19 in Russia’s Regions” (RoCIRR), which included responses from 23,000 individuals. The study measured respondents’ knowledge of both fake and true statements about COVID-19, as well as their attitudes toward these statements.

RESULTS: A positive association was observed between town-level fragmentation and individuals’ knowledge of fake statements, and a negative association with knowledge of true statements. There is a strong negative association between fragmentation and the average attitude toward true statements (P<.001), while the association with attitudes toward fake statements is positive but statistically insignificant (P=.55). Additionally, a strong association was found between network fragmentation and ideological differences in attitudes toward true versus fake statements.

CONCLUSIONS: While social media use plays an important role in the diffusion of health-related information, the structure of social networks can amplify these effects. Social network modularity plays a key role in the spread of information, with differing impacts on true and fake statements. These differences in information dissemination contribute to variations in attitudes toward true and fake statements about COVID-19. Ultimately, fragmentation was associated with individual-level polarization on medical topics. Future research should further explore the interaction between social media use and underlying network effects.

PMID:40570328 | DOI:10.2196/58302

JMIR Ment Health. 2025 Jun 26;12:e70577. doi: 10.2196/70577.

ABSTRACT

BACKGROUND: Anxiety and depression are serious mental health conditions affecting millions of people worldwide; however, they are often underdiagnosed due to limited health care resources. Mobile games, with their widespread popularity and availability, offer a unique opportunity to use user-game interaction data for mental health screening.

OBJECTIVE: This study aimed to explore whether swipe gesture interactions from mobile games can serve as indicators of anxiety and depression symptoms.

METHODS: A total of 82 participants played 3 casual mobile games (puzzle, infinite runner, and object slicing games) for 15 minutes each and completed validated measures of anxiety (Generalized Anxiety Disorder-7; GAD-7) and depression (Patient Health Questionnaire-8; PHQ-8). Data were logged for each swipe event, and metrics were computed using statistical measures, yielding roughly 150 metrics per game. Spearman rank correlations were calculated between each metric and GAD-7 and PHQ-8 scores.

RESULTS: Multiple swipe gesture metrics showed significant associations with both anxiety and depression scores. For the puzzle game, mean swipe speed correlated with PHQ-8 (ρ=-0.405; P<.001) and GAD-7 (ρ=-0.400; P<.001) scores. For the infinite runner game, mean variance in swipe end pressure showed moderate to strong negative correlation with PHQ-8 (ρ=-0.405; P<.001) and GAD-7 (ρ=-0.309; P=.007) scores. In the object slicing game, minimum swipe start position along the y-axis correlated positively with PHQ-8 (ρ=0.368; P<.001) and GAD-7 (ρ=0.370; P<.001) scores.

CONCLUSIONS: The findings from this exploratory study provide preliminary evidence supporting the feasibility of using swipe gesture interactions in mobile games as novel, engaging, and nonintrusive indicators of anxiety and depression.

PMID:40570324 | DOI:10.2196/70577

Otol Neurotol. 2025 Jun 18. doi: 10.1097/MAO.0000000000004526. Online ahead of print.

ABSTRACT

INTRODUCTION: Paragangliomas of the middle ear (glomus tympanicum, GT) are commonly encountered neoplasms of the temporal bone. GT is a benign tumor of vascular origin, arising from the neural crest cells and located on the promontory. The treatment of choice is surgical excision of the lesion.

OBJECTIVE: Our aim was to describe the surgical and hearing outcomes in a cohort of patients with middle ear paragangliomas following resection.

METHODS: We retrospectively reviewed the data of patients with GT who were treated with a CO2 laser from 2014 to 2021. Preoperative and postoperative audiometric outcomes, symptom evaluations, and otomicroscopic examinations were performed. The surgical approach was individualized for each patient based on tumor characteristics demonstrated on computed tomography. Three different approaches were used: (1) canal wall down, canal wall reconstruction, and mastoid obliteration (CWD, CWR, and MO) mastoidectomy; (2) canal wall up (CWU) mastoidectomy; and (3) endaural/transcanal.

RESULTS: Three males and 12 females aged between 33 and 76 years (mean, 56 yr) were included. Complete removal was accomplished in all cases using a CO2 laser with no recurrence or complications during the postoperative follow-up period.CWU mastoidectomy, CWD mastoidectomy with CWR/MO, and endaural/transcanal approaches were used in 5, 3, and 7 patients, respectively. A flexible 500-micron CO2 laser fiber was employed at 3-4 watts on the continuous mode setting.Three patients underwent concurrent ossicular chain reconstruction along with CWD/CWR mastoidectomy owing to preoperative conductive hearing loss with an air-bone gap (ABG) of wider than 30 dB, resulting in postoperative ABG closure. In relation to the remaining patients, no statistically significant postoperative worsening of audiometric outcomes in Word Recognition Score, pure tone average, and speech recognition threshold were observed. The mean follow-up period was 12 months.

CONCLUSIONS: We found that using a flexible CO2 laser fiber and CWD mastoidectomy with canal wall reconstruction and mastoid obliteration are beneficial for managing these tumors.CO2 lasers are safe and reliable for GT resection. The advantages of this modality include complete removal, low complication and recurrence rates, and minimum morbidity.

PMID:40570318 | DOI:10.1097/MAO.0000000000004526

Otol Neurotol. 2025 Jun 18. doi: 10.1097/MAO.0000000000004514. Online ahead of print.

ABSTRACT

INTRODUCTION: Idiopathic sudden sensorineural hearing loss (ISSNHL) exhibits a diverse range of clinical presentations and treatment responses. Currently, there are no established variables that clinicians can utilize for the purposes of patient counseling when treating ISSNHL.

MATERIALS AND METHODS: This prospective study involved 35 patients diagnosed with ISSNHL who were treated with oral and intratympanic steroid injections. We measured the peak and average slow phase velocity (SPV) (°/sec) of nystagmus after caloric stimulation during the first session of intratympanic steroid injection (ITI), and four variables were evaluated: age, time elapsed before treatment (ET), gain, and pure tone average (PTA) posttreatment. An association between these variables was determined using Spearman’s Rho statistical analysis, followed by regression modeling.

RESULTS: We found a strong significant correlation between SPV and gain and PTA posttreatment (Spearman Rho 0.000). A significant correlation between SPV and ET was also detected (Spearman Rho 0.05). The linear regression analysis indicated that for every 1° increase in SPV, there is an expected increase of 0.27 dB in gain and a decrease of 0.18 dB in PTA posttreatment. Furthermore, an SPV of 17.7 (°/sec) demonstrated a strong correlation with Siegel grade 1 posttreatment (p 0.000).

CONCLUSIONS: The SPV (°/sec) of nystagmus during the first ITI may serve as a valuable tool for patient counseling in the management of ISSNHL, thereby encouraging the continuation or consideration of alternative treatment options. Further studies are warranted to validate these findings.

PMID:40570313 | DOI:10.1097/MAO.0000000000004514