Tag: pubmed

Anal Chem. 2025 Jun 13. doi: 10.1021/acs.analchem.5c01279. Online ahead of print.

ABSTRACT

Recombinant proteins are critical for modern therapeutics and diagnostics, with Chinese hamster ovary (CHO) cells serving as the primary production platform. However, environmental and chemical stressors in bioreactors often trigger cell death, particularly apoptosis, posing a significant challenge to recombinant protein manufacturing. Rapid, label-free methods to monitor cell death are essential for ensuring better production quality. Stimulated Raman scattering (SRS) microscopy offers a powerful, label-free approach to measure lipid and protein compositions in live cells. We demonstrate that SRS microscopy enables rapid and reagent-free analysis of apoptotic and necrotic transitions. Our results show that apoptotic cells exhibit higher protein concentrations, while necrotic cells show an opposite trend. To enhance analysis, we developed a quantitative single-cell analysis pipeline that extracts chemotypic and phenotypic signatures of apoptosis and necrosis, enabling the identification of subpopulations with varied responses to stressors or treatments. Furthermore, the cell death analysis was successfully generalized to other stressors and cell types. This study highlights SRS microscopy as a robust and noninvasive tool for rapid monitoring of live cell apoptotic and necrotic transitions. Our method and findings hold potential for improving quality control in CHO cell-based biopharmaceutical production and for evaluating cell death in diverse biological contexts.

PMID:40513011 | DOI:10.1021/acs.analchem.5c01279

JMIR Ment Health. 2025 Jun 13;12:e70925. doi: 10.2196/70925.

ABSTRACT

BACKGROUND: Telemental health services effectively address major challenges in mental health care delivery. To maximize the potential of the services, it is essential to facilitate patient use and reduce use disparities. Nevertheless, determinants of patient use of telemental health services have been scarcely investigated thus far.

OBJECTIVE: We aimed to identify determinants of patient use of telemental health services since the onset of the COVID-19 pandemic and in the last 4 weeks.

METHODS: In December 2023, we conducted a cross-sectional, quota-based (gender and age group) online survey. The sample comprised individuals aged 18 to 74 years, who had been using mental health services since March 2020 (n=2082). Telemental health service use was assessed using items that inquired whether individuals had used the services since March 2020 or currently (in the last 4 weeks). Logistic regressions were computed to test the associations of socioeconomic, access, health, COVID-19-related, psychosocial, and service factors, as well as personality and provider characteristics with patient use.

RESULTS: Younger age, a more positive patient attitude toward telemental health services, a more positive provider attitude toward using the services, and higher provider skills for using the services were positively associated with patient use of telemental health services since the onset of the COVID-19 pandemic. When exclusively looking at current use, positive associations with full-time employment, lower neuroticism, a more positive provider attitude toward the services, and use of the services to avoid stigmatization, long waiting times, or inconvenient scheduling were observed. Access, health, and COVID-19-related factors were not associated with patient use (since the onset of the COVID-19 pandemic and currently).

CONCLUSIONS: Beyond socioeconomic factors, personality, and a positive patient attitude toward the services, patient use of telemental health services was associated with a positive provider attitude toward using the services and higher provider skills for using the services, which underscores the need for provider support and training in telemental health care. Furthermore, avoiding stigmatization and higher convenience of the services were associated with patient use, which highlights the substantial potential of the services to address current mental health care challenges.

PMID:40513010 | DOI:10.2196/70925

J Med Internet Res. 2025 Jun 13;27:e72260. doi: 10.2196/72260.

ABSTRACT

BACKGROUND: The exponential growth of digital technologies and the ubiquity of social media platforms have led to unprecedented mental health challenges among college students, highlighting the critical need for effective intervention approaches.

