Tag: pubmed

Health Econ Rev. 2025 Jun 5;15(1):47. doi: 10.1186/s13561-025-00644-5.

ABSTRACT

BACKGROUND: This review examined methodologies used to cost the impact of antimicrobial resistance (AMR) infections in humans from household and health system perspectives. Although extensive research has been conducted on the clinical AMR burden in low- and middle-income countries (LMICs) in terms of prevalence and other drivers of antimicrobial resistance, there is increased misuse and overuse of antibiotics which increases the risk of AMR infections compared to high-income countries. Lack of comprehensive estimates on economic costs of AMR in LMICs due to lack of standard methodologies that incorporate time biases and inference for instance, may negatively affect accuracy and robustness of results needed for reliable and actionable policies.

METHODS: We conducted a systematic review of studies searched in PubMed and other electronic databases. Only studies from LMICs were included. Data were extracted via a modified Covidence template and a Joanna Briggs Institute (JBI) assessment tool for economic evaluations to assess the quality of the papers.

RESULTS: Using PRISMA, 2542 papers were screened at the title and abstract levels, of which 148 were retrieved for full-text review. Of these, 62 articles met the inclusion criteria. The articles had a quality assessment score averaging 85%, ranging from 63 to 100%. Most studies, 13, were from China (21%), followed by 8 from South Africa (13%). Tuberculosis (TB), general bacterial, and nosocomial infection costs are the most studied, accounting for 40%, 39%, and 6%, respectively with TB common in South Africa than the rest of the countries. The majority of the papers used a microcosting approach (71%), followed by gross costing (27%), while the remainder used both. Most studies analyzed costs descriptively (61%), followed by studies using regression-based techniques (17%) and propensity score matching (5%), among others.

CONCLUSION: Overall, the use of descriptive statistics without justification, limited consideration for potential data challenges, including confounders, and short-term horizons suggest that the full AMR cost burden in humans in LMICs has not been well accounted for. Given the limited data available for these studies, the use of a combination of methodologies may help triangulate more accurate and policy-relevant estimates. While the resources to conduct such cost studies are limited, the use of modeling costs via regression techniques while adjusting for cofounding could help maximize robustness and better estimate the vast and varied burden derived directly and indirectly from AMR.

PMID:40471471 | DOI:10.1186/s13561-025-00644-5

Biomech Model Mechanobiol. 2025 Jun 5. doi: 10.1007/s10237-025-01969-0. Online ahead of print.

ABSTRACT

We present a continuum hypothesis-based two-dimensional biomorphoelastic model describing post-burn scar hypertrophy and contraction. The model is based on morphoelasticity for permanent deformations and combined with a chemical-biological model that incorporates cellular densities, collagen density, and the concentration of chemoattractants. We perform a sensitivity analysis for the independent parameters of the model and focus on the effects on the features of the post-burn dermal thickness given a low myofibroblast apoptosis rate. We conclude that the most sensitive parameters are the equilibrium collagen concentration, the signaling molecule secretion rate and the cell force constant, and link these results to stability constraints. Next, we observe a relationship between the simulated contraction and hypertrophy and show the effects for significant variations in the myofibroblast apoptosis rate (high/low). Our ultimate goal is to optimize post-burn treatments, by developing models that predict with a high degree of certainty. We consider the presented model and sensitivity analysis to be a step toward their construction.

PMID:40471469 | DOI:10.1007/s10237-025-01969-0

Ann Noninvasive Electrocardiol. 2025 Jul;30(4):e70096. doi: 10.1111/anec.70096.

ABSTRACT

BACKGROUND: Alcohol intake increases recurrence of atrial fibrillation (AF), but its relationship with cardiovascular outcomes is less well characterized. We aimed to study the association between different levels of alcohol intake and cardiovascular outcomes in a global cohort of patients with AF.

METHODS: This is a cross-sectional analysis of the RE-LY AF registry, including 15,400 patients with AF who visited emergency departments in 47 countries. Patients were categorized into abstainers, light (< 7 standard drinks [SD]/week), moderate (7-13 SD/week), and heavy drinkers (≥ 14 SD/week). Outcomes were stroke/systemic embolism, heart failure (HF) hospitalization, and major bleeding at 1-year follow-up. Logistic mixed-effects regression models were used to calculate multivariable-adjusted odds ratios (aOR) with a 95% confidence interval (CI).

