Tag: pubmed

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

JAMA Netw Open. 2025 Apr 1;8(4):e254715. doi: 10.1001/jamanetworkopen.2025.4715.

ABSTRACT

IMPORTANCE: Health-related social needs (HRSNs) contribute to appointment nonadherence. Childcare needs are an underrecognized HRSN that particularly affect women.

OBJECTIVE: To determine whether self-reported childcare barriers were associated with appointment nonadherence among women.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used linked survey and electronic health record (EHR) data. Survey data were collected from November 2023 to May 2024 and EHR data were extracted for the 1 year prior to the survey date for each participant. Data were analyzed between June and September 2024. This single-center study was conducted in a safety-net health system in Dallas County, Texas. EHR data included ambulatory care encounters. Eligible participants included women aged 18 years or older referred to gynecology for abnormal cervical cancer screening who reported having childcare responsibilities.

EXPOSURE: Self-reported childcare barriers to appointments in the past year.

MAIN OUTCOMES AND MEASURES: Regression analysis was used to evaluate the primary outcome of appointment nonadherence rate during the year prior to survey date.

RESULTS: Of 1264 women eligible for the survey, 836 were successfully reached by telephone, of whom 671 women (53.1% of eligible sample) were included in the sample. Among the 671 initial respondents, 486 women reported having childcare responsibilities (72.4%). The mean (SD) age of the study sample was 34.8 (8.6) years, 405 (83.3%) identified as Hispanic, and 349 (71.8%) preferred Spanish. Additionally, 105 women reported childcare barriers to attending appointments in the past year (21.6%). Women with self-reported childcare barriers were mean 2.9 years younger and more likely to receive Medicaid (38 [36.2%]) than women without childcare barriers (89 [23.4%]). Women with self-reported childcare barriers were more likely to care for an increased number of children and younger children than women without. The mean (SD) appointment nonadherence rate was 25.1% (21.8%) among women with self-reported childcare barriers compared with 15.2% (22.1%) among women without. The adjusted difference in appointment nonadherence was 8.8 (95% CI, 3.6-14.0) percentage points (P = .001) higher among women with self-reported childcare barriers.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of women in a safety-net health system, self-reported childcare barriers were associated with increased appointment nonadherence. Younger women with younger children were most likely to report childcare barriers to appointments. These findings highlight the importance of childcare needs as a HRSN that warrants screening and intervention.

PMID:40208589 | DOI:10.1001/jamanetworkopen.2025.4715

JAMA Netw Open. 2025 Apr 1;8(4):e258565. doi: 10.1001/jamanetworkopen.2025.8565.

ABSTRACT

IMPORTANCE: The economic value of cleaning and disinfection of shared medical equipment is currently unknown.

OBJECTIVE: To evaluate whether or not better environmental cleaning and disinfection of shared medical equipment would be cost-effective compared with usual care.

DESIGN, SETTING, AND PARTICIPANTS: This economic evaluation study was a within-trial cost-effectiveness analysis of a stepped-wedge cluster randomized clinical trial: the Cleaning and Enhanced Disinfection (CLEEN) study. The trial included 5002 inpatients and was conducted in 10 adult acute-care wards at a tertiary hospital in Australia between March 20, 2023, and November 24, 2023. The evaluation takes a hospital costing perspective. A decision-tree model was developed to evaluate the intervention; costs are presented in Australian dollars. Statistical analysis was performed from May to October 2024.

INTERVENTIONS: A multimodal cleaning intervention was introduced during the intervention, focusing on additional cleaning hours, education, audit, and feedback. The control group received usual care, including routine cleaning by clinical staff.

MAIN OUTCOMES AND MEASURES: Incremental cost-effectiveness ratio, where the mean change to costs associated with the intervention is divided by the mean change in outcomes.

RESULTS: This study assessed 5002 patients (2478 [49.5%] male, 2524 [50.5%] female [50.5%]; mean [SD] age, 71.6 [16.1] years). For a cohort of 1000 patients at risk of health care-associated infection (HAI), the estimated total costs associated with the intervention were $1 513 300, compared with $2 155 310 for usual care. The estimated number of HAIs was 100 in the intervention group, compared with 130 for the usual care group. Compared with usual care, the intervention was associated with reduced HAIs and costs, with a 90.5% chance that intervention adoption was cost-saving. This probability increased to 99.9% if a decision-maker was willing to pay $20 000 to avoid an infection.

CONCLUSIONS AND RELEVANCE: In this economic evaluation study of enhanced cleaning and disinfection of shared medical equipment, the intervention resulted in reduced HAIs and a $642 010 reduction in costs per 1000 patients, compared with the control group. These results suggest that the CLEEN intervention is a cost-saving initiative.

PMID:40208588 | DOI:10.1001/jamanetworkopen.2025.8565

Ann Am Thorac Soc. 2025 Apr 10. doi: 10.1513/AnnalsATS.202501-087OC. Online ahead of print.

ABSTRACT

BACKGROUND: Long-term exposure to air pollution has been linked with acute lower respiratory infections (ALRIs) in children, but the evidence in adults is still mixed and sparse. We aimed to examine the association between long-term exposure to air pollution and incident ALRIs in adults.

