Tag: pubmed

Diabetol Metab Syndr. 2025 Jun 4;17(1):191. doi: 10.1186/s13098-025-01761-1.

ABSTRACT

BACKGROUND: The pathogenesis of metabolic syndrome (MetS) is strongly linked to dysbiosis in the gut microbiota. However, studies investigating the association between the dietary index of gut microbiota (DI-GM) and MetS are limited. As such, the present study aimed to examine the association between DI-GM and the prevalence of MetS, as well as long-term mortality among individuals in the United States.

METHODS: Data from 30,372 participants, obtained from the 2007 to 2018 cycle of the National Health and Nutrition Examination Survey, were analyzed. Associations between DI-GM scores and the prevalence of MetS and long-term mortality were examined using weighted logistic regression and Cox regression, respectively. Restricted cubic spline (RCS) and subgroup analyses were performed to further explore these relationships.

RESULTS: An inverse association was observed between DI-GM and the prevalence of MetS, with each 1-unit increase in DI-GM corresponding to an 8.2% decrease in MetS prevalence (odds ratio 0.918 [95% CI 0.896-0.941]). Among participants with MetS, a 1-unit increase in DI-GM was associated with reduced risk for cardiovascular mortality (hazard ratio 0.922 [95% CI 0.854-0.994]). RCS analysis revealed a significant linear inverse association between DI-GM scores and MetS prevalence and cardiovascular mortality among participants with MetS. Subgroup analyses suggested that race, income level, and smoking status may modify the association between DI-GM and MetS prevalence.

CONCLUSIONS: Findings revealed that higher DI-GM scores were significantly associated with a lower prevalence of MetS in the general population and a reduced risk for cardiovascular mortality among individuals diagnosed with MetS. Further longitudinal studies are needed to confirm these associations and explore the underlying biological mechanisms.

PMID:40462146 | DOI:10.1186/s13098-025-01761-1

Pilot Feasibility Stud. 2025 Jun 3;11(1):77. doi: 10.1186/s40814-025-01659-9.

ABSTRACT

BACKGROUND: Child maltreatment has severe and lasting consequences, and evidence-based interventions are essential for its prevention. However, few randomized controlled trials (RCTs) have been conducted within child welfare settings in Norway. Pilot trials play an important part in assessing the acceptability and feasibility of such interventions prior to full scale evaluations. This study evaluated the acceptability and feasibility of conducting a full-scale RCT of the Family Partner home-visiting intervention, designed to reduce the risk of child maltreatment.

METHODS: Families from three child welfare offices in Norway with at least one child under the age of 12 were invited to participate in this pilot trial. A two-arm randomized design was used, with participants allocated in a 1:1 ratio to either the intervention or control group (n = 45). The intervention group received the home-visiting Family Partner intervention, while the control group received treatment as usual. A qualitative process evaluation was conducted alongside the trial, comprising 29 interviews with Family Partners, caseworkers, participating families, and other stakeholders. Statistical and qualitative analyses evaluated participant acceptability, adherence, and retention.

RESULTS: Qualitative findings indicate a high level of acceptability for the Family Partner intervention across all stakeholder groups. Adherence was strong, with no participants withdrawing consent and only two opting out of subsequent surveys. However, participant retention declined over time, with survey response rates dropping at each time point and only 42% completing the final assessment.

CONCLUSIONS: This pilot trial provides preliminary evidence supporting the acceptability of the Family Partner intervention within child welfare services and highlights important considerations regarding the feasibility of conducting RCTs in this setting.

TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT04957394.

PMID:40462144 | DOI:10.1186/s40814-025-01659-9

Crit Care. 2025 Jun 3;29(1):225. doi: 10.1186/s13054-025-05482-9.

ABSTRACT

BACKGROUND: The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock (J-SSCG) 2020 aimed to standardize sepsis care in Japan. However, the extent of their impact on clinical practice remains uncertain.

METHODS: We conducted a nationwide retrospective cohort study using the Japanese Diagnosis Procedure Combination database between April 2018 and December 2021. Of the 118 clinical questions (CQs) in the J-SSCG 2020, we identified 26 recommendations to which adherence could be evaluated using patient-level data. We evaluated adherence trends before and after the guideline’s publication using interrupted time series analysis and quantified hospital-level variation using intraclass correlation coefficients.

