Tag: pubmed

Curr Med Res Opin. 2025 Jun 10:1-18. doi: 10.1080/03007995.2025.2517697. Online ahead of print.

ABSTRACT

OBJECTIVE: Type 2 diabetes (T2D) is a chronic metabolic disorder requiring insulin therapy as β-cell function declines. Despite insulin’s proven efficacy, adherence remains a significant challenge. This study aims to identify factors influencing insulin adherence among patients with T2D to inform targeted clinical interventions.

METHODS: A cross-sectional study was conducted at a tertiary diabetes clinic, recruiting adult patients with T2D on insulin therapy for at least six months. A structured, validated questionnaire was administered in person to collect demographic, clinical, and treatment-related data, along with patient beliefs about insulin. Insulin adherence was defined as taking ≥80% of prescribed doses over the past month. Statistical analysis included univariate and multivariate logistic regression to identify independent predictors of adherence.

RESULTS: Among 111 patients, 49 (44.1%) were adherent, while 62 (55.9%) were non-adherent. Adherence was associated with male gender, higher education levels, smoking abstinence, and adherence to recommended diet and exercise regimens. Non-adherent patients had a higher prevalence of family history of diabetes, more diabetic complications, increased comorbidities, and more frequent hospitalizations. Self-injection of insulin and regular self-monitoring of blood glucose were linked to better adherence, whereas fear of injections and the use of herbal medicine were associated with lower adherence. Negative beliefs about insulin were not significantly different between groups.

CONCLUSION: Insulin adherence in T2D is influenced by lifestyle, clinical, and practical treatment factors rather than negative beliefs alone. Addressing practical barriers, such as fear of injection and alternative treatment use, through patient education and supportive interventions may improve adherence rates.

PMID:40493381 | DOI:10.1080/03007995.2025.2517697

JAMA Netw Open. 2025 Jun 2;8(6):e2513520. doi: 10.1001/jamanetworkopen.2025.13520.

ABSTRACT

IMPORTANCE: Commercial sexual exploitation (CSE) of young people (aged 6-26 years) poses a considerable public health and social challenge. Understanding how social network exposure to CSE influences CSE risk may inform targeted prevention strategies for at-risk youths.

OBJECTIVE: To examine the association between social network exposure to CSE and personal risk of experiencing CSE among youths, with a focus on how exposure interacts with childhood adversities.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data collected between January 1, 2015, and December 31, 2022, from a CSE program at a children’s advocacy center in the northeastern US. Eligibility criteria included referral for suspected or confirmed CSE risk. Social relationships with offenders, peers, and others sharing residential placements were examined as potential sources of exposure. The final analyses were completed on March 20, 2025.

EXPOSURE: Social network exposure to CSE among youths.

MAIN OUTCOMES AND MEASURES: Experiencing CSE was the main outcome. Logistic regression was used to assess associations between youth network exposure to CSE and the risk of experiencing CSE, and social network analyses were conducted to identify patterns in the connections between youths with and without CSE experiences.

RESULTS: A total of 997 youth were included in the study (mean [SD] age, 14.7 [2.1] years; 903 female [90.6%]). Youths exposed to CSE through their social networks were significantly more likely to experience CSE (adjusted odds ratio, 2.92; 95% CI, 1.91-4.47). A significant interaction between social exposure and childhood adversities revealed that social network exposure was associated with higher CSE risk among youth with fewer adversities (adjusted odds ratio, 1.45; 95% CI, 1.22-1.74). Network analyses revealed that youth experiencing CSE were more likely to be connected to one another (β [SE], 0.32 [0.14]), highlighting the clustering of CSE within social networks.

CONCLUSIONS AND RELEVANCE: These findings suggest that prevention strategies should aim to reduce unmitigated exposure to individuals experiencing CSE and focus on fostering supportive and healthy relationships. This study underscores the potential for social network modeling to identify at-risk youth and inform prevention efforts.

PMID:40493369 | DOI:10.1001/jamanetworkopen.2025.13520

JAMA Netw Open. 2025 Jun 2;8(6):e2514443. doi: 10.1001/jamanetworkopen.2025.14443.

ABSTRACT

IMPORTANCE: Firearm access increases fatal and nonfatal firearm injury risk among teens. Identifying parental firearm storage behaviors associated with teen access may inform efforts to prevent teen firearm injuries.

OBJECTIVE: To examine the associations between parent-reported household firearm storage behaviors and teen perceived access to firearms.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used national survey data of US firearm-owning parents and their teens (aged 14 to 18 years) surveyed between June and July 2020, with a response rate of 31% for parents and 21% for teens. Analyses were conducted January to May 2024.

