Tag: pubmed

JAMA Netw Open. 2025 Apr 1;8(4):e256852. doi: 10.1001/jamanetworkopen.2025.6852.

ABSTRACT

IMPORTANCE: Guidelines recommend annual imaging surveillance after endovascular abdominal aortic aneurysm repair (EVAR). How these guidelines translate into practice among veterans remains poorly described.

OBJECTIVE: To characterize post-EVAR surveillance among veterans.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study evaluated veterans who underwent EVAR between January 1, 2000, and December 31, 2023, at US Department of Veterans Affairs (VA) hospitals and received follow-up care at VA and non-VA hospitals and imaging centers with payment via Medicare or the VA. Veterans treated with EVAR in VA hospitals during the study period were included.

EXPOSURE: Years after EVAR.

MAIN OUTCOMES AND MEASURES: The primary outcome was annual surveillance adherence, measured as 1 or more imaging studies in the abdomen or pelvis each year after EVAR. Stepwise logistic regression modeling was used to determine factors associated with poor adherence. Secondary outcomes were imaging type (cross-sectional, ultrasonography, or ultrasonography followed by cross-sectional imaging) and factors associated with lower adherence.

RESULTS: The cohort included 27 792 veterans (27 624 male [99.4%]; 22 521 aged ≥65 years [81.0%]). Mean (SD) follow-up was 6.0 (4.0) years. The mean (SD) proportion of time that veterans were surveillance adherent was 71.1% (28.5%). Surveillance was initially high, with 25 026 of 27 792 veterans (90.0%) undergoing surveillance imaging in year 1 after EVAR. However, this proportion decreased further out from EVAR, with 12 401 of 21 384 veterans (58.0%) undergoing surveillance imaging by year 4 after EVAR. Veterans were most likely to undergo imaging with computed tomography scans (21 911 veterans [78.8%]). However, the proportion with surveillance via ultrasonography alone increased from 823 of 25 026 veterans (3.3%) in year 1 after EVAR to 2567 of 12 401 veterans (20.7%) in year 4 after EVAR. White race (odds ratio [OR] vs all other racial groups, 0.84; 95% CI, 0.72-0.98), married status (OR vs all other social status categories, 0.80; 95% CI, 0.71-0.89), having a service-connected disability (OR, 0.69; 95% CI, 0.62-0.77), and a higher Charlson Comorbidity Index score (OR per 1-unit increase, 0.93; 95% CI, 0.91-0.95) were associated with lower odds of poor surveillance adherence.

CONCLUSIONS AND RELEVANCE: In this study, post-EVAR imaging surveillance was high, although surveillance lapses were more likely further out from EVAR and for patients with certain characteristics. This information may inform future patient-centered efforts to improve post-EVAR imaging adherence.

PMID:40272801 | DOI:10.1001/jamanetworkopen.2025.6852

JAMA Netw Open. 2025 Apr 1;8(4):e257115. doi: 10.1001/jamanetworkopen.2025.7115.

ABSTRACT

IMPORTANCE: Mental and somatic health is often impaired among transgender persons. Studies regarding coexisting mental and somatic health outcomes among transgender persons are limited.

OBJECTIVE: To assess health diagnoses and medicine use among transgender persons compared with cisgender controls.

DESIGN, SETTING, AND PARTICIPANTS: This register-based national cohort study included data from January 1, 2000, to December 31, 2021. Transgender persons were included on the first date of receipt of a transgender identity contact code. Controls included 10 age-matched cisgender men (n = 5) and women (n = 5) for each transgender person. Statistical analyses were conducted from September to December 2024.

MAIN OUTCOMES AND MEASURES: The main outcomes were International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis codes and medicine use in a 5-year period up to the first date of transgender contact code for most commonly occurring mental and physical illnesses. The main outcomes were determined after data collection.

