Tag: pubmed

JAMA Health Forum. 2025 Jun 7;6(6):e251204. doi: 10.1001/jamahealthforum.2025.1204.

ABSTRACT

IMPORTANCE: Identifying effective and financially viable strategies to meet the care needs of perons with impaired function is a policy challenge for high-income countries with aging populations. The 2022 National Strategy to Support Family Caregivers identified a range of actions to support caregivers, while family-oriented policies to promote the affordability of care were promoted by both candidates in the 2024 presidential election.

OBJECTIVE: To examine public perceptions of federal policies to support older adults, adults living with disabilities, and their family caregivers by political affiliation and caregiving status.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study included adults in the CLIMB study, a nationally representative, longitudinal panel. Data were collected in March and April 2024. Data analyses occurred from September 2024 to February 2025.

EXPOSURES: Self-reported political party affiliation and caregiving responsibility.

MAIN OUTCOMES AND MEASURES: Endorsement of 6 policies. Responses based on a 5-point Likert scale were dichotomized to contrast “strongly” or “somewhat support” with “strongly oppose,” “somewhat oppose,” and “neither support nor oppose.” The probability of support and differences across political affiliations was presented.

RESULTS: Of 2059 respondents (1035 female individuals [50.9%]; mean [SD] age, 49.0 [18.2] years), 394 (20%) reported having caregiving responsibilities, with no significant difference across political affiliation. Endorsement was highest for policies to make care in facilities (1657 [79.0%]) and homes (1600 [75.4%]) more affordable, expand eligibility for financial access to care (1618 [77.3%]), and increase the capacity of the paid caregiving workforce (1649 [78.3%]) and was lower for expansion of paid family leave (1342 [65.4%]) and payment of family caregivers (1223 [61.2%]). Endorsement by political affiliation was most similar for policies to make care at home more affordable (13.7-percentage point difference; 95% CI, -20.4 to -7.1) and least similar for paid family leave (33.4-percentage point difference; 95% CI, -39.0 to -27.7). While respondents with caregiving responsibilities were more likely to support paying family caregivers, political affiliation was associated with the endorsement of policies to support the care economy that was stronger in magnitude than sociodemographic characteristics (eg, sex) or caregiving experiences.

CONCLUSIONS AND RELEVANCE: The results of this cohort study suggest that, despite some differences by political affiliation, there is high support of policies to support the adult care economy, suggesting a policy window to advance legislation and executive action to address the care needs of aging populations and populations with disabilities.

PMID:40478556 | DOI:10.1001/jamahealthforum.2025.1204

JAMA Health Forum. 2025 Jun 7;6(6):e251215. doi: 10.1001/jamahealthforum.2025.1215.

ABSTRACT

IMPORTANCE: In Medicare Advantage (MA), the private component of the Medicare program that enrolls more than half of beneficiaries, an increasing share of plans are offering Part B premium givebacks to pay for part or all of the at least $174.70 Part B monthly premium. Millions of dollars of Medicare expenditures are attributable to this benefit, yet little is known about its association with member enrollment or other plan characteristics.

OBJECTIVE: To document trends and expenditures in MA Part B premium givebacks and examine their association with plan enrollment.

DESIGN, SETTING, AND PARTICIPANTS: This longitudinal difference-in-differences analysis compared MA plan enrollment before and after the offer of a Part B giveback among plans that offered the giveback vs plans that did not. January MA plan enrollment and characteristics data from 2018 through 2024 were included. Data were analyzed from May 2024 to February 2025.

EXPOSURE: Adoption of a Part B giveback.

MAIN OUTCOMES AND MEASURES: Total plan enrollment.

RESULTS: A sample of 18 627 plan-years representing more than 130 million enrollee-years was included in the analysis. The percentage of MA plans offering a Part B premium giveback increased from 4.3% (93 of 2187) in 2018 to 18.7% (737 of 3940) in 2024. Plans offering Part B premium givebacks had lower median enrollment, belonged to newer, higher rated contracts, had higher cost-sharing, and had lower enrollee risk scores compared with plans that did not offer givebacks. In 2024, the 3.4 million enrollees in plans with Part B givebacks received a mean (SD) of $77 ($42), amounting to as much as approximately $261 million in total monthly expenditures across the MA program. Adoption of a Part B giveback was associated with a 33.3% (95% CI, 9.3-56.9) increase in enrollment, robust to all model specifications. There was a dose-response association between the size of the giveback and enrollment.