RESULTS: A total of 213,099 patients with sepsis from 791 hospitals were included. Adherence rates varied widely across CQs (range: 0.5-98.7%). Recommendations “against” interventions generally showed high adherence, whereas those “for” interventions exhibited lower and more variable adherence. After guideline publication, adherence increased by < 3% points for most CQs. Interrupted time series analysis demonstrated no abrupt or substantial changes, and statistically significant trends were modest (< 2% annually). Among the 26 CQs, 14 were consistent with J-SSCG 2016 and 12 were newly introduced in 2020; both groups showed similarly limited changes in adherence. Adjusted intraclass correlation coefficients exceeded 10% for 22 CQs, indicating persistent between-hospital variation, which remained unchanged after the guideline’s release.

CONCLUSIONS: This nationwide study identified persistent evidence-practice gaps, minimal improvements in adherence after J-SSCG 2020, and substantial interhospital variation that remained unaltered. These findings underscore the challenges of implementing guidelines in practice and highlight the need to better understand contextual barriers to standardized sepsis care in Japan.

PMID:40462110 | DOI:10.1186/s13054-025-05482-9

BMC Public Health. 2025 Jun 3;25(1):2053. doi: 10.1186/s12889-025-23237-7.

ABSTRACT

BACKGROUND: The prevalence of high body mass index (BMI) has been increasing over the past three decades, resulting in significant public health challenges. This study aims to comprehensively analyze global, regional, and national trends in death and disability-adjusted life years (DALYs) attributable to high BMI from 1990 to 2021.

METHODS: We utilized data from the Global Burden of Disease study to estimate deaths and DALYs linked to high BMI across 204 countries and territories. Temporal trends were analyzed by sex, age group, region, and Socio-demographic index (SDI). Decomposition analyses were conducted to assess the impact of demographic factors on BMI-related disease burden. All estimates are presented with 95% uncertainty interval (UI) to quantify statistical uncertainty. The autoregressive integrated moving average model was employed to project future trends to 2036.

RESULTS: Globally, BMI-related deaths increased from 1.46 million (95% UI 0.72, 2.29) in 1990 to 3.71 million (95% UI 1.85, 5.66) in 2021. DALYs rose from 48 million (95% UI 21.2, 77.3) to 128.5 million (95% UI 56, 202.4) over the same period. Diabetes and kidney diseases have now overtaken cardiovascular diseases as the leading cause of DALYs, despite cardiovascular diseases remain the major contributor to BMI-related deaths. They accounted for 82.01% of deaths and 73.91% of DALYs. Among the four regions with the highest SDI, three showed a decline in BMI-related deaths and DALYs, except for high-income North America. In contrast, low-SDI regions continued to face escalating health burdens. Population aging was a primary driver of the increasing burden, which made up 49.43% of the increase in deaths and 47.03% in DALYs.

CONCLUSIONS: The increasing prevalence of high BMI has resulted in significant health burdens over the past three decades, with cardiovascular diseases, diabetes and kidney diseases being primary contributors. Low- and middle-income regions bear a larger share of the burden, while population aging exacerbates these challenges. Developing equitable and effective public health strategies is essential for addressing the growing obesity epidemic.

PMID:40462096 | DOI:10.1186/s12889-025-23237-7

BMC Med Educ. 2025 Jun 3;25(1):828. doi: 10.1186/s12909-025-07424-z.

ABSTRACT

BACKGROUND: An increasingly ageing population and the resulting multimorbidity is a growing challenge for healthcare systems. A solution to tackle this problem is interprofessional collaboration. Interprofessional education, as an early meeting point, could foster a future successful interprofessional collaboration. So, the aim of our pilot study was to assess whether the “interprofessional collaboration between medical and pharmacy students to improve medication safety in polypharmacy” (PILLE) project changed the perception of medical and pharmacy students towards interprofessional collaboration.