RESULTS: The cohort included 3812 transgender persons (1993 transmasculine persons [52.3%] with a median age of 19 years [IQR, 15-24 years] and 1819 transfeminine persons [47.7%] with a median age of 23 years [IQR, 19-33 years]) and 38 120 cisgender controls. The odds for a mental health diagnosis was up to 12 times higher among transgender persons compared with cisgender controls. Among transmasculine and transfeminine persons, neurotic, stress-related disorders (transmasculine: adjusted odds ratio [AOR], 4.70 [95% CI, 4.02-5.50]; transfeminine: AOR, 5.27 [95% CI, 4.28-6.49]); developmental disorders, including autism (transmasculine: AOR, 11.67 [95% CI, 8.85-15.39]; transfeminine: AOR, 9.39 [95% CI, 7.05-12.50]); mood (affective) disorders (transmasculine: AOR, 5.41 [95% CI, 4.32-6.77]; transfeminine: AOR, 5.61 [95% CI, 4.16-7.57]); and behavioral disorders (transmasculine: AOR, 4.50 [95% CI, 3.61-5.62]; transfeminine: AOR, 4.15 [95% CI, 3.19-5.39]) were the most frequent mental health diagnoses compared with cisgender controls of the opposite sex at birth. Transmasculine persons had higher odds for somatic diagnosis codes of diabetes (AOR, 2.00 [95% CI, 1.12-3.56]), asthma (including chronic obstructive lung disease; AOR, 1.40 [95% CI, 1.06-1.85]), injury and poisoning (AOR, 1.28 [95% CI, 1.15-1.41]), and pain (AOR, 1.29 [95% CI, 1.12-1.49]) compared with control cisgender women. Among transfeminine persons, somatic diagnosis codes of infection (AOR, 1.68 [95% CI, 1.33-2.13]), anemia (AOR, 3.08 [95% CI, 1.36-6.97]), diabetes (AOR, 1.95 [95% CI, 1.25-3.05]), sleep apnea (AOR, 3.41 [95% CI, 1.84-6.31]), and pain (AOR, 1.31 [95% CI, 1.08-1.58]) were more frequent compared with control cisgender men. Transgender persons had higher use of psychopharmacologic medicine, antacids, and laxatives compared with cisgender controls (transmasculine persons vs control cisgender women, antipsychotics: AOR, 6.20 [95% CI, 5.07-7.59]; hypnotics-sedatives: AOR, 4.45 [95% CI, 3.78-5.23]; antacids: AOR, 1.25 [95% CI, 1.07-1.45]; and laxatives: AOR, 1.53 [95% CI, 1.17-1.99]; transfeminine persons vs control cisgender men, antipsychotics: AOR, 4.74 [95% CI, 3.92-5.74]; hypnotics-sedatives: AOR, 3.01 [95% CI, 2.53-3.57]; and antacids: AOR, 1.32 [95% CI, 1.12-1.56]). Mental health diagnoses and use of psychopharmacologic drugs were coexisting with somatic diagnoses and use of drugs for somatic diseases.

CONCLUSIONS AND RELEVANCE: This cohort study of Danish transgender persons and cisgender controls found significantly higher risks for mental and somatic health diagnoses among transgender persons. Coexistence of mental health outcomes and somatic health outcomes among transgender persons could be associated with stress encountered due to belonging to a gender identity or sexual orientation minority group; mental and physical morbidity should be considered an integrated part of transgender care.

PMID:40272800 | DOI:10.1001/jamanetworkopen.2025.7115

JAMA Netw Open. 2025 Apr 1;8(4):e257202. doi: 10.1001/jamanetworkopen.2025.7202.

ABSTRACT

IMPORTANCE: Bloodstream infections (BSIs) associated with peripheral intravenous catheters (PIVCs) are rare but preventable adverse events. The association of dwell time with the risk of BSIs with PIVCs remains controversial.

OBJECTIVE: To analyze the risk of BSIs during PIVC maintenance therapy.

DESIGN, SETTING, AND PARTICIPANTS: In this observational cohort study, all patients hospitalized at Geneva University Hospitals with at least 1 PIVC insertion on the upper extremity (N = 371 061) between January 1, 2016, and February 29, 2020, were evaluated. Statistical analysis was performed from January 2023 to January 2025.

EXPOSURE: At least 1 PIVC insertion on the upper extremity.

MAIN OUTCOMES AND MEASURES: The primary outcome was BSIs with PIVCs; data were collected by prospective BSI surveillance. The daily risk of BSIs with PIVCs was analyzed using the hazard rate function by kernel-based methods. Multivariable logistic models were performed to evaluate the risk of BSIs with PIVCs comparing different cutoff values of dwell times (>3 vs ≤3 days, >4 vs ≤4 days, >5 vs ≤5 days, and >6 vs ≤6 days).