METHOD: We followed all Danish residents aged 30 or older (N=3,083,227) for the first-ever hospital contact (in-, outpatient, or emergency) for ALRIs (and pneumonia or influenza separately) from 2000 to 2018. Long-term exposure to air pollution was defined as annual mean concentrations of fine particulate matter (PM2.5), nitrogen dioxide (NO2), and black carbon (BC), which were modeled using hybrid land-use regression models and assigned to baseline residential addresses. Cox regression models were used to assess the association between air pollution and incidence of ALRIs in total, pneumonia, and influenza.

RESULTS: During 16 years’ mean follow-up, there were 322,035, 309,092 and 11,977 incident cases of ALRIs, pneumonia, and influenza, respectively. We detected positive associations of air pollution and incident ALRIs, with hazard ratios (95% confidence interval) of 1.08 (1.07, 1.09) per 10 μg/m3 for NO2, 1.07 (1.06, 1.08) per 0.5 10-5 m-1 for BC, and 1.04 (1.03, 1.04) per 2 μg/m3 for PM2.5. We detected similar associations with pneumonia, but no detected association with influenza.

CONCLUSION: Long-term exposure to air pollution may contribute to an increased risk of contracting ALRIs, particularly pneumonia, that require hospital care. Associations persisted for all major pollutants (PM2.5, NO2 and BC) even at exposure lower than the current EU limits and WHO guideline.

PMID:40208575 | DOI:10.1513/AnnalsATS.202501-087OC

Omega (Westport). 2025 Apr 10:302228251333838. doi: 10.1177/00302228251333838. Online ahead of print.

ABSTRACT

This study assessed the relationship between grief and posttraumatic growth (PTG) in 2415 individuals from six Latin American countries, and how the relationship between these variables is moderated by gender and age. The Posttraumatic Growth Inventory-Short Form and Pandemic Grief Scale were used. Moderation analysis utilized Model 2, proposed by Hayes. The findings from the analysis indicate that the proposed regression model is statistically significant in most countries. Gender moderated the relationship between grief and PTG in El Salvador and Peru; meanwhile, age moderated this relationship in Uruguay. The findings support the importance of incorporating gender and age differences into both the theory of grief and PTG and empirical studies investigating these variables in Latin America. Furthermore, mental health professionals should consider gender and age differences when planning interventions aimed at fostering PTG in individuals who have experienced the loss of a loved one in the evaluated countries.

PMID:40208570 | DOI:10.1177/00302228251333838

Multivariate Behav Res. 2025 Apr 10:1-33. doi: 10.1080/00273171.2025.2480437. Online ahead of print.

ABSTRACT

In this work, we introduce a multiple-group longitudinal IRT model that accounts for skewed latent trait distributions. Our approach extends the model proposed by Santos et al. in 2022, which introduced a general class of longitudinal IRT models. The latent traits follow a multivariate skew-normal distribution, induced by an antedependence structure with centered skew-normal errors. Additionally, latent mean trajectories are modeled using quadratic curves, while structured covariance matrices capture within-participant dependencies. A three-parameter probit model is employed for dichotomous items. Bayesian parameter estimation and model fit assessment are conducted through a hybrid MCMC algorithm, combining the FFBS sampler with Metropolis-Hastings steps. The model’s effectiveness is demonstrated through an application to real data from the Longitudinal Study of the 2005 School Generation in Brazil (GERES project), where it outperforms the normal model by better capturing asymmetry in latent traits. A simulation study further supports its robustness across various test conditions.

PMID:40208567 | DOI:10.1080/00273171.2025.2480437

CNS Drugs. 2025 Apr 10. doi: 10.1007/s40263-025-01175-7. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Residual sleepiness can occur in adult patients with obstructive sleep apnea (OSA) despite adequate treatment with continuous positive airway pressure (CPAP). Various wake-promoting agents (WPAs) have been shown to reduce residual sleepiness in CPAP-treated patients with OSA. This systematic review and network meta-analysis aimed to compare the efficacy and safety of WPAs in this setting.

METHODS: We searched MEDLINE, Scopus, and ClinicalTrials.gov up to 9 January 2025 for randomized controlled trials (RCTs) examining WPAs for treating sleepiness in patients with OSA. Included were all RCTs that explored the efficacy and/or safety of any approved WPAs (i.e., modafinil, armodafinil, solriamfetol, or pitolisant) in patients with OSA (aged ≥ 18 years) treated with CPAP but who are still sleepy [Epworth sleepiness scale (ESS) score ≥10]. Studies that were conducted in patients whose comorbidities cause daytime somnolence [i.e., psychiatric conditions (other than depression), other sleep disorders, medical or surgical conditions], open label extension studies, and studies published in a language other than English were excluded. The primary outcomes included ESS, maintenance of wakefulness test (MWT), and adverse events. Two authors independently assessed the risk of bias using the revised Cochrane risk-of-bias tool for randomized trials 2.0.

