Tag: pubmed

J Perinat Neonatal Nurs. 2025 Apr 8. doi: 10.1097/JPN.0000000000000925. Online ahead of print.

ABSTRACT

BACKGROUND: Conventional surfactant administration via tracheal tube involves short periods of positive pressure ventilation, which carries the risk of lung injury. The aim of this study was to investigate the feasibility and potential benefits of the less invasive surfactant administration (LISA) method in premature infants compared to the usual intubation-surfactant-extubation (INSURE).

METHODS: This randomized clinical trial was performed in Yazd between 2021 and 2023. One hundred twenty neonates with RDS were included in the study. The INSURE group (n = 60) was injected with surfactant in the usual way inside the tracheal tube, and the LISA group was injected using nasal continuous positive airway pressure (CPAP) with a thin surfactant catheter.

RESULTS: Duration of need for respiratory support by nasal CPAP (nCPAP) and high-flow nasal cannula was significantly more in the LISA group (P value = .00). Primary and secondary outcomes during surfactant injection in 2 groups were not statistically significant.

CONCLUSION: In our study, there was no significant difference between the primary and secondary outcomes between LISA and INSURE groups. Therefore, more studies are needed in this field.

PMID:40208657 | DOI:10.1097/JPN.0000000000000925

JAMA Surg. 2025 Apr 10. doi: 10.1001/jamasurg.2025.1107. Online ahead of print.

NO ABSTRACT

PMID:40208622 | DOI:10.1001/jamasurg.2025.1107

JAMA Ophthalmol. 2025 Apr 10. doi: 10.1001/jamaophthalmol.2024.6371. Online ahead of print.

ABSTRACT

IMPORTANCE: Vision outcomes in response to anti-vascular endothelial growth factor therapy for diabetic macular edema (DME) may differ between races. This meta-analysis investigated whether vision outcomes differed among racial subgroups treated with ranibizumab for DME in a clinical trial setting.

OBJECTIVE: To assess the impact of race on vision outcomes in participants with DME treated with ranibizumab.

DATA SOURCES: Five randomized clinical trials were preselected for analysis, including the RIDE and RISE trials (Ranibizumab Injection in Subjects With Clinically Significant Macular Edema With Center Involvement Secondary to Diabetes Mellitus); Protocol I (Intravitreal Ranibizumab or Triamcinolone Acetonide in Combination With Laser Photocoagulation for Diabetic Macular Edema), Protocol S (Prompt Panretinal Photocoagulation Versus Intravitreal Ranibizumab With Deferred Panretinal Photocoagulation for Proliferative Diabetic Retinopathy), and Protocol T (A Comparative Effectiveness Study of Intravitreal Aflibercept, Bevacizumab and Ranibizumab for Diabetic Macular Edema).

STUDY SELECTION: Targeted meta-analysis of data from 5 trials.

DATA EXTRACTION AND SYNTHESIS: Total enrollment numbers allowed for comparison of Black and White participants with DME who were treated with ranibizumab (0.3 mg or 0.5 mg) and had best-corrected visual acuity (BCVA) data at baseline and month 24. Lower total enrollment of participants of other races precluded statistical analysis. All ranibizumab-treated arms were pooled. Differences in vision outcomes between Black and White participants were evaluated, adjusting for baseline vision. Propensity score-matched models for participants in RIDE/RISE were used to control for differences in baseline and on-study characteristics.

MAIN OUTCOMES AND MEASURES: Mean BCVA over time and mean change from baseline at month 24 by race (Black and White).

RESULTS: Among the 1109 participants, the mean age was 60.0 years (95% CI, 59.4-60.7); 621 participants were male and 488 were female; 181 participants were Black and 928 were White. BCVA was better at baseline in Black vs White participants (mean Early Treatment Diabetic Retinopathy Study [ETDRS] letter score, 66.7 [95% CI, 65.0-68.4] vs 62.0 [95% CI, 61.1-62.8], respectively) but similar at month 24 (mean ETDRS letter score, 72.8 [95% CI, 70.2-75.4] vs 72.2 [95% CI, 71.2-73.1]). Mean BCVA change from baseline at month 24 was lower in Black vs White participants (6.1 ETDRS letters [95% CI, 3.6-8.6] vs 10.2 ETDRS letters [95% CI, 9.3-11.1]) and after adjusting for differences in baseline BCVA (7.7 ETDRS letters [95% CI, 5.8-9.7] vs 9.9 ETDRS letters [95% CI, 9.0-10.7]). When groups were propensity score-matched in RIDE/RISE, mean BCVA change from baseline appeared similar between Black vs White participants (10.6 ETDRS letters [95% CI, 7.1-14.1] vs 10.1 ETDRS letters [95% CI, 7.3-12.9]; P = .83).