METHODS: PILLE consisted of three parts: (1) A mandatory 90-minutes interprofessional seminar; (2) A voluntary 120-minutes practical training; (3) A voluntary half-day interprofessional tandem work shadowing at a General Practitioner’s (GP) office. We used a controlled study design. Medical and pharmacy students from the intervention group attended the seminar (1). Medical students of the control group attended an interactive 90-minutes monoprofessional seminar only. Working together on cases was the similarity of both seminars. The students from the intervention group could attend (2) and (3). The outcome of interest was the change in students’ perception towards interprofessional collaboration after participating in PILLE, using pre- and post-questionnaires with the validated German version of Student Perceptions of Physician-Pharmacist Interprofessional Clinical Education (SPICE-2D) instrument. Descriptive and statistical evaluation was conducted. To assess if there is a significant pre-post-difference in the SPICE-2D overall score within the individual groups, paired t-tests were executed. To investigate if there is a significant change in SPICE-2D overall score difference between the medical students control and intervention group, an unpaired t-test was performed.

RESULTS: In total, 436 students participated: 96 medical students and 116 pharmacy students in the intervention group, and 224 medical students in the control group. The participating students from both professions already had a pronounced positive perception at baseline. All pre-post-mean-differences within the individual groups and between the medical students control and intervention group were not statistically significant.

CONCLUSION: Participating medical and pharmacy students already had a positive perception at baseline. A one-time and short-term mandatory seminar of 90-minutes seems not to be sufficient to measure a change in perception. Future interprofessional education projects should focus on frequent meeting points between students.

PMID:40462092 | DOI:10.1186/s12909-025-07424-z

BMC Public Health. 2025 Jun 3;25(1):2058. doi: 10.1186/s12889-025-23332-9.

ABSTRACT

BACKGROUND: Nepal’s complicated topography and tectonic susceptibility leads to extreme vulnerability to earthquakes, floods and landslides which especially poses significant risks to its population; including school children. This study aims to identify the knowledge of Disaster Risk Reduction (DRR) among secondary school students in Pokhara Metropolitan, Nepal. Despite the susceptibility, there is limited understanding of DRR knowledge among students, who are key in disseminating preparedness information within communities and families.

METHODS: A cross-sectional, quantitative study was conducted among 342 students of grades 9 and 10 across six public schools of Pokhara Metropolitan, Nepal. A multistage probability sampling was used to select desired number of samples. Data were collected after obtaining ethical approval from Institutional Review Committee of Pokhara University using a standardized questionnaire. The tool was designed to assess students’ disaster-related knowledge, preparedness, adaptation, and risk perception related to DRR issues objectively. The descriptive statistics and Chi square tests were applied and the knowledge scores were categorized using Bloom’s taxonomy for learning objectives.

RESULTS: Most of the students (92.7%) recognized disasters as unforeseen events requiring assistance. However, significant gaps were identified in disaster preparedness and adaptation knowledge, with 42.1% of students unaware of disaster-related facts. Majority (86.8%) had ever experienced disasters; predominantly reporting earthquakes (90.2%). No significant differences were observed in DRR knowledge by academic grades; while significant associations were found between DRR knowledge and institutional sources of information, such as teachers and the Nepal Junior Red Cross (p = 0.014) and prior disaster experiences (p = 0.045). Similarly, positive risk perception was strongly associated with information from digital media (p < 0.001) and institutional education (p < 0.001).

CONCLUSION: This study highlights that great majority had understanding of disaster issues; however, critical knowledge gap of DRR was evident among students in disaster-prone regions among secondary students in Pokhara Metropolitan Nepal. The findings underscore the urgency of integrating DRR education into school curricula, complemented by practical training, drills, and collaboration with disaster management organizations to enhance preparedness and community resilience in this city. Further researches are recommended ensuring the comprehensiveness of variables and rigorous methods to affirm the generality of the findings.

PMID:40462089 | DOI:10.1186/s12889-025-23332-9

BMC Med Inform Decis Mak. 2025 Jun 3;25(1):204. doi: 10.1186/s12911-025-03034-3.

ABSTRACT

BACKGROUND: Fatigue is a prevalent and debilitating symptom of non-communicable diseases (NCDs); however, its biological basis are not well-defined. This exploratory study aimed to identify key biological drivers of fatigue by integrating metabolomic, microbiome, and genetic data from blood and saliva samples using a multi-omics approach.