OBJECTIVE: This study aimed to explore the relationship between meeting the 24-hour movement guidelines (24-HMG) health behavior combinations and the risk of social network addiction (SNA) as well as mental health issues among university students. It further sought to compare differences in mental health indicators and SNA levels across various risk groups and adherence patterns, and to identify the optimal 24-HMG health behavior intervention strategies for students at high risk of SNA.

METHODS: This cross-sectional study recruited a total of 12,541 university students from the university town of Guizhou Province as participants. Data were collected through standardized questionnaires, including the Chinese version of Social Network Addiction Scale for College Students (SNAS-C), the adult attention-deficit/hyperactivity disorder (ADHD) self-report scale (ASRS), and the Chinese version of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Self-Report Level 1 Cross-Cutting Symptom Measure for Adults (DSM-5 CCSM), among others. The primary analytical method used was the random forest model, which was used to explore the relationship between different 24-HMG behavior combinations and mental health variables among student at high-risk of SNA. In addition, the study aimed to identify the optimal 24-HMG health behavior intervention strategies for this high-risk group.

RESULTS: Participants in the meeting none group exhibited the highest SNA scores (57.98), which declined progressively with greater adherence. Among single-guideline groups, meeting physical activity (PA; 53.07) and meeting sedentary time (ST; 52.72) showed similar scores. Further reductions were seen in meeting PA+ST (49.68), meeting sleep (48.44), and meeting ST+sleep (44.75), with the lowest in meeting PA+ST+sleep. Approximately 6% of the variance in SNA was attributable to differences in adherence patterns (η²=0.06). Students meeting all three 24-HMG components-PA, sleep, and ST-demonstrated the strongest protection against attention deficit, depression, and anxiety. All 24-HMG behaviors were inversely associated with mental health symptoms, except academic satisfaction, which was positively correlated. Random forest modeling identified meeting sleep+ST as the most impactful for mania (0.4491), sleep disturbance (0.4032), personality (0.3924), and dissociation (0.3832). Meeting ST alone showed the strongest effects on substance (0.6176) and alcohol use (0.6597). Depression was influenced by meeting sleep+ST (0.2053), meeting PA+ST+sleep (0.1650), and meeting PA+ST (0.1634). The model achieved high accuracy for ASRS (0.912; F1-score=0.927), with robust predictions for substance use (F1-score=0.873) and mania (F1-score=0.836).

CONCLUSIONS: Adherence to the health behaviors recommended by the 24-HMG can significantly improve the mental health outcomes of university students at high risk for SNA. The findings of this study support the development of mental health intervention strategies for students at high-risk of SNA based on the 24-HMG framework.

PMID:40512996 | DOI:10.2196/72260

JMIR Med Inform. 2025 Jun 13;13:e72238. doi: 10.2196/72238.

ABSTRACT

BACKGROUND: Insulin resistance (IR), a precursor to type 2 diabetes and a major risk factor for various chronic diseases, is becoming increasingly prevalent in China due to population aging and unhealthy lifestyles. Current methods like the gold-standard hyperinsulinemic-euglycemic clamp has limitations in practical application. The development of more convenient and efficient methods to predict and manage IR in nondiabetic populations will have prevention and control value.

OBJECTIVE: This study aimed to develop and validate a machine learning prediction model for IR in a nondiabetic population, using low-cost diagnostic indicators and questionnaire surveys.

METHODS: A cross-sectional study was conducted for model development, and a retrospective cohort study was used for validation. Data from 17,287 adults with normal fasting blood glucose who underwent physical exams and completed surveys at the Health Management Center of Xiangya Third Hospital, Central South University, from January 2018 to August 2022, were analyzed. IR was assessed using the Homeostasis Model Assessment (HOMA-IR) method. The dataset was split into 80% (13,128/16,411) training and 20% (32,83/16,411) testing. A total of 5 machine learning algorithms, namely random forest, Light Gradient Boosting Machine (LightGBM), Extreme Gradient Boosting, Gradient Boosting Machine, and CatBoost were used. Model optimization included resampling, feature selection, and hyperparameter tuning. Performance was evaluated using F1-score, accuracy, sensitivity, specificity, area under the curve (AUC), and Kappa value. Shapley Additive Explanations analysis was used to assess feature importance. For clinical implication investigation, a different retrospective cohort of 20,369 nondiabetic participants (from the Xiangya Third Hospital database between January 2017 and January 2019) was used for time-to-event analysis with Kaplan-Meier survival curves.