RESULTS: In total,14,058 patients (mean age = 65.9 ± 14.7 years, 48.0% women) with available alcohol intake level data were included. This consisted of 12,091 (86.0%) abstainers, 1150 (8.2%) light, 458 (3.3%) moderate, and 359 (2.6%) heavy drinkers. The odds of stroke/systemic embolism were not significantly different in light (aOR = 0.88, 95% CI: 0.60-1.28), moderate (aOR = 0.91, 95% CI: 0.53-1.57) or heavy drinkers (aOR = 0.79, 95% CI: 0.41-1.54) compared to abstainers. Major bleedings were numerically, but not statistically significantly, higher among heavy drinkers (aOR = 1.52, 95% CI: 0.82-2.80). Compared to abstainers, alcohol intake was associated with fewer HF hospitalizations (light: aOR = 0.73, 95% CI: 0.58-0.92; moderate: aOR = 0.53, 95% CI: 0.35-0.78; heavy: aOR = 0.63, 95% CI: 0.41-0.98). However, this protective association was observed only in upper-middle and high-income countries (p-interaction < 0.001).

CONCLUSION: Alcohol drinking is unlikely to be associated with increased thromboembolic events in patients with AF, but may be associated with a lower risk of HF hospitalizations.

PMID:40470582 | DOI:10.1111/anec.70096

Catheter Cardiovasc Interv. 2025 Jun 5. doi: 10.1002/ccd.31668. Online ahead of print.

ABSTRACT

BACKGROUND: Various drug-eluting stents (DES) are currently used for percutaneous coronary intervention (PCI). However, long-term trials reveal inconsistent results in head-to-head comparisons.

AIMS: To conduct a network meta-analysis of relevant trials to assess the performance of different DES currently used in PCI.

METHODS: We systematically searched major databases for randomized controlled trials (RCTs) reporting 5-year outcomes of currently used DES and conducted a network meta-analysis using a frequentist random-effects model with odds ratios (ORs) as effect measures. DES were ranked by P-scores across several outcomes, with definite/probable stent thrombosis as the primary outcome. Statistical analyses were conducted in R software (v4.4.1), with significance set at p < 0.05.

RESULTS: Twenty-nine RCTs involving 46,502 patients were included in the analysis. Six currently used DES-Orsiro, Xience, Resolute, Nobori/BioMatrix, Synergy, and Promus-were analyzed. All comparisons showed nonsignificant results for outcomes at 5-year follow-up. Synergy ranked highest for definite/probable stent thrombosis (p = 0.85), all-cause mortality (p = 0.76), cardiac death (p = 0.87), and target vessel revascularization (p = 0.91). Promus ranked best for any myocardial infarction (MI) (p = 0.86), target lesion revascularization (p = 0.93), and target vessel-related MI (p = 0.73). Nobori/BioMatrix ranked highest for target lesion failure (p = 0.80). The newer generation Biofreedom stent also showed nonsignificant results but was excluded from the main analysis due to the availability of 5-year outcomes from only one study. Global and local inconsistencies were nonsignificant for all outcomes and comparisons.

CONCLUSION: The analysis revealed no significant differences in 5-year outcomes among the various DES. However, Synergy and Promus performed best for key outcomes such as stent thrombosis, mortality, and MI, suggesting their potential for favorable performance in clinical practice.

PMID:40470578 | DOI:10.1002/ccd.31668

Mol Ecol. 2025 Jun 5:e17805. doi: 10.1111/mec.17805. Online ahead of print.

ABSTRACT

Migratory birds are inherently vagile, a strategy that may reduce the impacts of habitat loss and fragmentation on genetic diversity. However, specialist resource requirements and range-edge distribution can counteract these benefits. The European nightjar (Caprimulgus europaeus) is a long-distance migratory bird and resource specialist. Like other long-distance migrants, nightjar populations have declined across the British Isles and Northwestern Europe over the past century. With this decline well documented in the British Isles, there is a need to quantify its genetic impacts. We applied full genome resequencing to 60 historic (1841-1980) and 36 contemporary British nightjars. Nightjars exhibited a statistically significant 34.8% loss in heterozygosity and an increase in inbreeding over the last ~180 years, showing a departure from panmixia towards weak spatial structure in the modern population. Such fine-scale structuring in migratory birds is rare. Our results provide a case study of fragmentation’s impact on a species with specialist resource requirements at its range limit. Similar demographic declines in nightjars and other long-distance migrants across Northern and Western Europe suggest that genetic patterns seen in the British population may reflect those in other nightjar populations and European avifauna. Whilst our results indicate no immediate conservation concern, they depict a trajectory of declining genetic diversity, increasing inbreeding and genetic structure, potentially shared with other migratory species. Our study highlights the value of applying spatiotemporal population genetics analysis to migratory birds, despite their inherent vagility.

PMID:40470571 | DOI:10.1111/mec.17805

Clin Exp Rheumatol. 2025 May 30. doi: 10.55563/clinexprheumatol/iqfq8c. Online ahead of print.