CONCLUSIONS AND RELEVANCE: In this study, the adoption of Part B premium givebacks among MA plans was associated with a substantial increase in plan enrollment. Further research will be needed to understand the total value to enrollees of Part B givebacks, which confers hundreds of millions of dollars monthly to Medicare beneficiaries.

PMID:40478555 | DOI:10.1001/jamahealthforum.2025.1215

JAMA Health Forum. 2025 Jun 7;6(6):e251430. doi: 10.1001/jamahealthforum.2025.1430.

ABSTRACT

IMPORTANCE: Evidence is limited regarding the physician characteristics associated with the provision of low-value services in primary care, especially outside of the US.

OBJECTIVE: To measure physician-level use of 10 low-value care services that provide no net clinical benefit and to investigate the characteristics of primary care physicians who frequently provide low-value care in Japan.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional analysis used a nationwide electronic health record database linked with claims data in Japan to assess visits by adult patients (age ≥18 years) to a solo-practice primary care physician from October 1, 2022, through September 30, 2023. Data analysis was performed from June 2024 to February 2025.

MAIN OUTCOMES AND MEASURES: Multivariable-adjusted composite rate of low-value care services delivered per 100 patients per year, aggregated across 10 low-value measures, after accounting for case mix and other characteristics.

RESULTS: Among 2 542 630 patients (mean [SD] age, 51.6 [19.8] years; 58.2% female) treated by 1019 primary care physicians (mean [SD] age 56.4 [10.2] years; 90.4% male), 436 317 low-value care services were identified (17.2 cases per 100 patients overall). Nearly half of these low-value care services were provided by 10% of physicians. After accounting for patient case mix, older physicians (age ≥60 years) delivered 2.1 per 100 patients (95% CI, 1.0-3.3) more low-value care services than those younger than 40 years; not board-certified physicians delivered 0.8 per 100 patients (95% CI, 0.2-1.5) more than general internal medicine board-certified physicians; physicians with higher patient volumes delivered 2.3 per 100 patients (95% CI, 1.5-3.2) more than those with low patient volumes; and physicians practicing in Western Japan delivered 1.0 per 100 patients (95% CI, 0.5-1.5) more than those in Eastern Japan.

CONCLUSIONS AND RELEVANCE: The findings of this cross-sectional analysis suggest that low-value care services were common and concentrated among a small number of primary care physicians in Japan, with older physicians and not board-certified physicians being more likely to provide low-value care. Policy interventions targeting at a small number of certain types of physicians providing large quantities of low-value care may be more effective and efficient than those targeting all physicians uniformly.

PMID:40478554 | DOI:10.1001/jamahealthforum.2025.1430

Mil Med. 2025 Jun 6:usaf262. doi: 10.1093/milmed/usaf262. Online ahead of print.

ABSTRACT

INTRODUCTION: Most mortality studies among Norwegian military veterans from international peacekeeping missions were conducted among men, as the number of women participants in each mission has been too small to give statistically robust results. However, women have served in every peacekeeping operation since 1978. As the number of military women increases, knowledge about the causes of death among female military peacekeepers is increasingly important to ensure the Armed Forces’ military operability and preventive initiatives. Hence, we aimed to study mortality in a cohort comprising all military women who participated in such service back to 1978.

MATERIALS AND METHODS: The cohort was established by the Norwegian Armed Forces Health Registry and included 2,365 women eligible for follow-up from their first day of peacekeeping service through 2023. We calculated standardized mortality ratios (SMRs) with 95% confidence intervals (CIs) by comparing the observed numbers of deaths with the expected numbers calculated from national population rates in Norway.

RESULTS: A total of 65 deaths observed during follow-up gave a lower-than-expected all-cause SMR of 0.79 bordering on statistical significance (95% CI, 0.61-1.01). This was because of to low mortality from diseases. Mortality from (nonmalignant) respiratory diseases was lower than expected (SMR = 0.18, 95% CI, 0.00-0.99), on the other hand, the risk of dying from cerebrovascular diseases (stroke) was elevated (SMR = 2.64, 95% CI, 1.21-5.01). Mortality from all external causes combined, as well as from accidents and suicide, did not differ from that of the national rates, the same was true for breast cancer and lung cancer mortality.