RESULTS: Data from 16,411 nondiabetic individuals were analyzed. We randomly selected 13,128 participants for the training group, and 3283 participants for the validation group. The final model included 34 lifestyle-related questionnaire features and 17 biochemical markers. In the validation group, their AUC were all greater than 0.90. In the test group, all AUC were also greater than 0.80. The LightGBM model showed the best IR prediction performance with an accuracy of 0.7542, sensitivity of 0.6639, specificity of 0.7642, F1-score of 0.6748, Kappa value of 0.3741, and AUC of 0.8456. Top 10 features included BMI, fasting blood glucose, high-density lipoprotein cholesterol, triglycerides, creatinine, alanine aminotransferase, sex, total bilirubin, age, and albumin/globulin ratio. In the validation queue, all participants were separated into the high-risk IR group and the low-risk IR group according to the LightGBM algorithm. Out of 5101 high-risk IR participants, 235 (4.6%) developed diabetes, while 137 (0.9%) of 15,268 low-risk IR participants did. This resulted in a hazard ratio of 5.1, indicating a significantly higher risk for the high-risk IR group.

CONCLUSIONS: By leveraging low-cost laboratory indicators and questionnaire data, the LightGBM model effectively predicts IR status in nondiabetic individuals, aiding in large-scale IR screening and diabetes prevention, and it may potentially become an efficient and practical tool for insulin sensitivity assessment in these settings.

PMID:40512995 | DOI:10.2196/72238

J Prim Care Community Health. 2025 Jan-Dec;16:21501319251340818. doi: 10.1177/21501319251340818. Epub 2025 Jun 13.

ABSTRACT

INTRODUCTION/OBJECTIVES: Stable housing is a well-recognized health-related social need (HRSN) with little attention in medical training. This study examined the efficacy of a resident housing curriculum on referrals to a Community Health Worker (CHW) intervention to assist patients with unmet housing needs.

METHODS: This was a retrospective cohort study conducted on Internal Medicine residents at a large urban residency program in Bronx, NY. We utilized multivariate mixed-effects logistic regression to determine whether clinician curriculum exposure increased CHW referrals among patients who self-reported housing needs in a HRSN screening tool between July 2021 and August 2024.

RESULTS: Nine hundred six unique patients screened positive for unmet housing needs, and 303 (33.4%) patients were referred to CHWs by eligible clinicians (n = 118). Clinician exposure to the curriculum was not a significant predictor of CHW referrals (aOR = 1.03, 95% CI = 0.69-1.54), adjusting for covariates. Patient age (aOR = 0.98, 95% CI = 0.97-0.99), Spanish language (aOR = 1.65, 95% CI = 1.09-2.51), and Medicaid coverage (aOR = 1.61, 95% CI = 1.03-2.51) were associated with likelihood of referral.

CONCLUSIONS: Our findings demonstrate that the curriculum did not increase CHW referrals. Multimodal educational and systemic interventions that support the use of existing workflows may be needed to increase uptake of interventions to address HRSNs.

PMID:40512994 | DOI:10.1177/21501319251340818

Womens Health (Lond). 2025 Jan-Dec;21:17455057251347079. doi: 10.1177/17455057251347079. Epub 2025 Jun 13.

ABSTRACT

BACKGROUND: Overactive bladder and urinary incontinence are strongly associated with falling in older adults. Despite this established link, research on how women experience these coexisting conditions is lacking.