ABSTRACT

OBJECTIVES: We aimed to assess lung involvement in patients with psoriatic arthritis (PsA), hypothesising that lung diseases (LDs) represent a distinct comorbidity of PsA and that the association between these two conditions is not merely coincidental.

METHODS: Cross-sectional study of 322 patients with a diagnosis of PsA from three Italian centres. Each patient underwent a chest high-resolution CT prior to the start of a biological DMARDs. After pneumologists’ evaluation, patients were divided into three groups [chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), and non-LD]. Univariate and multivariate statistical analysis were performed to analyse demographic and clinical characteristics of the total cohort and to compare disease characteristics between PsA patients with and without lung involvement.

RESULTS: COPD was diagnosed in 39 patients (12.1%) and ILD in 27 patients (8.4%). The inflammatory burden [DAPSA>14 (OR 4.3, p.adj=0.03), swollen joint count (SJC)>3 (OR 3.2, p.adj=0.02), PASI>10 (OR 3.6, p.adj=0.008), BMI ≥30 (OR 3, p.adj=0.04)] emerged as the most important risk factor for COPD development in PsA patients. This association was weaker in patients with ILD and PsA, since just SJC emerged as a risk factor for ILD development [SJC>3 (OR 3, p.adj=0.04)]. Old age (≥65 years) increased the risk of COPD by up to 9.6 times (p.adj=0.004) and ILD by up to 7.6 times (p.adj=0.04).

CONCLUSIONS: Our data support the hypothesis of a correlation between PsA and LDs highlighting that non-traditional risk factors may contribute to the development of LDs in PsA patients, especially in cases of uncontrolled, active articular disease.

PMID:40470557 | DOI:10.55563/clinexprheumatol/iqfq8c

Clin Exp Rheumatol. 2025 May 31. doi: 10.55563/clinexprheumatol/2pmt67. Online ahead of print.

ABSTRACT

OBJECTIVES: Pain catastrophising (PC), a maladaptive cognitive response to pain, has been implicated in poor outcomes in inflammatory arthritis, but its relationship with psoriatic arthritis difficult-to-treat (D2T) remains underexplored. This study aimed to investigate how the D2T phenotype impacts pain catastrophising (PC) and its domains (helplessness, rumination, magnification), along with other psychosocial and functional dimensions in PsA patients.

METHODS: A cross-sectional study was conducted in a cohort of 182 PsA patients. Clinical and psychosocial data were collected, including Disease Activity for Psoriatic Arthritis (DAPSA), Minimal Disease Activity (MDA), Pain Catastrophising Scale (PCS), HADS anxiety and HADS depression. Univariable and multivariable regressions were used to evaluate psychometric variables associated with D2T.

RESULTS: Univariable analysis showed a significant association between high PCS scores and D2T status. Multivariable models, adjusted for age, sex, disease duration, BMI, fibromyalgia, and disease activity, confirmed this relationship (b=7.637, 95% CI 3.261-12.014, p=0.001), specifically with PCS’ dimensions helplessness and rumination, but not magnification. Additionally, D2T predicted higher HADS anxiety scores, while its association with HADS depression was not statistically significant.

CONCLUSIONS: Our results indicate that D2T status remains a significant predictor of PC, even when controlling for relevant clinical characteristics, including fibromyalgia and disease activity, highlighting the intricate relationship between D2T PsA and psychological dimensions, which may exacerbate disease burden and hinder treatment targets.

PMID:40470553 | DOI:10.55563/clinexprheumatol/2pmt67

Clin Exp Rheumatol. 2025 May 31. doi: 10.55563/clinexprheumatol/b90gug. Online ahead of print.

ABSTRACT

OBJECTIVES: Ultrasound (US) detection of peritenon extensor tendon inflammation (PTI) was found highly specific for spondyloarthropathies (SpA), including psoriatic arthritis (PsA). However, this finding has not been extensively investigated. This study aimed to investigate the value of PTI at metacarpophalangeal (MCP) joint level in the differential diagnosis between rheumatoid arthritis (RA) and PsA, and analyse the differences between early (less than 1 year of disease duration) and established (more than 1 year of disease duration) disease groups.

METHODS: Consecutive RA and PsA patients with clinical involvement of at least one MCP joint were enrolled. The 2nd to the 5th MCP joints of both hands were scanned on the dorsal aspect to detect intra-articular and peri-tendinous inflammatory findings using both B-mode and power Doppler (PD) mode.

RESULTS: The study included a total of 69 patients, 37 patients with RA and 32 patients with PsA. PTI was found in a significantly higher number of patients with PsA rather than in RA patients. Conversely, there was no statistical difference in terms of PTI prevalence between RA and PsA patients in the early disease groups. On the other hand, no statistically significant difference was found in terms of synovitis prevalence between RA and PsA patients.