EXPOSURES: The number of firearms stored in the household as (1) unlocked, (2) loaded, (3) unlocked and loaded, and (4) unlocked or loaded.

MAIN OUTCOMES AND MEASURES: Teen perceived firearm access, overall and stratified by teen gender, parental education, and urbanicity. Survey-weighted logistic regression analyses assessed the associations between the number of firearms parents reported storing in each unsecured state (unlocked and loaded, unlocked, loaded, and unlocked or loaded) and teen perceived firearm access, overall and stratified by teen gender, parental education, and urbanicity (metropolitan vs nonmetropolitan). The areas under the receiver operating characteristic curves (AUROC) were used to identify the firearm storage behaviors with the best ability to estimate teen perceived firearm access.

RESULTS: Analyses included 487 parent-teen dyad respondents. The mean (SE) ages of parents and teens were 46.6 (0.80) and 16.0 (0.12) years, respectively. Most parent respondents were male (58.1%; 95% CI, 50.3%-65.8%) and White (73.5%; 95% CI, 66.1%-80.9%), and most teen respondents were female (55.7%; 95% CI, 47.8%-63.6%) and White (69.5%; 95% CI, 61.8%-77.2%). All 4 unsecured firearm storage behaviors were associated with greater teen perceived firearm access (odds ratio [OR], 1.27-1.44; 95% CI, 0.99-2.10), but associations disappeared after restricting to those who stored at least 1 firearm unsecured (OR, 0.99-1.18; 95% CI, 0.67-1.89). The number of firearms stored unlocked performed the best in estimating teen perceived access to firearms in US households (AUROC, 65.7; 95% CI, 61.4-70.1), regardless of teen gender, parental education, and urbanicity. However, sensitivity of this measure was universally low (range, 42%-64%). Additionally, 36.3% (95% CI, 23.6%-49.0%) of teens reported access to a firearm in households where all firearms were stored locked and unloaded.

CONCLUSIONS AND RELEVANCE: This study found that parent-reported firearm storage may be a poor estimator of teen perceived firearm access, regardless of teen gender, parental education, and urbanicity. Strictly focusing safety efforts on locked and unloaded firearm storage may not fully negate teen’s perceptions that they can access and load household firearms. Storing additional firearms securely may not prevent teen access if at least 1 household firearm remains unlocked.

PMID:40493368 | DOI:10.1001/jamanetworkopen.2025.14443

JAMA Netw Open. 2025 Jun 2;8(6):e2514508. doi: 10.1001/jamanetworkopen.2025.14508.

ABSTRACT

IMPORTANCE: Current guidelines recommend oseltamivir treatment for all patients hospitalized with influenza, but this guidance is based on suboptimal evidence.

OBJECTIVE: To evaluate outcomes associated with oseltamivir treatment when compared with supportive care for severe seasonal influenza requiring hospitalization.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study using target trial emulation included adult patients admitted to hospital with influenza from 30 hospitals in Ontario, Canada, from January 2015 to June 2023. Data were analyzed from November 2024 to March 2025.

EXPOSURE: Oseltamivir treatment on hospital day 0 or 1 vs supportive care without oseltamivir.

MAIN OUTCOME AND MEASURES: The primary outcome was in-hospital mortality. Secondary outcomes included time to being discharged alive and readmission within 30 days. Overlap weighting of propensity scores was used to balance covariates, and a competing risk model was used to compare time to being discharged alive.

RESULTS: Of 11 073 patients (mean [SD] age, 72.6 [16.8] years; 5793 female [52.3%]), there were 7632 patients (68.9%) and 3441 patients (31.1%) in the oseltamivir and supportive care groups, respectively. In hospital, 268 patients (3.5%) and 168 patients (4.9%) in the oseltamivir and supportive care groups died, respectively, with an adjusted risk difference of -1.8% (95% CI, -2.8% to -0.9%; P < .001). The oseltamivir treatment group was more likely to be discharged alive (adjusted subdistribution hazard ratio, 1.20; 95% CI, 1.15 to 1.25; P < .001). After discharge, 645 patients (8.5%) and 336 patients (9.8%) were readmitted in the oseltamivir and supportive care groups, respectively, with an adjusted risk difference of -1.5% (95% CI, -2.8% to -0.2%; P = .02).

CONCLUSIONS AND RELEVANCE: In this cohort study of patients hospitalized with influenza, oseltamivir treatment was associated with a lower in-hospital mortality risk, earlier discharge, and lower readmission rate, supporting evidence for the current guideline recommendation of oseltamivir treatment for severe influenza. Clinical trials are needed to definitively answer this question.