CONCLUSION: Generally, military women peacekeepers did not have an increased risk of mortality overall, but the risk of death from stroke was increased. Most of the stroke deaths were haemorrhagic, for which parity and old age at menopause are known risk factors.

PMID:40478536 | DOI:10.1093/milmed/usaf262

Mil Med. 2025 Jun 6:usaf254. doi: 10.1093/milmed/usaf254. Online ahead of print.

ABSTRACT

PURPOSE: Regulatory T cells (Tregs) are well-known to play an essential role in neuroinflammatory conditions. However, their role in visual deficits after military-relevant neurotrauma is not known. This study aims to decipher the role of CD4 + Foxp3 + Tregs in the development of visual deficits in a mild traumatic brain injury (mTBI) mouse model.

MATERIALS AND METHODS: Seventeen-week-old genetically modified mice [C57BL/6-Tg(Foxp3-HBEGF/EGFP)23.2 Spar/Mmjax] in which Foxp3 + Tregs are fluorescently labeled were used in the study. Mice were subjected to a 50-psi air pulse on the left side of the head overlying the forebrain, resulting in an mTBI. A low-dose diphtheria toxin (DTx, ip, 0.05 mg/g body weight) allowed for specific ablation of Foxp3 + Treg cells. DTx treatment began 3 days before causing a blast injury and continued every 3 days to keep Tregs depleted for 30 days after the injury. Mice receiving no DTx served as Treg control, with sham-blast mice serving as additional controls for blast injury. One month following the injury, vision function was assessed by opto kinetic nystagmus and electroretinography (ERG), followed by molecular and immunohistological analysis for neuroinflammatory markers.

RESULTS: Intraperitoneal administration of DTx effectively depleted Foxp3 + Treg cells in the spleen, both in sham and blast-injured mice. The blast injury resulted in a significant reduction in visual acuity and increased contrast sensitivity requirements, with these effects being exacerbated by DTx treatment. Electroretinography revealed a decrease in “b” wave amplitude post-blast injury, which was further reduced with DTx, though not significantly. Neuroinflammatory gene expression, including IL1β, CD86, TNFα, and CXCL10, was elevated in blast-injured mice, with DTx alone also inducing similar increases. Immunohistological analysis showed increased macroglia positive for GFAP and microglia/macrophages positive for IBA1 expression in the retina of blast-injured mice, with further increases observed in the DTx-treated group, although these changes did not reach statistical significance.

CONCLUSIONS: Our studies suggest that depletion of Treg cells followed by blast injury leads to increased retinal degeneration and neuroinflammation. This highlights the continuous requirement of Foxp3 + Treg cell activity to prevent neurodegeneration in mTBI. Future studies should fully explore the relationship of immunomodulatory Treg cells with neurodegeneration in blast-associated visual deficits. Therapeutics aiming to modulate Treg cells could be tested in DEREG transgenic mice after blast injury.

PMID:40478534 | DOI:10.1093/milmed/usaf254

Eur J Public Health. 2025 Jun 6:ckaf066. doi: 10.1093/eurpub/ckaf066. Online ahead of print.

ABSTRACT

Prostate cancer (PCa) poses a significant global health threat, with high incidence and mortality rates. In 2022, the Council of the European Union (EU) updated its screening recommendations, prioritizing PCa screening. This signals a crucial step towards establishing new early detection programmes in EU member states. This study investigates the role of policy makers and governance in cancer screening to inform the development of PCa screening. We had a mixed-method study design. First, a rapid review was conducted on policy making and governance in EU-funded cancer screening initiatives. Second, a focus group discussion reviewed study concepts and methods. Third, a systematic literature review was performed and, fourth, a series of in-depth interviews with actors involved in PCa screening pilots was conducted. Data were analysed thematically and the findings are used to propose 10 recommendations for policy makers. The results of the rapid review and focus group discussion framed the study in the context of existing cancer screening programmes across the EU, and highlighted what already exists in terms of governance tools and methodology. The literature review and in-depth interviews presented key learnings from the literature and real-life settings. These findings are reported using a pre-existing conceptional framework for effective health system governance. The study underscores the critical importance of governance in effective cancer screening programmes. Ten recommendations are proposed, including: defining cancer screening governance, allocating budgets and defining common approaches and key performance indicators for evaluation, establishing methods to enhance citizen participation, and reinforcing network governance.