RESULTS: In total, 14 RCTs studying four WPAs (total N = 2969) including modafinil (six RCTs; 200-400 mg/day), armodafinil (four RCTs; 150-250mg/day), solriamfetol (two RCTs; 37.5-300 mg/day), and pitolisant (two RCTs; 5-40 mg/day) were included. Solriamfetol, modafinil, and armodafinil were efficacious in reducing subjective sleepiness as measured by ESS [mean difference (95% confidence interval) at ≤ 4 weeks: -3.84 (-5.60, -2.07), -2.44 (-3.38, -1.49), and -2.41 (-3.60, -1.21) for solriamfetol, modafinil, and armodafinil, respectively; at > 4 weeks: -4.11 (-6.14, -2.08), -2.88 (-3.85, -1.91), -2.46 (-3.68, -1.24) for solriamfetol, armodafinil, and modafinil, respectively] and clinical global impression of change, as well as the objective MWT [at ≤ 4 weeks: 11.66 min (9.70, 13.61), 3.61 min (2.48, 4.73), and 2.52 min (1.27, 3.76) for solriamfetol, modafinil, and armodafinil, respectively; at > 4 weeks: 10.34 min (4.16, 16.52) for solriamfetol]. Pitolisant showed later improvements in ESS [at > 4 weeks: -2.70 (-3.66, -1.73)], with limited data on MWT. Sensitivity analyses restricted to U.S. Food and Drug Administration-approved solriamfetol dosages (37.5-150 mg/day) still showed higher efficacy, but lower anxiety risk.

CONCLUSIONS: Among all WPAs, solriamfetol demonstrated the highest efficacy on ESS and MWT, with the latter being significant. Modafinil demonstrated the best clinician impression, albeit not statistically significant. All four WPAs were associated with a low risk of serious or adverse events.

REGISTRATION: PROSPERO registration number, CRD42022359237.

PMID:40208562 | DOI:10.1007/s40263-025-01175-7

Methods Mol Biol. 2025;2922:335-354. doi: 10.1007/978-1-0716-4510-9_26.

ABSTRACT

The clinical application of tissue engineered products aims to regenerate skin and enhance the appearance, texture, sensation, and functionality of affected skin or scars. To evaluate the efficacy and effectiveness of novel products, level 1 randomized controlled trials are required. However, currently a significant challenge in this field is the clinical and statistical heterogeneity of trial designs and outcome measures for tissue engineered products. To address this challenge and improve clinical outcomes, it is essential to standardize high-quality outcome measures. These measures are clinimetrically developed tools designed to reliably and validly assess specific health outcomes across diverse patient populations, clinical settings, and studies. This chapter proposes a core set of outcome measurements designed to evaluate the most relevant, feasible, reliable, and valid parameters in the clinical application of tissue engineered products. For routine clinical practice, we recommend the inclusion of photography, graft take, re-epithelialization, and scar quality assessment using the Patient and Observer Scar Assessment Scale. For clinical trials, additional measures such as colorimetry and elasticity assessment are advised. Detailed protocols for these methods are provided, resulting in a standardized core outcome set. High-quality outcome assessment also necessitates specialized training and the presence of trained personal at all assessment points. The chapter further addresses specific considerations for outcome assessment in pediatric patients, remote assessment strategies, and additional recommendations for optimizing clinical and research practices in this field. The implementation of standardized outcome measurement is essential for improving the outcomes of patients treated with tissue engineered products.

PMID:40208548 | DOI:10.1007/978-1-0716-4510-9_26

J Neurooncol. 2025 Apr 10. doi: 10.1007/s11060-025-04996-0. Online ahead of print.

ABSTRACT

PURPOSE: Glioma patients often suffer from psychiatric and neurological conditions. However, little is known about the patterns of use of psychotropic drugs pre- and post-glioma diagnosis. Therefore, we assessed temporal patterns of psychotropic prescriptions among glioma patients, compared to an age and sex matched comparison cohort in four European countries.

METHODS: Incident gliomas were identified in Wales from the Secured Anonymized Information Linkage Databank (2005-2016) and population-based registries in Denmark (2001-2016), Norway (2006-2019), and Sweden (2008-2018). From each data source, a cancer-free comparison cohort was matched to the glioma cases by age and sex. We calculated rates of new psychotropic prescriptions and any psychotropic prescriptions during the 2 years prior to and post glioma diagnosis. Analyses were stratified by histological subtypes and subclasses of psychotropic medications.

RESULTS: We identified 16,007 glioma patients. The rate of new psychotropic drug use increased from 7 months before diagnosis, peaking around the month of glioma diagnosis (with peak rates ranging from 227 to 753 new psychotropic drugs per 1000 person-months). New use remained substantially higher among glioma patients than comparators throughout the 2-year follow-up period after glioma diagnosis, though rates of new use continued to decline throughout. New use was largely driven by antiepileptics, anxiolytics, hypnotics, and sedatives. Patterns were similar when analyses were stratified by histological subtype.

CONCLUSION: Psychotropic drug use among glioma patients was high, and elevations observed around the time of cancer diagnosis, largely driven by antiepileptics, anxiolytics, hypnotics, and sedatives, are likely associated with the consequences of the disease.

PMID:40208515 | DOI:10.1007/s11060-025-04996-0