PMID:40493366 | DOI:10.1001/jamanetworkopen.2025.14508

JAMA Netw Open. 2025 Jun 2;8(6):e2514519. doi: 10.1001/jamanetworkopen.2025.14519.

ABSTRACT

IMPORTANCE: Targeted therapies and immunotherapies prolong survival but are associated with high costs for patients with advanced non-small cell lung cancer (aNSCLC). To date, little is known about survival and medication cost by biomarker status in the US.

OBJECTIVE: To estimate survival and medication cost by aNSCLC biomarker status.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study using Flatiron Health data identified patients diagnosed with aNSCLC from January 1, 2016, through December 31, 2022. Each patient had received at least 1 biomarker test and 1 documented line of therapy; follow-up was through September 31, 2023. Patients were categorized based on the presence of driver alterations, including ALK rearrangement, BRAF variation, or EGFR variation. Patients without driver alterations were divided into 3 groups based on their programmed cell death 1 ligand 1 (PD-L1) expression (<1%, 1%-49%, or ≥50%).

MAIN OUTCOMES AND MEASURES: The primary outcome was medication costs, which were a function of survival probability and monthly medication costs. The secondary outcome was medication costs per survivor, defined as the mean aggregate medication costs within each patient cohort for each 1- or 2-year survivor.

RESULTS: The study cohort consisted of 26 635 patients with aNSCLC (mean [SD] age at diagnosis, 68.9 [10.0] years; 13 750 [52%] male; 2610 [10%] African American, 687 [3%] Asian, 18 352 [69%] White, and 4986 [19%] other race, including any race other than African American, Asian, or White). The median overall survival was 39.9 (95% CI, 33.9-48.5) months for patients with ALK rearrangement, 27.0 (95% CI, 24.8-28.8) months for EGFR variation, 18.7 (95% CI, 16.0-20.6) months for BRAF variation, 12.3 (95% CI, 12.0-12.7) months for PD-L1 less than 1%, 13.7 (95% CI, 13.1-14.3) months for PD-L1 of 1% to 49%, and 16.2 (95% CI, 15.3-17.0) months for PD-L1 of 50% or greater. The 1- and 2-year medication costs per patient for the overall cohort were $120 420 (95% CI, $115 540-$126 470) and $182 560 (95% CI, $172 900-$196 040), respectively. Patients with EGFR variation or PD-L1 of 50% or greater incurred relatively higher 1-year medication cost ($131 700 [95% CI, $125 340-$138 280] and $123 590 [95% CI, $115 970-$130 840], respectively) compared with patients with PD-L1 less than 1% ($110 350 [95% CI, $101 680-$120 040]). Patients with ALK rearrangement or EGFR variation incurred the highest 2-year medication cost ($242 130 [95% CI, $206 220-$267 330] and $241 940 [95% CI, $230 840-$254 730], respectively), whereas patients with PD-L1 less than 1% and PD-L1 of 1% to 49% had the lowest 2-year medication cost ($156 340 [95% CI, $142 450-$172 800] and $163 410 [95% CI, $152 410-$174 180], respectively). The medication costs per 1-year survivor were $152 370 (95% CI, $133 550-$178 080) for patients with ALK rearrangement, $175 720 (95% CI, $167 330-$185 390) for EGFR variation, $211 100 (95% CI, $195 030-$229 400) for PD-L1 less than 1%, $210 260 (95% CI, $193 190-$226 580) for PD-L1 of 1% to 49%, and $211 630 (95% CI, $198 670-$224 210) for PD-L1 of 50% or greater, whereas the costs per 2-year survivor were $363 480 (95% CI, $314 710-$401 320) for patients with ALK rearrangement, $468 400 (95% CI, $441 340-$497 860) for patients with PD-L1 of 50% or greater, $460 790 (95% CI, $427 340-$494 080) for patients with PD-L1 of 1% to 49%, and $500 220 (95% CI, $456 900-$556 730) for patients with PD-L1 less than 1%.

CONCLUSIONS AND RELEVANCE: In this cohort study, patients with aNSCLC with driver alterations experienced better survival and incurred lower medication costs per survivor than those without driver variation, indicating the need to develop more affordable and effective medications for patients without driver alterations.

PMID:40493365 | DOI:10.1001/jamanetworkopen.2025.14519

Obes Surg. 2025 Jun 10. doi: 10.1007/s11695-025-07946-x. Online ahead of print.