OBJECTIVE: This study aimed to better understand how older women with both urgency urinary incontinence and an increased risk of falls perceive their urinary symptoms in relation to fall risk.

DESIGN: Mixed-methods study using concurrent triangulation design with qualitative interviews and quantitative patient-reported outcome measures.

METHODS: English-speaking women aged 60 and older with urgency or mixed urinary incontinence who screened positive for fall risk were recruited through online advertising. Fall risk was assessed using the Centers for Disease Control and Prevention’s Stopping Elderly Accidents, Deaths, and Injuries “3 Key Questions.” Semistructured interviews explored participants’ perspectives on urinary symptoms, fall risk, and quality of life. Standardized measures included the Falls Efficacy Scale International, PROMIS Physical Function, The International Consultation on Incontinence Modular Questionnaire – Overactive Bladder symptom severity scale, The International Consultation on Incontinence Modular Questionnaire Lower Urinary Tract Symptoms Quality of Life Module, and Functional Comorbidity Index. Thematic analysis of interview transcripts was conducted using constant comparison. Multiple regression models examined associations between fear of falling, symptom severity, physical function, and urinary incontinence-related quality of life.

RESULTS: Sixty women responded to the online advertising for the study and completed the initial screening questionnaire. Twenty-five were enrolled and interviewed. Mean age was 68 ± 4.7. None were aware of linkages between urinary incontinence and falls. Their concerns about falling were unique to the experience of living with a urinary condition and often interacted with social stigma such as embarrassment from incontinence after a fall. Fear of falling was more strongly associated with urinary incontinence-related quality of life than symptom severity, physical functioning, or comorbid burden after adjusting for age (p < 0.01). Fear of falling and symptom severity were the only factors significantly associated with urinary incontinence-related quality of life in regression models.

CONCLUSION: There is a need to better communicate to older women with urinary incontinence the known risk of falling associated with their urinary condition.

PMID:40512992 | DOI:10.1177/17455057251347079

Transl Behav Med. 2025 Jan 16;15(1):ibaf026. doi: 10.1093/tbm/ibaf026.

ABSTRACT

Physical activity and nutrition programs improve children’s health. However, cost and competition for resources between programs are common implementation challenges. Currently, no guidance exists for practitioners about how to spend money within various programs. This study examines spending patterns of schools that concurrently delivered multiple programs to help provide spending guidance. Middle schools (n = 8; 75% rural) that participated in the Healthy School Recognized Campus (HSRC) initiative were provided $3500. To achieve HSRC recognition, schools complete a school-wide walking program, a physical activity or nutrition program for students, and a physical activity or nutrition program for adults (teachers and parents). We tracked purchases, grouped receipts by categories and program, and analyzed spending using descriptive statistics. On average, schools spent $3383.26 ± $159.27. For both adult and teacher incentives, over half of the schools spent $0. Program equipment ($1145.14 ± $1139.10; e.g. cooking equipment and hydroponics kit) was the largest category of spending, followed by student incentives ($945.04 ± $946.62). Schools purchased 5031 items (628.88 ± 926.50 items/school) categorized as small student incentives (e.g. water bottles and gift cards), averaging $1.04 each, and 12 items (1.5 ± 2.78 items/school) on large student incentives (e.g. bike) averaging $124.72 each. On average schools completed 2.88 ± 0.83 (range 2-4) youth programs and 1.50 ± 0.93 (range 0-2) adult programs, which cost around $300-$1500 and $0-$700 per program, respectively. Schools spent almost all the money allocated for HSRC and made strategic spending decisions to maximize student engagement, specifically prioritizing student programs over adult ones. This information about how schools spend their money offers insights for decision-making in future programs.

PMID:40512531 | DOI:10.1093/tbm/ibaf026

JAMA Health Forum. 2025 Jun 7;6(6):e251288. doi: 10.1001/jamahealthforum.2025.1288.