CONCLUSIONS AND RELEVANCE: This meta-analysis evaluating ranibizumab for DME found that baseline BCVA was better in Black vs White participants, and BCVA change from baseline at month 24 was smaller in Black vs White participants. No difference in BCVA was observed in Black vs White participants at 2 years. Smaller enrollment numbers precluded analysis of participants of other races, suggesting lack of robust diversity beyond Black and White participants in these trials.

PMID:40208611 | DOI:10.1001/jamaophthalmol.2024.6371

JAMA Oncol. 2025 Apr 10. doi: 10.1001/jamaoncol.2025.0519. Online ahead of print.

NO ABSTRACT

PMID:40208607 | DOI:10.1001/jamaoncol.2025.0519

Qual Manag Health Care. 2025 Apr 4. doi: 10.1097/QMH.0000000000000499. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: This research aims to examine the current level of soft and hard Total Quality Management (TQM) at Shahroud University of Medical Sciences and explore the factors contributing to its success.

METHODS: The present cross-sectional study included 462 university managers and employees selected by stratified random sampling method in 2022. The participants were asked to answer TQM, soft TQM, and hard TQM questionnaires. The data were analyzed using ANOVA and chi-square tests, Pearson’s correlation coefficient, and structural equation modeling.

RESULTS: Managers made up 73 of the participants (15.8%). The average score for TQM was 143.02 ± 11.56, soft TQM 52.47 ± 9.35, and hard TQM 36.49 ± 9.54. There was no statistically significant variation in the mean score of hard TQM, soft TQM, and TQM based on gender or course completion. There was a strong and positive link between the scores of soft TQM, hard TQM, and TQM. Leadership commitment, employee suggestion systems, problem-solving groups, information quality, and preventive maintenance were strongly associated with quality management in the structural equation model.

CONCLUSION: Given the university’s average level of TQM implementation, it appears that steps should be taken to improve the evaluation process and provide feedback to employees. Steps should also be taken toward improving the commitment of senior management to implementing and enhancing the system of employee suggestions, establishing problem-solving groups, and training job duties. TQM can assist employees and increase the quality of the information to improve the university’s rank in quality management.

PMID:40208601 | DOI:10.1097/QMH.0000000000000499

JAMA Oncol. 2025 Apr 10. doi: 10.1001/jamaoncol.2025.0473. Online ahead of print.

ABSTRACT

IMPORTANCE: Approximately 29.9 million cancer cases and 15.3 million deaths are anticipated by 2040 globally, necessitating cancer system strengthening. A greater understanding of health system factors that can be leveraged to improve cancer control may guide health system planning.

OBJECTIVE: To evaluate predictors of improved cancer outcomes globally.

DESIGN, SETTING, AND PARTICIPANTS: This pan-cancer ecological study used the most recent available national health system metrics and cancer statistics, spanning the breadth of global income levels across 185 countries. Estimates of age-standardized mortality to incidence ratios were derived from GLOBOCAN 2022 for patients with cancer of all ages. The analysis took place on November 27, 2024.

MAIN OUTCOMES AND MEASURES: Health spending as a percent of gross domestic product (GDP), physicians per 1000 population, nurses and midwives per 1000 population, surgical workforce per 1000 population, GDP per capita, Universal Health Coverage (UHC) service coverage index, availability of pathology services, human development index, gender inequality index (GII), radiotherapy centers per 1000 population, and out-of-pocket expenditure as percentage of current health expenditure were collected. The association between the mortality to incidence ratio (MIR) and each metric was evaluated using univariable linear regressions (α = .0045), which were used to construct multivariable models (α = .05). Variation inflation factor allowed exclusion of variables with significant multicollinearity. R2 measured goodness of fit.