ABSTRACT

INTRODUCTION: The rising prevalence of obesity and demand for minimally invasive treatments has led to increased adoption of endoscopic sleeve gastroplasty (ESG). As telemedicine expands in bariatrics, understanding the role of virtual follow-up care is crucial. This study aims to use propensity-matching to compare weight loss and metabolic outcomes between virtual and in-person follow-up modalities post-ESG.

METHODS: Data from patients with obesity who underwent ESG at a single tertiary care center between August 2013 and November 2024 were prospectively collected and retrospectively analyzed. Eligible patients were those with a body mass index (BMI) of 30 kg/m² or greater (or > 27 kg/m² with comorbidities). All procedures were performed by a single therapeutic endoscopist using a full-thickness technique. Patients were categorized into virtual or in-person follow-up groups based on whether over 70% of their post-procedure visits were conducted virtually or in-person, respectively. To account for potential baseline differences, propensity score matching was employed. The primary outcomes assessed were the impact of follow-up method on percent total body weight loss (%TBWL) and changes in metabolic parameters at 12 and 36 months post-ESG.

RESULTS: Data from 113 patients (mean age, 43.9 years; 80.5% female, BMI 36.0 kg/m²), were analyzed, and stratified by follow-up modality (in-person: n = 54, virtual: n = 59). After propensity matching, baseline differences were eliminated and both groups demonstrated improvements in ALT, HbA1c, LDL, TG, SBP, and mean %TBWL exceeding ten at all time points, with no statistically significant differences between groups at 12 or 36 months.

DISCUSSION: Telemedicine is expected to remain in the management of obesity due to its convenience. This study found no significant differences in weight loss or metabolic changes between propensity-matched groups, demonstrating comparable effectiveness of virtual and in-person follow-up. Future research should refine telemedicine strategies and assess their long-term impact on weight maintenance.

PMID:40493351 | DOI:10.1007/s11695-025-07946-x

Environ Sci Pollut Res Int. 2025 Jun 10. doi: 10.1007/s11356-025-36584-0. Online ahead of print.

ABSTRACT

This study employed a passive dust sampling method using flat glass traps at 44 locations across Tehran, which allowed for detailed analysis of V, Pb, Cu, Zn, Cd, Ni, and Cr concentrations. It offers an essential understanding of the spatial distribution and seasonal variation of urban dust pollution, along with its associated environmental and human health risks. The results indicate that Zn, Pb, Cu, and Cd are key factors influencing the dust pollution burden in Tehran. The findings highlight the pollution and ecological impacts of dust, showing that most of the dust throughout Tehran has “moderate to high pollution levels” and “considerable ecological risk”. In addition, these studies show that Cd and Pb need special attention. Multivariate statistical analyses demonstrated that Cu, Zn, Pb, and Cd were predominantly affected by human activities, while Ni and Cr were affected to a lesser degree, and V appeared to be more influenced by geological sources. The assessment of health risks showed that these levels were within the safe limits (non-carcinogenic < 1 and carcinogenic < 1 ✕ 10^-6), and the possible health risks in children were more than in adults. The most unsafe route of exposure in children was ingestion, followed by dermal contact and inhalation. The findings of this research showed that cold seasons can be most problematic with the negative effects of pollution and ecological risks, and may also have health risks in the long term. The findings pointed to reasons such as increased consumption of fossil fuels, increased traffic, temperature inversion, and atmospheric stability.

PMID:40493347 | DOI:10.1007/s11356-025-36584-0

Adv Ther. 2025 Jun 10. doi: 10.1007/s12325-025-03227-2. Online ahead of print.

ABSTRACT

INTRODUCTION: Understanding the 24-h efficacy and safety of a novel therapy option, sepetaprost ophthalmic solution 0.002% vs. latanoprost ophthalmic solution 0.005%, may delineate its future position in glaucoma treatment.

METHODS: In this exploratory study (EudraCT 2020-004836-93), adults with primary open-angle glaucoma (POAG) or ocular hypertension (OHT) were randomized to sepetaprost or latanoprost for 3 months following a ≤ 35-day screening period. The primary endpoint was mean 24-h intraocular pressure (IOP) at month 3 with sepetaprost vs. latanoprost. Safety outcomes included rate of adverse events (AEs).