ABSTRACT

IMPORTANCE: Children experiencing parental opioid use disorder are a growing population at heightened risk of physical and mental health issues over the life course. Yet these children are less likely to receive comprehensive, ongoing health care and their parents are more likely to report barriers to access health care for their children. School-based health services have potential to overcome some of these health care access barriers, including parental burden, transportation, time, costs, and health care discontinuity. In 2014, Medicaid revoked its longstanding free care rule, expanding the scope of school-based health services eligible for Medicaid reimbursement. Subsequently, some states began to expand their school Medicaid programs to benefit from the new federal rule.

OBJECTIVE: To estimate the early effects of state school Medicaid expansions on the receipt of Medicaid-funded school-based health services among children who have experienced parental opioid use disorder.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study using nationwide Medicaid claims data included Medicaid-enrolled children aged 5 to 18 years who experienced parental opioid use disorder at any point before age 19 years. A difference-in-differences design that exploits the staggered implementation of school Medicaid expansions between 2014 and 2019 was used. Data were analyzed between January 2023 and January 2025.

EXPOSURES: Children living in states implementing (treatment group) and not implementing (comparison group) school Medicaid expansions, before and after state-specific expansion dates.

MAIN OUTCOMES AND MEASURES: Binary measures indicating receipt of school-based health services, primary care, prevention, rehabilitative, dental, and mental health services, emergency department visits, and inpatient hospital stays.

RESULTS: The sample comprised 6 628 404 person-years from 1 700 304 children. The mean (SD) age was 10.5 (3.9) years and 3 371 918 (51%) were male. School Medicaid expansions increased the receipt of Medicaid-funded school-based health services by 8.9 percentage points (pp; P = .01). Growth was primarily driven by school claims for nursing services (difference, 7.4 pp; P = .02) and for Early and Periodic Screening, Diagnostic and Treatment services (difference, 8.6 pp; P = .04). Reductions in emergency department visits among children aged 5 to 11 years were also documented (difference, -1.8 pp; P = .02).

CONCLUSIONS AND RELEVANCE: This cohort study found that, given the complex health and health care needs of children growing up amid the opioid crisis, integrating health care into schools may offer a promising policy solution.

PMID:40512511 | DOI:10.1001/jamahealthforum.2025.1288

JAMA Health Forum. 2025 Jun 7;6(6):e251369. doi: 10.1001/jamahealthforum.2025.1369.

ABSTRACT

IMPORTANCE: In the context of the US opioid crisis, factors associated with the prevalence of opioid use disorder (OUD) must be identified to aid prevention and treatment. State medical cannabis laws (MCL) and recreational cannabis laws (RCL) are potential factors associated with OUD prevalence.

OBJECTIVE: To examine changes in OUD prevalence associated with MCL and RCL enactment among veterans treated at the Veterans Health Administration (VHA) and whether associations differed by age or chronic pain.

DESIGN, SETTING, AND PARTICIPANTS: Using VHA electronic health records from January 2005 to December 2022, adjusted yearly prevalences of OUD were calculated, controlling for sociodemographic characteristics, receipt of prescription opioids, other substance use disorders, and time-varying state covariates. Staggered-adoption difference-in-difference analyses were used for estimates and 95% CIs for the relationship between MCL and RCL enactment and OUD prevalence. The study included VHA patients aged 18 to 75 years. The data were analyzed in December 2023.

MAIN OUTCOME AND MEASURES: International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) or International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) OUD diagnoses.

