Tag: pubmed

N Z Med J. 2025 Apr 11;138(1613):79-86. doi: 10.26635/6965.6809.

ABSTRACT

BACKGROUND: Delayed ovarian torsion management can lead to unnecessary oophorectomy and halving of a woman’s fertility potential.

AIMS: To improve recognition and efficiency of ovarian torsion management at Waitematā by examining common presenting symptoms/signs and identifying areas of treatment delay.

METHODS: An audit of all ovarian torsion cases at Waitematā over 24 months (01/05/2022-30/04/2024).

RESULTS: Forty-five women had ovarian torsion, and 42 were premenopausal. Common presenting features included abdominal pain (100%), ovarian cysts (97.8%), nausea (82%) and vomiting (51%). Peritonism was rare (13.3%). Oophorectomy was performed in 26 cases (57.8%). Rates of oophorectomy increased with increasing time from symptom onset until presentation. The time from presentation until surgery (average of 28 hours) was longer than other tertiary centres, with delays largely arising from triage to ultrasound, and then while awaiting access to theatre.

CONCLUSIONS: Improving torsion recognition and expediting both imaging and surgery should reduce oophorectomy rates. Women presenting with symptomatic ovarian cysts without torsion should be adequately counselled on the risk of future torsion events and encouraged to seek acute medical attention for changes in symptoms. Additionally, more study is needed to determine if relying on computed tomography (CT) findings alone (e.g., presence of ovarian cysts more than 5cm) in the presence of symptoms suggestive of ovarian torsion can reduce time to diagnosis and improve surgical outcomes, compared to the commonly used CT followed by ultrasound.

PMID:40209197 | DOI:10.26635/6965.6809

N Z Med J. 2025 Apr 11;138(1613):50-66. doi: 10.26635/6965.6806.

ABSTRACT

AIM: The New Zealand population defined as “Pacific” is ethnically diverse, but this diversity is seldom examined in health research. This paper applies novel methods for describing health outcomes for specific Pacific populations in New Zealand using all-cancer and gastric cancer incidence and mortality as examples. Effects of loss to follow-up from leaving the country are also assessed.

METHOD: The New Zealand Cancer Registry was linked to administrative datasets and analysed within Stats NZ’s Integrated Data Infrastructure (IDI). All-cancer and gastric cancer incidence was examined over the 1995-2022 period, as well as 1-5-year mortality among 1998-2017 diagnoses.

RESULTS: There was variability in age-standardised all-cancer incidence and gastric cancer incidence for different Pacific groups. Less variation in mortality was identified between groups, and these rates increased only modestly when adjusting for those who left the country. Lower all-cancer mortality was observed in 2008-2017 compared with 1998-2007.

CONCLUSION: Variation in health outcomes among specific Pacific ethnicities is masked when examining Pacific peoples as an aggregated ethnic group. However, small counts among small ethnicities create challenges for producing detailed, reliable data when using the IDI.

PMID:40209195 | DOI:10.26635/6965.6806

Eur J Gen Pract. 2025 Dec;31(1):2485073. doi: 10.1080/13814788.2025.2485073. Epub 2025 Apr 10.

ABSTRACT

BACKGROUND: COVID-19 pandemic caused a significant impact on healthcare workers’ mental health and burnout, which continues after the pandemic.

OBJECTIVES: To assess the levels of burnout in general practitioners (GP) in Catalonia at three different times.

METHODS: Cross-sectional study involving members of the GPs’ Catalan Society (n = 4700). A self-administered survey was sent via institutional email in June-July 2021 (T1), in March-April 2022 (T2), and in May-June 2023 (T3). Probable burnout was assessed through Maslach Burnout Inventory (MBI) test, with three independent dimensions: emotional exhaustion, depersonalisation, and personal achievement. A descriptive analysis was performed, as well as a comparison between T1, T2, and T3 results.

RESULTS: 500 GPs responded in T1, 454 in T2, and 386 in T3. Samples were similar in demographic variables. Regarding burnout dimensions, the level of emotional exhaustion was 67.5% in T1, with a statistically significant decrease in T2 and T3 (56.4 and 58.1%, respectively, p = 0.001); levels of depersonalisation were 42.7% in T1, 37.0% in T2 and 36.7% in T3 (p = 0.091); levels of personal achievement were 29.9% in T1, 30.4% in T2 and 24.2% in T3 (p = 0.086). Starting at high levels of emotional exhaustion and depersonalisation, the prevalence decreased significantly over time in two groups: women and GPs who worked <10 years at the same workplace.

CONCLUSION: Catalan GPs experienced significant burnout during the COVID-19 pandemic with emotional exhaustion being particularly high. Although the prevalence of burnout decreased slightly over time, over half of the participants consistently reported high levels of emotional exhaustion.

PMID:40208687 | DOI:10.1080/13814788.2025.2485073

J Med Microbiol. 2025 Apr;74(4). doi: 10.1099/jmm.0.002000.

ABSTRACT

Introduction. Previous studies have shown vast differences in the skin and oral microbiomes of newborns based on delivery method [Caesarean section (C-section) vs vaginal]. Exposure to or absence of certain bacteria during delivery can impact the neonate’s future susceptibility to infections, allergies or autoimmunity by altering immune functions. Few studies have focused on the impact of maternal obesity on the variations of newborn skin and oral microbiomes. Obese pregnant women typically have a higher vaginal microbiome diversity, and their pregnancies are at higher risk for adverse outcomes and complications.Hypothesis. We hypothesized that the skin and oral microbiomes of newborns born to obese mothers would include more diverse, potentially pathogenic bacteria and that the skin and oral microbiome in C-section delivered newborns would be less diverse than vaginally delivered newborns.Aim. We aim to begin to establish maternal obesity and mode of delivery as factors contributing to increased risk for negative newborn outcomes through impacts on newborn bacterial dysbiosis.Methodology. A skin swab was collected immediately following delivery of 39 newborns from 13 healthy weight body mass index (BMI 18.50-24.99), 11 overweight (BMI 25.0-29.99) and 15 obese (BMI ≥30.00) pregnant participants. An oral swab was collected immediately following delivery for 38 of these newborns from 13 healthy weight, 10 overweight and 15 obese pregnant participants. Bacterial genera were identified via 16S rRNA amplicon sequencing.Results. The newborn skin microbiome was comprised of typical skin bacteria (i.e. Corynebacterium). Newborns of obese participants had a higher relative abundance of Peptoniphilus in their skin microbiome compared to newborns of healthy weight participants (P=0.007). Neonates born via C-section had a higher relative abundance of Ureaplasma in their oral microbiome compared to neonates delivered vaginally (P=0.046).Conclusion. We identified differences in the newborn skin and oral microbiomes based on pre-pregnancy BMI and method of delivery. These differences could be linked to an increased risk of allergies, autoimmune disease and infections. Future longitudinal studies will be crucial in determining the long-term impact of these specific genera on newborn outcomes. Understanding these connections could lead to targeted interventions that reduce the risk of adverse outcomes and improve overall health trajectory.

PMID:40208663 | DOI:10.1099/jmm.0.002000

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