RESULTS: On univariable analysis, all metrics were significantly associated with MIR of cancer (P < .001 for all), including UHC index (β, -0.0076 [95% CI, -0.0083 to -0.0068]), GDP per capita (β, -5.10 × 10-6 [95% CI, -5.75 × 10-6 to -4.46 × 10-6]), clinical and workforce capacity, radiotherapy capacity (β, -88.25 [95% CI, -100.43 to -76.06]), and gender inequality index (β, 0.63 [95% CI, 0.57-0.70]). After including metrics significant on univariable analysis and correcting for multicollinearity, on multivariable analysis, greater UHC index and GDP per capita were independently associated with lower (improved) MIR for cancer. The multivariable model had R2 of 0.87. On multivariable analysis stratified by sex, greater UHC index and greater GDP per capita were independently associated with improved MIR for all cancers. R2 for the multivariable models was 0.87 for females and 0.85 for males.

CONCLUSIONS: This study found that global health system metrics related to progress toward universal health care, greater health care spending and GDP per capita, strengthened clinical workforce and capacity, and increased gender equity were associated with improved pan-cancer outcomes at a population level on univariable analysis. The degree of UHC and GDP per capita were independently associated with improved cancer outcomes in multivariable models with good explanatory power. These exploratory findings merit further validation and may guide health system planning and prioritization.

PMID:40208599 | DOI:10.1001/jamaoncol.2025.0473

JAMA Netw Open. 2025 Apr 1;8(4):e254439. doi: 10.1001/jamanetworkopen.2025.4439.

ABSTRACT

IMPORTANCE: Measures of childhood adiposity merit investigation, particularly in individuals of South Asian descent.

OBJECTIVE: To investigate prenatal and childhood factors associated with the trajectory of adiposity in South Asian children, and the cumulative contribution of modifiable factors, such as diet and physical activity, on this trajectory.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study was a prospective analysis of the South Asian Birth Cohort (START; 2011-2015) for discovery; and the Family Atherosclerosis Monitoring In Early Life (FAMILY; 2002-2009) in Ontario, Canada, and the Born in Bradford (BiB; 2008-2009) cohort in Bradford, UK, for validation. Mother-child pairs included 903 South Asian individuals (START), 675 White European individuals (FAMILY), and 1593 individuals (BiB), of which 52% were South Asian. Analysis was conducted from March 2020 to September 2024.

EXPOSURE: Maternal, infancy, and early childhood exposures.

MAIN OUTCOMES AND MEASURES: Adiposity, assessed by the sum of subscapular and triceps skinfold thicknesses (SSF) from birth to 3 years, aggregated to a single measure as total area under the growth curve (AUC for SSF); multivariable linear regression models to identify determinants of AUC for SSF; and a cumulative score to assess joint contribution of modifiable risk factors to AUC for SSF.

RESULTS: START included 903 children (456 female [50.5%]; mean [SD] maternal age, 30.2 [4.0] years; maternal mean [SD] prepregnancy body mass index [BMI], 23.8 [4.50]). Maternal sum of skinfold thicknesses (β = 0.80 [95% CI, 0.30-1.30] per 10 mm), gestational weight gain (β = 0.38 [95% CI, 0.02-0.74] per 5 kg), a health-conscious diet score (β = -0.68 [95% CI, -1.26 to -0.10] per 1 SD), and infant breastfeeding for the first year (β = -1.68 [95% CI, -2.94 to -0.42), as well as physical activity (β = -0.33 [95% CI, -0.57 to -0.09] per 30-min/d) and screen time (β = 0.49 [95% CI, 0.18-0.81] per 30-min/d) were each independently associated with AUC for SSF. These 6 early-life modifiable factors combined into a single score had a direct, graded association between number of factors and AUC for SSF (P for trend < .001). In the validation cohorts, maternal BMI, breastfeeding, and child physical activity were replicated and showed a similar graded association with AUC for SSF (P for trend < .001) when combined.

CONCLUSIONS AND RELEVANCE: In this cohort study of South Asian children, 6 modifiable factors were associated with lower adiposity and combined into a single score. This score may be useful in clinical and public health settings to help mitigate childhood obesity in South Asian individuals and beyond.

PMID:40208595 | DOI:10.1001/jamanetworkopen.2025.4439

JAMA Netw Open. 2025 Apr 1;8(4):e254462. doi: 10.1001/jamanetworkopen.2025.4462.