RESULTS: Overall, 33 participants received treatment (sepetaprost, n = 17; latanoprost, n = 16). Mean 24-h IOP was numerically lower with sepetaprost vs. latanoprost at month 3 (- 0.88 mmHg; 95% confidence interval [CI] – 2.89, 1.14; not statistically significant at the 0.05 level [NS]). Mean change from baseline in IOP at month 3 ranged from – 5.63 to – 7.00 mmHg for sepetaprost and – 3.84 to – 6.66 mmHg for latanoprost. Lower nocturnal IOP was observed with sepetaprost vs. latanoprost at month 3 (- 1.61 mmHg difference; 95% CI – 4.05, 0.83; not statistically significant; however, the 90% CI was – 5.27, – 0.17 and therefore, nominal statistical significance was achieved at the 0.10 level). Mean difference between groups indicated similar, or numerically lower, IOP with sepetaprost at individual time points at week 6 and month 3. At 36 and 48 h following sepetaprost cessation, mean IOP was lower vs. baseline IOP at the same time points. AEs occurred in 13 (76.5%) vs. 11 (68.8%) participants treated with sepetaprost vs. latanoprost.

CONCLUSION: In participants with POAG or OHT, mean 24-h IOP and nocturnal IOP at month 3 were consistently numerically lower with sepetaprost vs. latanoprost. Safety profiles were similar between groups.

TRIAL REGISTRATION: EudraCT 2020-004836-93.

PMID:40493333 | DOI:10.1007/s12325-025-03227-2

Int J Clin Pharm. 2025 Jun 10. doi: 10.1007/s11096-025-01947-7. Online ahead of print.

ABSTRACT

BACKGROUND: Pharmaceutical calculations are required elements of the Doctor of Pharmacy curriculum in the United States. With the growth of artificial intelligence chatbots, pharmacists and educators are exploring their application. The accuracy of artificial intelligence chatbots in performing pharmaceutical calculations remains unknown.

AIM: To evaluate the accuracy of artificial intelligence chatbots for pharmaceutical calculations.

METHOD: Eleven free-access chatbots were tested using 7 faculty-generated questions: 1 control, 2 creatinine clearance, 1 oral to intravenous dose conversion, 2 antibiotic pharmacokinetic dosing, and 1 number needed to harm. Descriptive statistics were used to evaluate the primary outcome, which was proportion of correct responses. Secondary outcomes included types of errors and teachability.

RESULTS: Ten (90.9%) chatbots answered the control question correctly, and all answered the dose conversion question correctly. Eight (72.7%) chatbots correctly calculated number needed to harm. Only 1 (9.1%) provided the correct antibiotic dosing, and none correctly calculated creatinine clearance. Common errors included incorrect weight selection for creatinine clearance and use of incorrect formulas. Nine (81.8%) chatbots were teachable on at least 1 question.

CONCLUSION: Artificial intelligence chatbots demonstrated limited accuracy for multi-step pharmaceutical calculations and may be more reliable for low complexity calculations.

PMID:40493330 | DOI:10.1007/s11096-025-01947-7

Am J Cardiovasc Drugs. 2025 Jun 10. doi: 10.1007/s40256-025-00738-9. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim was to systematically evaluate the effect of semaglutide on blood pressure in obese populations using meta-analysis methods.

METHODS: Randomized controlled trials on the effect of semaglutide on blood pressure regulation published from the inception of the databases to October 2024 were searched for in PubMed, Embase, the Cochrane Library, and Web of Science. Stata software was used for statistical analysis of the outcome measures in all included studies. Egger’s test was applied to assess the risk of publication bias.

RESULTS: A total of 22 studies involving 15,347 participants were included in this meta-analysis. The results showed that, compared to the control group, the semaglutide group significantly reduced systolic blood pressure (SBP) (mean difference [MD] – 2.90, 95% confidence interval [CI] – 3.70 to – 2.11; P < 0.01) and diastolic blood pressure (DBP) (MD – 0.86, 95% CI – 1.34 to – 0.38; P < 0.01). Further subgroup analysis revealed that, compared to diabetic populations, semaglutide had a more significant reduction in SBP (- 1.87, 95% CI – 2.67 to – 1.06, vs – 5.02, 95% CI – 6.10 to – 3.94) and DBP (- 0.43, 95% CI – 0.89 to 0.02, vs – 1.96, 95% CI – 3.12 to – 0.80) in non-diabetic populations. The higher dose of semaglutide (2.4 mg) was found to significantly lower SBP (MD – 4.31, 95% CI – 5.18 to – 3.44) and DBP (MD – 1.84, 95% CI – 2.70 to – 0.98), although mild heterogeneity was present. Sensitivity analysis showed that the exclusion of any single study did not significantly affect the final results.

CONCLUSION: Current evidence suggests that semaglutide can lower SBP and DBP, and increasing the dosage can enhance the blood pressure-lowering effect.

PMID:40493329 | DOI:10.1007/s40256-025-00738-9