RESULTS: A total of 371 061 PIVCs (median patient age, 63 years [IQR, 41-79 years]; 187 786 women [51%]) with documented catheter duration were included. A total of 140 178 PIVCs (38%) had a dwell time of 1 to 2 days, 119 252 (32%) had a dwell time of 3 to 4 days, and 111 631 (30%) had a dwell time of more than 4 days. The instantaneous risk of BSIs with PIVCs was low in the first 2 days of dwell time and increased rapidly thereafter. The risk of BSIs was significantly increased after 3 days of catheter maintenance (adjusted odds ratio [AOR], 13.55; 95% CI, 5.44-34.00). This risk was the highest after 3 days and remained increased thereafter (>4 days: AOR, 8.53; 95% CI, 4.47-16.28; >5 days: AOR, 5.38; 95% CI, 3.23-8.96; and >6 days: AOR, 7.63; 95% CI, 4.57-12.74).

CONCLUSIONS AND RELEVANCE: In this cohort study of 371 061 PIVCs, dwell time was associated with the development of BSIs with PIVCs. After day 3, PIVC indication should be reviewed and PIVC replacement considered.

PMID:40272799 | DOI:10.1001/jamanetworkopen.2025.7202

Facial Plast Surg Aesthet Med. 2025 Apr 24. doi: 10.1089/fpsam.2024.0250. Online ahead of print.

ABSTRACT

Background: Chemodenervation is a mainstay in the treatment of nonflaccid facial paralysis (NFFP). This study investigates how electromyography (EMG) guidance during chemodenervation may allow for more accurate needle placement. Study Objective: To compare the accuracy with needle EMG chemodenervation compared with standard non-EMG approaches in patients receiving treatment for NFFP with botulinum toxin (BT) as measured by physician and EMG verification. Methods: The use of needle EMG across three surgeons was recorded to determine if the use of EMG changed the location, angle, or depth of needle insertion into the targeted facial muscle. The determination of accurate needle placement was self-reported by the physician coupled with the physician assessment of muscle EMG activity. Accuracy was determined as the ratio of the number of successful EMG needle insertions (placed within muscle with adequate signal) over the total number of EMG needle insertions. Results: A total of 137 patients underwent treatment for NFFP, with an average age of 54 (interquartile range [IQR]: 44-65) and weight of 73 kg (IQR: 64-90). Of the 14 facial mimetic muscles, the posterior belly of digastric (accuracy = 19%, standard deviation [SD] 0.4), risorius (accuracy = 46%, SD 0.5), and zygomaticus (accuracy = 47%, SD 0.5) had the lowest accuracy in BT placement (Table 3). Of all the muscles included, only the buccinator (p = 0.015), platysma (p = 0.0093), and zygomaticus (p = 0.024) had statistically significant variation in the accuracy of BT placement between surgeons. Conclusions: EMG guidance for the treatment of NFFP may improve the precision of needle placement and BT delivery, particularly in the mid and lower facial muscles.

PMID:40272786 | DOI:10.1089/fpsam.2024.0250

J Racial Ethn Health Disparities. 2025 Apr 24. doi: 10.1007/s40615-025-02424-7. Online ahead of print.

ABSTRACT

Discrepancies in healthcare outcomes and quality of treatment between White people and people of color are known and statistically relevant in the USA. The possible root causes of this issue, however, are not discussed enough, further enhancing an unequal access to proper healthcare and not acknowledging the role of racism and White supremacy in the consolidation of the medical field in the country. This article used discourse and document analysis to understand the role in which racism and narratives regarding Black bodies during the consolidation of medicine and gynecology had in the USA during the nineteenth century to create discrepancies in access and quality of care for Black patients today. The findings suggest that the dehumanizing narratives of Black patients in the past still impact the quality of care, creating higher mortality rates, worse prognosis, and lack of proper pain management, reinforcing health disparities.

PMID:40272774 | DOI:10.1007/s40615-025-02424-7

J Cancer Educ. 2025 Apr 24. doi: 10.1007/s13187-025-02630-1. Online ahead of print.