ABSTRACT

IMPORTANCE: Influenza vaccination is a safe, effective way to mitigate influenza infection but remains underused by some groups, including older Black and Hispanic adults. There is concern that changing attitudes toward vaccination during the COVID-19 pandemic could decrease influenza vaccination rates.

OBJECTIVE: To examine national patterns of influenza vaccination among older adults with Medicare, including analyses stratified by race and ethnicity, educational attainment, and rurality.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective, cross-sectional survey study of responses to the 2019 and 2022 Medicare Consumer Assessment of Healthcare Providers and Systems surveys used cross-sectional analysis for data from a weighted sample of 285 265 community-dwelling Medicare Advantage and Medicare Fee-for-Service enrollees aged 65 years or older living in the 50 US states and Washington, DC, who answered a survey question about influenza immunization.

EXPOSURES: Race and ethnicity, educational attainment, and rurality of survey respondents.

MAIN OUTCOMES AND MEASURES: The primary outcome was self-reported influenza vaccination.

RESULTS: The weighted sample combining both years of data for 285 265 individuals included 54.5% women. A total of 4.2% were Asian American, Native Hawaiian, and Other Pacific Islander; 8.0% were Black; 6.9% were Hispanic; and 76.2% were White. Between 2019 and 2022, overall influenza vaccination rates for older adults increased by 0.7 percentage points (95% CI, 0.2-1.1 percentage points), from 76.3% to 77.0%. Whereas influenza vaccination rates for Asian American, Native Hawaiian, and Other Pacific Islander older adults (from 81.2% to 83.1%) and White older adults (from 77.7% to 77.9%) were essentially unchanged between 2019 and 2022, they increased by 3.8 percentage points (95% CI, 1.8-5.7 percentage points) for Black older adults (from 66.9% to 70.7%) and 2.3 percentage points (95% CI, 0.5-4.0 percentage points) for Hispanic older adults (from 72.7% to 75.0%). Black and Hispanic older adults living in rural areas had the largest increases during this period (Black, 7.0 percentage points [95% CI, 0.3-13.8 percentage points]; Hispanic, 8.2 percentage points [95% CI, 0.8-15.5 percentage points]), while White older adults with lower educational attainment and/or living in rural areas had decreases in vaccination rates (White with lower educational attainment, -1.9 percentage points [95% CI, -2.8 to -1.0 percentage points]; White living in rural areas, -2.0 percentage points [95% CI, -3.2 to -0.8 percentage points]; White with lower educational attainment and living in rural areas, -3.7 percentage points [95% CI, -5.5 to -1.9 percentage points]).

CONCLUSIONS AND RELEVANCE: In this cross-sectional survey study, although overall influenza vaccination rates changed little from 2019 to 2022, they increased substantially for Black and Hispanic older adults, particularly those in rural areas, and decreased for some groups of White older adults. Determining the reasons for these divergent changes in influenza vaccination rates is a high priority for future research.

PMID:40208594 | DOI:10.1001/jamanetworkopen.2025.4462

JAMA Netw Open. 2025 Apr 1;8(4):e254470. doi: 10.1001/jamanetworkopen.2025.4470.

ABSTRACT

IMPORTANCE: The relationship of neighborhood environmental and socioeconomic factors with mental health across childhood and adolescence remains unclear.

OBJECTIVE: To investigate the associations of neighborhood characteristics with mental health at various developmental stages, from early childhood to late adolescence.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study used data from the Millennium Cohort Study, including approximately 19 000 children born in the UK from 2000 to 2002. This analysis included individuals in England with complete data on neighborhood exposures at ages 3, 5, 7, 11, 14, and 17 years. Data were analyzed from January to December 2023.

EXPOSURES: Neighborhood-level air pollution, green space, and socioeconomic status.

MAIN OUTCOMES AND MEASURES: Strengths and Difficulties Questionnaire (SDQ) scores linked with exposure to air pollution, green space, and socioeconomic status, measured at participants’ residential addresses, were analyzed using a hierarchical bayesian regression model. Hypotheses were formulated after data collection.