METHODS: Metabolomic, microbiome, and single nucleotide polymorphisim analyses were conducted on saliva and blood samples from 52 patients with NCDs. Fatigue dimensions were assessed using the Multidimensional Fatigue Inventory and correlated with biological markers. LightGBM, a gradient boosting algorithm, was used for fatigue prediction, and model performance was evaluated using the F1-score, accuracy, and receiver operating characteristic area under the curve using leave-one-out cross-validation. Statistical analyses included correlation tests and multiple comparison adjustments (p < 0.05; false discovery rate <0.05). This study was approved by the Yokohama City University Hospital Ethics Committee (F230100022).

RESULTS: Plasmalogen synthesis was significantly associated with physical fatigue in both blood and saliva samples. Additionally, homocysteine degradation and catecholamine biosynthesis in the blood were significantly associated with mental fatigue (Holm p < 0.05). Microbial imbalances, including reduced levels of Firmicutes negativicutes and Patescibacteria saccharimonadia, correlated with general and physical fatigue (r = – 0.379, p = 0.006). Genetic variants in genes, such as GPR180, NOTCH3, SVIL, HSD17B11, and PLXNA1, were linked to various fatigue dimensions (r range: -0.539-0.517, p < 0.05). Machine learning models based on blood and salivary biomarkers achieved an F1-score of approximately 0.7 in predicting fatigue dimensions.

CONCLUSION: This study provides preliminary insights into the potential involvement of alterations in lipid metabolism, catecholamine biosynthesis disruptions, microbial imbalances, and specific genetic variants in fatigue in patients with NCDs. These findings lay the groundwork for personalized interventions, although further validation and model refinement across diverse populations are needed to enhance the prediction performance and clinical applicability.

PMID:40462080 | DOI:10.1186/s12911-025-03034-3

BMC Pulm Med. 2025 Jun 3;25(1):279. doi: 10.1186/s12890-025-03747-1.

ABSTRACT

BACKGROUND: This study aimed to evaluate the diagnostic efficacy of nanopore sequencing for Mycobacterium tuberculosis (MTB) drug resistance in respiratory specimens from pulmonary tuberculosis (PTB) patients. It compared it to the Xpert MTB/RIF and fluorescent polymerase chain reaction (PCR) melting curve to explore the validity and feasibility of detecting MTB drug resistance in respiratory specimens.

METHODS: This study retrospectively analyzed 52 respiratory specimens. The proportional method applied the phenotypic drug susceptibility test (pDST) to respiratory specimens. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), consistency statistic (kappa) with phenotypic drug susceptibility testing (pDST), and the area under the curve (AUC) from the receiver operating characteristic (ROC) curve were calculated for nanopore sequencing, Xpert MTB/RIF, and fluorescent PCR melting curve. These calculations used the pDST results as the reference standard.

RESULTS: Among the resistance mutation genes detected by nanopore sequencing, rpoB, and katG were the most frequent, followed by embB, rpsL, gyrA, inhA, ahpC, gyrB, gid, and rrs. In bronchoalveolar lavage fluid (BALF) specimens, nanopore sequencing showed high sensitivity (100.00%,90.32%,82.35%,82.35%,100.00%,76.92%), specificity (70.00%,81.82%,88.00%,96.00%93.75%,93.10%0.100.00%), and AUC values (0.85,0.86,0.85, 0.89,0.97,0.85) for rifampicin (RIF), isoniazid (INH), ethambutol (EMB), streptomycin (SM), levofloxacin (LFX), moxifloxacin (MFX). Nanopore sequencing exhibited good detection efficacy (kappa value ≥ 0.70) and perfect diagnostic resistance value (AUC value ≥ 0.85). For RIF, nanopore sequencing showed Kappa values of 0.01 and 0.38 and AUC values of 0.02 and 0.18 higher than the Xpert MTB/RIF and fluorescent PCR melting curve, respectively; for INH, nanopore sequencing had a higher Kappa value of 0.65 and a higher AUC value of 0.32 than the fluorescent PCR melting curve. Nanopore sequencing provided superior overall performance.

CONCLUSION: Nanopore sequencing has significant technical advantages and clinical application potential in detecting MTB drug resistance. Its rapid and highly accurate detection capabilities support early diagnosis and personalized treatment of drug-resistant MTB. As the technology continues to mature and the cost is further reduced, it is expected that nanopore sequencing technology will play a more important role in MTB resistance detection.