RESULTS: From 2005 to 2022, most patients were male (86.7.%-95.0%) and non-Hispanic White (70.3%-78.7%); the yearly mean age was 61.9 to 63.6 years (approximately 3.2 to 4.5 million patients per year). During the study period, OUD decreased from 1.12% to 1.06% in states without cannabis laws, increased from 1.13% to 1.19% in states that enacted MCL, and remained stable in states that also enacted RCL. OUD prevalence increased significantly by 0.06% (95% CI, 0.05%-0.06%) following MCL enactment and 0.07% (95% CI, 0.06%-0.08%) after RCL enactment. In patients aged 35 to 64 years and 65 to 75 years, MCL and RCL enactment was associated with increased OUD, with the greatest increase after RCL enactment among older adults (0.12%; 95% CI, 0.11%-0.13%). Patients with chronic pain had even larger increases in OUD following MCL (0.08%; 95% CI, 0.07%-0.09%) and RCL enactment (0.13%; 95% CI, 0.12%-0.15%). Consistent with overall findings, the largest increases in OUD occurred among patients with chronic pain aged 35 to 64 years following the enactment of MCL and RCL (0.09%; 95% CI, 0.07%-0.11%) and adults aged 65 to 75 years following RCL enactment (0.23%; 95% CI, 0.21%-0.25%).

CONCLUSIONS AND RELEVANCE: The results of this cohort study suggest that MCL and RCL enactment was associated with greater OUD prevalence in VHA patients over time, with the greatest increases among middle-aged and older patients and those with chronic pain. The findings did not support state cannabis legalization as a means of reducing the burden of OUD during the ongoing opioid epidemic.

PMID:40512510 | DOI:10.1001/jamahealthforum.2025.1369

JAMA Health Forum. 2025 Jun 7;6(6):e251376. doi: 10.1001/jamahealthforum.2025.1376.

ABSTRACT

IMPORTANCE: National continuous Medicaid eligibility under the Families First Coronavirus Response Act (FFCRA) may have differentially affected children’s health care depending on whether states had preexisting 12-month continuous Medicaid eligibility for children.

OBJECTIVE: To estimate the association of states newly implementing continuous Medicaid eligibility under the FFCRA with children’s health care access, health care use, and barriers to care.

DESIGN, SETTING, AND PARTICIPANTS: This survey study used a difference-in-differences research design comparing states before (2017-2019) and during (2020-2022) the FFCRA overall, by caregiver-reported race and ethnicity, and among publicly insured children. Analyses used data from the National Survey of Children’s Health (NSCH), an annual household survey on the health and well-being of children 0 to 17 years old in the US. Data were analyzed from September 2024 to March 2025.

EXPOSURES: Whether states had pre-FFCRA 12-month continuous Medicaid eligibility for children.

MAIN OUTCOMES AND MEASURES: Insurance coverage, gaps in coverage, unmet health care needs, any health care visits, preventive visits, emergency department visits, hospitalizations, any time spent weekly arranging children’s health care, and problems paying medical bills.

RESULTS: The sample included 215 884 children, with children in states with pre-FFCRA continuous eligibility being similar to children in states newly implementing continuous eligibility with respect to age (8.6 years old in both sets of states), gender (49.6% female compared to 48.5%), and nativity (66.7% third generation or longer with all parents born in the US vs 69.6%), with lower proportions who were non-Hispanic Black (11.9% compared to 13.8%) or non-Hispanic White (50.5% compared to 52.9%), and higher proportions who were Hispanic (25.5% compared to 23.9%). In adjusted difference-in-difference models, newly implementing continuous eligibility under the FFCRA was associated with a 0.7-percentage point (95% CI, -1.2 to -0.1 percentage point) reduction in children’s unmet health care needs. There was no evidence of additional FFCRA-associated changes in outcomes overall. In subgroup analyses, there were reductions in coverage gaps, unmet health care needs, and time spent arranging care among Hispanic children and publicly insured children.

CONCLUSIONS AND RELEVANCE: In this survey study, newly implementing continuous eligibility for children under the FFCRA was associated with reductions in unmet health care needs and no additional changes in health care outcomes overall, with additional benefits for Hispanic children and publicly insured children. This could reflect expected changes under mandatory, national 12-month continuous eligibility for children implemented in January 2024.

PMID:40512509 | DOI:10.1001/jamahealthforum.2025.1376