ABSTRACT

Esophageal cancer is a prevalent cancer worldwide, with incidence rates rising significantly in recent years, particularly in high-risk regions where case numbers continue to escalate. As one of the most visited social media platforms globally, TikTok has emerged as a key source for health information. This study aims to evaluate Chinese TikTok videos on esophageal cancer, focusing on content integrity, informational quality, source credibility, usefulness, and reliability.: We assessed 246 esophageal cancer-related videos using the Content Integrity Score based on Goobie’s coding scheme for content evaluation and the DISCERN instrument for assessing information reliability and treatment guidance. Videos were categorized by duration, source, publication year, and user engagement metrics (likes, comments, favorites, shares). Statistical analysis was conducted using Shapiro-Wilk, Kruskal-Wallis and post hoc Bonferroni tests. Additionally, Spearman’s correlation analysis was applied to explore relationships between key quantitative variables. Of the videos analyzed, 212(86.2%) were uploaded by doctors, and 168(68.3%) lacked content related to risk factors. and 217(88.2%) had a quality score rated as poor or below. User engagement metrics, including likes, comments, saves, and shares, exhibited strong intercorrelations. However, only shares showed a weak correlation with DISCERN scores (R = 0.134, p = 0.036). Additionally, DISCERN scores were positively correlated with video duration (R = 0.352, p < 0.001). Chinese TikTok videos on esophageal cancer generally offer low-quality information that lacks accuracy and is insufficient for guiding patients in making informed health decisions. Given the low quality and reliability of such content, TikTok is not a suitable source for patient education.

PMID:40272765 | DOI:10.1007/s13187-025-02630-1

Cancer Causes Control. 2025 Apr 24. doi: 10.1007/s10552-025-01998-1. Online ahead of print.

ABSTRACT

PURPOSE: Acute leukemia is the most common childhood malignancy, with suspected contributions from environmental factors and immune responses to common pathogens. A recent meta-analysis indicated possible spatiotemporal clustering, though the findings were hindered by data quality limitations. We investigated spatial and spatiotemporal clustering of childhood leukemia using advanced methods and complete residential histories.

METHODS: We included patients aged 0-17 years diagnosed in 1990-2019, using data from the Finnish Cancer Registry. A 1:3 age- and sex-matched case-control design was employed and residential history data with exact coordinates was collected. Clustering was evaluated using the Cuzick-Edwards test, Knox test, Kulldorff’s scan statistic, and Jacquez’s Q statistic.

RESULTS: The dataset included 1,626 childhood leukemia cases (median age 5.0 years, 54% male). The Knox test revealed no evidence of spatiotemporal clustering. However, the Cuzick-Edwards test revealed spatial clustering at diagnosis addresses for children under 1 year (OR 1.35, 95% CI 1.14-1.57). Further analysis with Jacquez’s Q test using complete residential histories identified significant spatiotemporal clustering in young children (ages 1.5-5.99 years) with acute lymphoblastic leukemia (ALL, p = 0.037). We also tested for co-incidence between leukemia and type 1 diabetes but found no clustering.

CONCLUSION: Overall, we found limited evidence for clustering. In the subgroup analyses, significant spatiotemporal clustering in acute lymphoblastic leukemia cases among children aged 1.5-5.99 years was observed, coinciding with the peak incidence in early childhood. Previous research has shown that this age group has distinct genetic characteristics and may possess a unique etiology.

PMID:40272762 | DOI:10.1007/s10552-025-01998-1

CJEM. 2025 Apr 24. doi: 10.1007/s43678-025-00906-5. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to assess the efficacy of a single dose of nebulized glucocorticoids (dexamethasone or budesonide) compared to a placebo in relieving sore throat symptoms. The primary outcome was complete symptom resolution at 24 h. Secondary objectives included evaluating pain scores at 48 h, time to pain relief within 7 days, absenteeism, and ED visits or hospital admissions for acute pharyngitis (AP) symptoms or complications within 7 days.

METHODS: This multicenter, double-blind, randomized controlled trial was conducted across three EDs targeting patients over 5 years old with acute pharyngitis, excluding those with recent steroid or antibiotic use, adenotonsillectomy, or pregnancy. Participants were randomly assigned to one of three groups: nebulized dexamethasone, budesonide, or placebo. Pain severity was assessed using a numeric rating scale from 0 to 10. Analysis involved descriptive statistics and Chi-square tests to compare outcomes across treatment groups.