RESULTS: The sample included 3595 children and adolescents, with 1826 (50.5%) female; 3012 participants (83.8%) were White and 583 participants (16.2%) were another ethnicity. The mean (SD) SDQ score was 7.1 (5.1). After adjusting for individual and household factors, neighborhood socioeconomic status emerged as the strongest factor associated with mental health. Residing in affluent neighborhoods was associated with improved mental health, with this association magnifying through adolescence. For children of the same age, those in the most affluent neighborhoods had log-transformed SDQ scores 0.73 (95% credible interval [CrI], 0.58 to 0.88) lower at age 17 years compared with their peers in the most deprived areas; at age 5 years, scores were 0.31 (95% CrI, 0.17 to 0.45) lower. Exposure to particulate matter with diameter less than 2.5 μm was associated with poorer mental health during early childhood (age 3 years), with an effect size of 0.15 (95% CrI, 0.08 to 0.22). While green space was not directly associated with improved mental health, a sex-based difference was observed, with males showing more favorable associations (interaction, -0.10 [95% CrI, -0.17 to -0.03]).

CONCLUSIONS AND RELEVANCE: In this cohort study of children and adolescents, associations between neighborhood characteristics and mental health evolved from childhood through adolescence. These findings suggest that targeted interventions in disadvantaged neighborhoods and strategies to protect young children from air pollution are essential. A comprehensive approach is recommended to incorporate air pollution, green space, and socioeconomic status not only in residential neighborhoods but also in other settings, such as schools.

PMID:40208593 | DOI:10.1001/jamanetworkopen.2025.4470

JAMA Netw Open. 2025 Apr 1;8(4):e254508. doi: 10.1001/jamanetworkopen.2025.4508.

ABSTRACT

IMPORTANCE: Multiarterial coronary bypass procedures offer improved clinical outcomes compared with single arterial grafting with supplementary saphenous vein grafts. However, the survival advantage of multiarterial grafting across varying levels of left ventricular impairment remains uncertain.

OBJECTIVE: To compare long-term survival outcomes of patients undergoing multiple vs single arterial grafting, stratified by preoperative ejection fraction.

DESIGN, SETTING, AND PARTICIPANTS: A complete-case retrospective cohort study was conducted using data from a multicenter population-based cardiac registry established by the Australian & New Zealand Society of Cardiac & Thoracic Surgeons with linkage to the National Death Index. Participants were individuals who underwent primary isolated coronary bypass surgery between June 1, 2001, and January 31, 2020. Exclusion criteria were nonadults, reoperations, concomitant or previous cardiac surgical procedures, single-graft procedure, and cases without any arterial grafts. Statistical analyses were conducted in September 2024.

EXPOSURES: Patients underwent either multiple or single arterial grafting, stratified by their preoperative left ventricular ejection fraction.

MAIN OUTCOMES AND MEASURES: Long-term all-cause mortality.

RESULTS: The study included 59 641 patients (mean [SD] age at the time of surgery, 65.8 [10.2] years; 48 321 men [81.0%]). The median follow-up duration was 5.0 years (IQR, 2.3-8.6 years). Multiarterial grafting was associated with a 19.0% relative reduction in all-cause mortality compared with single arterial grafting among patients with a normal left ventricular ejection fraction (hazard ratio [HR], 0.81; 95% CI, 0.75-0.87; P < .001). Similar survival benefits were observed among patients with mild (HR, 0.83; 95% CI, 0.77-0.90; P < .001), moderate (HR, 0.82; 95% CI, 0.74-0.90; P < .001), and severe left ventricular impairment (HR, 0.82; 95% CI, 0.71-0.96; P = .01). A multivariable Cox proportional hazards regression interaction-term analysis indicated no significant differences in the multiarterial survival benefit by ejection fraction stratification (P = .75). Multiarterial grafting with exclusively arterial conduits was associated with enhanced survival benefits compared with other multiarterial procedures with saphenous vein grafts, except when the left ventricular ejection fraction was below 30% (HR, 0.87; 95% CI, 0.67-1.13; P = .30).

CONCLUSIONS AND RELEVANCE: In this retrospective cohort study using data from a binational database, multiarterial procedures were associated with reduced long-term mortality risk compared with single arterial grafting across the spectrum of preoperative left ventricular ejection fractions. Total arterial revascularization was associated with incrementally improved survival, particularly among patients with preserved ejection fraction. Because most coronary surgery practice continues to use single arterial grafting, consideration to alter grafting strategy to multiarterial procedures may be indicated.

PMID:40208590 | DOI:10.1001/jamanetworkopen.2025.4508