PMID:40478531 | DOI:10.1093/eurpub/ckaf066

Mil Med. 2025 Jun 6:usaf274. doi: 10.1093/milmed/usaf274. Online ahead of print.

ABSTRACT

INTRODUCTION: Force readiness and disease prevention are critical responsibilities for military physicians. The prevalence of chronic noncommunicable diseases such as obesity and type II diabetes has been increasing among active duty service members. The Department of Defense spends over 3 billion dollars annually managing these conditions. Despite known links between lifestyle factors and disease, lifestyle and performance medicine (LPM) is not commonly integrated into medical education. This research aims to assess military medical students’ knowledge, perceptions, and preparedness regarding LPM.

MATERIALS AND METHODS: An Institutional Review Board (IRB)-approved survey among a select group of medical students participating in the Health Professions Scholarship Program (HPSP) or attending the Uniformed Services University of the Health Sciences (USUHS) was performed. The survey was distributed via the Student Association of Military Osteopathic Physicians and Surgeons email list and military social media pages. The survey intended to gather student perspectives and preparedness to incorporate LPM into future practice. Demographics data were also collected and statistical analysis was performed using SPSS and R-studio.

RESULTS: Of 107 students across 24 medical institutions, 95% felt LPM was relevant to their careers as military physicians. However, only 45% felt adequately prepared by their institutions, and only 30% felt they gained in-depth experience regarding LPM skills like nutrition and exercise prescriptions in medical school. Notably, 78% thought their medical institutions should dedicate more time to LPM in the medical school curriculum.

DISCUSSION: Most students in this study do not feel adequately prepared to incorporate LPM interventions and think they would benefit from more LPM training in their medical school curriculum. These results are consistent with previous studies performed among civilian medical students. This study was conducted exclusively among military medical students, many indicated that they feel the principles of LPM are important to force readiness and missions preparedness. However, they also feel that they lack the skills necessary to adequately integrate LPM into their future practice. This study has several limitations. Responses were collected voluntarily in a non-randomized fashion leaving the possibility for selection bias. Additionally, the survey was available for 4 weeks in the summer of 2024. The methods in which the survey was collected makes so an exact response rate cannot be calculated. However, this study offers valuable insight into the demand for LPM education among current military medical students and the implications LPM can have on future force health and deployment readiness.

CONCLUSIONS: Our findings underscore an expectation among military medical students to integrate more comprehensive LPM education within military medical training programs. By enhancing LPM education, military medical students may be better prepared to address noncommunicable diseases such as diabetes and obesity. This in turn may have broader implications as it pertains to improved force readiness and health outcomes.

PMID:40478528 | DOI:10.1093/milmed/usaf274

Qual Life Res. 2025 Jun 6. doi: 10.1007/s11136-025-03962-7. Online ahead of print.

ABSTRACT

BACKGROUND/OBJECTIVES: Long COVID is a long-term legacy of the global pandemic. This study aimed to illuminate how Long COVID impacts individuals, and how response-shift effects influence Long COVID’s impact. Methodologically, it expands the application of longitudinal statistical methods to test a more dynamic investigation of psychosocial factors in health over time.

METHODS: This quasi-experimental longitudinal cohort study collected data up to four times over 3 years of the COVID pandemic (May 2020 to April 2023). This study focused on 1151 participants divided into four Long-COVID Symptom Burden groups (Never Had COVID; Low, Medium, and High Long-COVID Symptom Burden). It examined COVID-specific outcomes: General Hardship, Healthcare Hardship, Worry, and Social Support. The Quality of Life Appraisal Profile_v2-Short Form assessed cognitive-appraisal processes. Direct and moderated response-shift effects were tested using longitudinal mixed models that examined main effects and interactions of individuals’ changes in cognitive-appraisal processes from their usual, over time, and by group over time, after adjusting for sociodemographic covariates and individual’s usual appraisal processes, and considering the impact of multiple comparisons.

RESULTS: Notable response-shift effects were revealed on all four COVID-specific outcomes, reflecting both direct and moderated response-shift effects. The experience of COVID-specific adversity was related to various appraisal processes but the nature of the relationship often varied by Long-COVID symptom burden. The appraisal processes that were most salient included patterns of emphasis related to getting used to and handling demands or recent changes, problem-solving goals, and comparing oneself to similar others. Individuals in the high Long-COVID Symptom-Burden Group were particularly highlighted in response-shift effects. The broad conclusions of both raw and multiplicity-adjusted results were similar. That is, there were notable reprioritization and reconceptualization response-shift effects for all outcomes, and notable but fewer recalibration response-shift effects.