MAIN RESULTS: A total of 163 patients with AP were enrolled. No significant difference in the primary outcome, complete symptom resolution at 24 h, was observed between the glucocorticoids (dexamethasone, budesonide) and placebo groups, with relative risks of 2.2 (95% confidence interval [CI] 0.8-5.1) and 1.1 (95% CI 0.9-1.2), respectively. Among secondary outcomes, time to pain relief was significantly shorter in the glucocorticoid groups (mean onset: 2.6 h for dexamethasone, 3.1 h for budesonide) compared to the placebo group (4.1 h; p = 0.003). There were no significant differences in pain scores at 48 h, ED re-attendance, hospital admissions, or absenteeism. All treatments were well-tolerated, with no significant adverse events reported.

CONCLUSION: Despite a statistically significant earlier onset of pain relief, the study found no significant difference in complete resolution of sore throat at 24 or 48 h between glucocorticoids and placebo groups. Therefore, the routine use of nebulized steroids for managing acute pharyngitis may not be warranted, emphasizing the importance of maintaining standard care practices and considering alternative adjunct therapies.

TRIAL REGISTRATION NUMBER: Clinicaltrial.com NCT04027322. Date: 07/18/2019.

PMID:40272745 | DOI:10.1007/s43678-025-00906-5

AIDS Behav. 2025 Apr 24. doi: 10.1007/s10461-025-04744-5. Online ahead of print.

ABSTRACT

The Ending the HIV Epidemic (EHE) initiative aims to reduce new HIV infections by 90% by 2030 in the United States (US). However, rising sexually transmitted infection (STI) rates exacerbate the bidirectional infection risk between HIV and STIs. Most research on STIs among people with HIV (PWH) has focused on high-risk groups, resulting in limited data on broader populations. This study addresses that gap by examining the incidence and risk factors for gonorrhea, chlamydia, and syphilis in a statewide cohort of PWH in South Carolina. Data from South Carolina’s HIV and STI surveillance systems were linked, and all PWH aged 18 and older who were diagnosed with HIV between 2007 to April 2018 were included. Cohort demographics were analyzed using descriptive statistics and chi-squared tests, and a Cox Proportional Hazards model examined time to first STI after HIV diagnosis. The study found an increase in the incidence of gonorrhea, chlamydia, and syphilis over the study period. Young adults, men, Black individuals, MSM, and urban residents were found to be at increased risk for STI diagnosis. Clinical risk factors associated with increased STI risk included lower initial CD4 counts, and higher initial viral loads. The findings underscore a considerable STI burden among PWH in South Carolina. To mitigate STI transmission in the context of HIV, targeted interventions for high-risk populations are needed.

PMID:40272742 | DOI:10.1007/s10461-025-04744-5

J Mol Neurosci. 2025 Apr 24;75(2):56. doi: 10.1007/s12031-025-02354-3.

ABSTRACT

Emerging evidence suggests that sleep deprivation may contribute to cancer risk. However, the genetic association between sleep deprivation and glioblastoma (GBM) remains unexplored. This study aimed to investigate the causal relationship between sleep traits and GBM using genome-wide association study (GWAS) data of sleep duration, sleeplessness, GBM, and immune cell traits from the UK Biobank and FinnGen databases. Mendelian randomization (MR) analyses were conducted to assess potential causal links between sleep traits and GBM risk. Mediation analysis was performed to identify immune mediators affected by sleep duration that might influence GBM development. Single-nucleus RNA sequencing (snRNA-seq) was utilized to examine cellular subpopulation changes in brain tissue from sleep-deprived (SD) and ad libitum sleep mice. Additionally, a mouse model of sleep deprivation was established for transcriptomic analysis. We found a significant causal association between reduced sleep duration and increased GBM risk (IVW OR = 6.000 × 10^-5, P = 0.003, Bonferroni P = 0.025). Sleeplessness also emerged as a potential risk factor for GBM (OR-IVW = 20.221, P = 0.038). Mediation analysis identified CD80 expression on plasmacytoid dendritic cells (pDCs) as a mediator in the association between sleep duration and GBM, with a mediation effect of 0.256. SnRNA-seq confirmed significant alterations in CD80 + pDCs in sleep-deprived mice. Transcriptomic analysis of SD mice demonstrated upregulation of GBM-related markers (Egfr, Tert, and Mgmt) and associated signaling pathways. These findings suggest a potential causal link between insufficient sleep and increased GBM risk, highlighting the importance of sleep management for GBM patients.

PMID:40272711 | DOI:10.1007/s12031-025-02354-3