PMID:40462071 | DOI:10.1186/s12890-025-03747-1

BMC Health Serv Res. 2025 Jun 3;25(1):794. doi: 10.1186/s12913-025-12704-x.

ABSTRACT

BACKGROUND: Recognising the diverse healthcare needs of the population, there is a growing emphasis on tailoring hospital discharge processes to address the unique challenges faced by individuals who are homeless, aiming to enhance the efficiency and effectiveness of post-hospitalisation care for this vulnerable demographic. This study aimed to evaluate the costs and consequences of specialist hospital discharge and intermediate care (support after discharge) services for people who are homeless in England.

METHODS: We estimated the comparative costs and consequences of different types of specialist care provided by 17 homeless hospital discharge and intermediate care services. We compared ‘clinically-led’ (multidisciplinary) services with those that were ‘housing-led’ (uniprofessional). A retrospective observational study was conducted to estimate effectiveness and costs for two’intervention groups'(clinically-led and housing-led) and a previously published RCT for’standard care’. Use of resources data for specialist care was sourced through linkage with Hospital Episode Statistics. The measure of effectiveness was the number of bed days avoided (in terms of hospital stays for all readmissions in the follow-up period) per homeless user. Additional secondary analysis of three services looked at quality-adjusted life years (QALYs) and service delivery costs. The perspective adopted was NHS in England.

RESULTS: Data from the comparative analysis showed that specialist homeless hospital discharge (HHD) care is likely to be cost-effective compared with standard care. Patients accessing specialist care use fewer bed days per year (including both planned and unplanned readmissions). Patients using specialist care have more planned readmissions to hospital and, overall, use more NHS resources than those who use standard care. We interpret this as a positive outcome indicating that specialist care is likely to work more effectively than standard care to improve access to healthcare for this marginalised group. Specialist care remained cost-effective over a range of sensitivity analyses. Secondary analyses of three specific schemes found better QALY outcomes, but results are not generalisable to all 17 schemes.

CONCLUSION: Specialist HHD services are likely to be cost-effective for the NHS compared with standard care, although further research is needed to access patient level data for both costs and outcomes to conduct a rigorous statistical analysis between groups and address possible underlying biases due to data coming from non-randomised study design.

PMID:40462065 | DOI:10.1186/s12913-025-12704-x

BMC Oral Health. 2025 Jun 3;25(1):896. doi: 10.1186/s12903-025-06194-w.

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate the adequacy of responses provided by experts and artificial intelligence-based chatbots (ChatGPT-4.0 and Microsoft Copilot) to frequently asked orthodontic questions, utilizing scores assigned by patients and orthodontists.

METHODS: Fifteen questions were randomly selected from the FAQ section of the American Association of Orthodontists (AAO) website, addressing common concerns related to orthodontic treatments, patient care, and post-treatment guidelines. Expert responses, along with those from ChatGPT-4.0 and Microsoft Copilot, were presented in a survey format via Google Forms. Fifty-two orthodontists and 102 patients rated the three responses for each question on a scale from 1 (least adequate) to 10 (most adequate). The findings were analyzed comparatively within and between groups.

RESULTS: Expert responses consistently received the highest scores from both patients and orthodontists, particularly in critical areas such as Questions 1, 2, 4, 9, and 11, where they significantly outperformed chatbots (P < 0.05). Patients generally rated expert responses higher than those of chatbots, underscoring the reliability of clinical expertise. However, ChatGPT-4.0 showed competitive performance in some questions, achieving its highest score in Question 14 (8.16 ± 1.24), but scored significantly lower than experts in several key areas (P < 0.05). Microsoft Copilot generally received the lowest scores, although it demonstrated statistically comparable performance to other groups in certain questions, such as Questions 3 and 12 (P > 0.05).

CONCLUSIONS: Overall, the scores for ChatGPT-4.0 and Microsoft Copilot were deemed acceptable (6.0 and above). However, both patients and orthodontists generally rated the expert responses as more adequate. This suggests that current current chatbots does not yet match the theoretical adequacy of expert opinions.

PMID:40462054 | DOI:10.1186/s12903-025-06194-w