CONCLUSIONS: Response-shift effects, measured via the direct assessment of cognitive-appraisal processes, were prominent in dealing with the COVID pandemic. The present study documented that COVID-specific adversity can be attenuated or exacerbated depending on individuals’ patterns of emphasis, goals, and standards of comparison. The study’s utilization of data collected at four time points over 3 years of the global pandemic provided a more comprehensive and far-reaching evaluation of response shift than earlier work. The theory-driven analytic methodology developed in the present work facilitated a more nuanced description of direct and moderated response-shift effects.

PMID:40478517 | DOI:10.1007/s11136-025-03962-7

Jpn J Ophthalmol. 2025 Jun 6. doi: 10.1007/s10384-025-01209-z. Online ahead of print.

ABSTRACT

PURPOSE: To examine the reoperation rate of amniotic membrane transplantation (AMT) and clarify the risk factors for AMT reoperation in severe ocular surface (OS) disorders (OSD).

STUDY DESIGN: Retrospective cohort study.

PARTICIPANTS: We reviewed the medical records of all AMT cases between April 1998 and June 2019 at the Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.

METHODS: Primary diseases and AMT reoperation rates were examined. In severe OSD cases (Stevens-Johnson syndrome, ocular cicatricial pemphigoid, and chemical/thermal burns), preoperative OS Grading Score (OSGS), surgical procedures combined with AMT, and risk factors for reoperation were investigated and assessed.

RESULTS: Over a period of 21 years and 3 months, 750 AMTs were performed on 664 eyes of 594 cases. AMT was repeated on 51 of those 664 eyes (7.7%), and most frequently performed on 25 out of 196 eyes (12.8%) afflicted with severe OSDs. In severe OSDs, OSGS was significantly higher in the reoperation group compared to no-reoperation group (P<0.05), suggesting corneal epithelial defects, conjunctival hyperemia, trichiasis, mucocutaneous junction involvement, and corneal opacity as being risk factors for re-AMT (univariate analysis). In logistic regression analysis, only conjunctival hyperemia was a risk factor, with odds ratios (OR) of 2.65 (95%CI: 1.34-5.22, P=0.005). AMT combined with cultivated or donor corneal epithelial transplantation reduced reoperation risk with an OR of 0.92 and 0.63, respectively.

CONCLUSIONS: In severe OSD cases, the effect of AMT is limited. Higher OSGSs, especially in conjunctival hyperemia, are associated with a high risk of repeat AMT.

PMID:40478507 | DOI:10.1007/s10384-025-01209-z

J Neurooncol. 2025 Jun 6. doi: 10.1007/s11060-025-05025-w. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with meningiomas often suffer from brain tumor-related epilepsy for which they are prescribed antiseizure medication (ASM). ASMs have been associated with neuropsychiatric side effects such as depression, anxiety, and cognitive impairments. However, the association between ASM use and mood and cognition in meningioma patients remains unclear. In this study, we aimed to investigate the association of ASM use, and specifically the use of levetiracetam, with depression, anxiety, and neurocognitive functioning.

METHODS: In this multicentre retrospective study, data from 187 meningioma patients were collected from neurocognitive tests, the HADS questionnaire, and medical records. Multivariable logistic regression analyses were used to evaluate the association between ASM use, and depression, anxiety and neurocognitive impairment. Potential confounders were included based on the existing literature. Due to sample size limitations, the association of levetiracetam use with depression, anxiety and neurocognitive impairment could not be statistically analyzed.

RESULTS: The prevalence of depression, anxiety and cognitive impairment did not differ significantly for patients using ASM (n = 41) as compared to patients not using ASM (n = 146) (aOR = 0.81; 95% CI 0.26-2.54; aOR = 0.63; 95% CI 0.22-1.82; aOR = 1.42; 95% CI 0.51-3.98).

CONCLUSION: Our findings show no significant association between ASM use and mood and neurocognitive dysfunction in meningioma patients.

PMID:40478500 | DOI:10.1007/s11060-025-05025-w