CONCLUSIONS: PTI was found more frequently in PsA rather than in RA patients. Nevertheless, since no statistically significant difference was found between RA and PsA patients with less than 1 year of disease duration, PTI may represent an inflammatory feature of the early phases of both the diseases.

PMID:40470548 | DOI:10.55563/clinexprheumatol/b90gug

JMIR Public Health Surveill. 2025 Jun 4;11:e67725. doi: 10.2196/67725.

ABSTRACT

BACKGROUND: Nonpharmaceutical interventions (NPIs) are effective tools for pandemic containment but often impose significant socioeconomic consequences that intensify over time. Public support and compliance to NPIs are crucial to ensure their effectiveness.

OBJECTIVES: This study aimed to elicit preferences of a Singaporean population for the reintroduction of NPIs in response to the emergence of a new SARS-CoV-2 variant during the COVID-19 endemic phase.

METHODS: A web-based discrete choice experiment (DCE) was conducted. DCE attributes reflected key NPIs implemented in Singapore during the COVID-19 pandemic from 2020 to 2022, including mask wearing, dining restrictions, suspension of vocalization activities and large-scale events, quarantine after international travel, and mandatory vaccine boosters. Participants were recruited from a demographically representative online panel. Statistical analysis was performed using a mixed-logit model and mixed-mixed multinomial logit model.

RESULTS: A total of 1552 participants were included in the analysis. Overall preferences from the mixed-logit model showed that mask wearing was valued, both in public and indoors. Dining restrictions allowing groups of up to 5 people were preferred, but stricter dining restrictions allowing up to 2 people or no dining out were not favored. Prohibiting large-scale events was not preferred. Participants accepted quarantine at home but opposed quarantine in government facilities. Two classes emerged from the mixed-mixed logit model: class 1 (“Prefer NPIs”) and class 2 (“Prefer No NPIs”). While class 1 (39%) was only opposed to a complete prohibition on dining in at food and beverage establishments, no NPIs were preferred by class 2 (61%). Both classes were not opposed to mandatory mask wearing, dining restrictions allowing groups of up to 5 people, and mandatory vaccine boosters. Sex, age, education, employment status, the number of COVID-19 vaccine shots received, and risk attitude were associated with individuals’ likelihood of belonging to a specific preference group.

CONCLUSIONS: Following the emergence of a new SARS-CoV-2 variant after a prolonged period of restrictions, less disruptive NPIs such as mask wearing indoors were valued by the public and should be swiftly reinstated. Adaptive strategies should be adopted for more contentious NPIs, such as strict dining restrictions and quarantine policies. Public preferences should be considered in the design and selection of NPIs for future pandemic containment strategies to enhance compliance and effectiveness.

PMID:40470547 | DOI:10.2196/67725

High Alt Med Biol. 2025 Jun 5. doi: 10.1089/ham.2025.0028. Online ahead of print.

ABSTRACT

Berendsen, Remco R., Dirk C A.A. de Vries, Alea Steger, Nadine Herold, Feico J.J. Halbertsma, Adriaan F. Norbart, Hannes Gatterer, and Bengt Kayser. Lack of altitude medicine knowledge among mountaineers in the Italian Alps. High Alt Med Biol. 00:00-00, 2025. Introduction: In 2022, expert consensus defined a set of minimum altitude medicine knowledge statements for laypersons traveling to high altitudes (STAK: strengthening altitude knowledge). We used these statements to assess knowledge among mountaineers in the Italian Alps. Methods: Mountaineers in a hut (3,647 m) completed an online STAK-based questionnaire, also indicating their confidence after each answer. A score of ≥19/28 was used as a statistical threshold, exceeding chance alone. Logistic regression assessed the link between confidence and correctness; multivariate regression explored demographic, educational, and behavioral predictors of achieving an above-threshold score. Results: Of 576 participants, 412 (72%) were included in the final analysis and 115 (28%) scored ≥19. Among them, 59% of medical professionals, 36% of mountain guides, and 23% of general participants reached the threshold; the medical professionals scored significantly higher than the general participants (p < 0.001). Both being a mountain guide (odds ratios [OR]: 2.3, 95% confidence intervals [CI]: 1.0-5.0, p < 0.05) and being a medical professional (OR: 4.5, 95% CI: 2.1-10.0, p < 0.001) were associated with higher scores. Conclusion: Using STAK as a benchmark, we found a substantial lack of altitude medicine knowledge in mountaineers, even among guides and medical professionals. These findings suggest a potential for targeted educational interventions.

PMID:40470536 | DOI:10.1089/ham.2025.0028