Pre-exposure prophylaxis (PrEP) and condom use have contributed to a global decline in the incidence of human immunodeficiency virus (HIV) infections. However, despite concerted preventive efforts, HIV infections remain highly prevalent in West and Central Africa (WCA) among key populations, particularly among men who have sex with men (MSM). We conducted a scoping review to gain a better understanding of the status of PrEP adoption and condom use as effective HIV prevention measures among MSM in WCA and identified gaps. The review was conducted based on JBI Scoping Review Guidelines spanning 1 January 2017 to 10 April 2025. A comprehensive search was conducted in PubMed, CINAHL Ultimate, PsycINFO, ProQuest, Scopus, and OpenAIRE. This was supplemented with a manual search of reference lists, websites, and other online sources to capture key information relevant to the review objectives. Emerging patterns from the data were described and synthesised. Of the 713 identified studies, 22 studies comprising 19 quantitative and 3 qualitative studies were included in the final synthesis. The results indicate uneven with generally low to high uptake of PrEP, persistent inconsistencies in condom use, and risk compensation behaviours among MSM in WCA. Given that our findings are primarily from quantitative studies, additional qualitative studies on the lived experiences of MSM regarding these preventive measures are needed. From a policy implementation perspective, emphasis should be placed on MSM-inclusive, context-sensitive, and community-aligned HIV prevention strategies in WCA.
This Viewpoint discusses how leadership and structural changes at the US Preventive Services Task Force could affect clinicians’ access to evidence-based recommendations and therefore the health of US patients.
Thiazolidinediones (TZD) are a class of oral antidiabetic medications that improve glycemic control and insulin sensitivity. We evaluated the cardiovascular outcomes according to thiazolidinedione (TZD) use in patients with type 2 diabetes mellitus (T2DM) undergoing percutaneous coronary intervention (PCI). Using the national health claims database in South Korea, we constructed a cohort of type 2 diabetes mellitus patients who underwent PCI between 2015 and 2022. Patients were classified as TZD users or nonusers and matched at a 1:3 ratio using propensity score matching. Stratified Cox regression analysis was performed to evaluate the risk for the primary composite outcome, which included myocardial infarction (MI), stroke, and all-cause death. Among 169,747 patients with type 2 diabetes mellitus who underwent PCI, 7.4% were TZD users. During a mean follow-up of 3.63 ± 2.30 years, 31,813 patients (18.7%) experienced the primary outcome. In the stratified Cox regression analysis, which consisted of 12,597 TZD users and 37,791 nonusers, TZD treatment was associated with a lower risk of primary outcome (HR 0.87, 95% CI: 0.83-0.92, P < 0.001). No difference was observed in the risk of heart failure admission between TZD nonusers and users. TZD treatment in type 2 diabetes mellitus patients undergoing PCI was associated with a reduced risk of adverse cardiovascular events.
Research on the impact of vaccine rollout and vaccination on the relationship between perceived importance of and adherence to preventive behaviors in Canada remains limited. This study assessed adherence to preventive behaviors (mask wearing, hand washing, social distancing, self-isolating when sick, refraining from visiting hospitality venues, and refraining from gathering with others) as a function of vaccination status after vaccines became available in Canada as of December 2020. As part of the iCARE study, five cross-sectional age, sex, and province-weighted population-based samples totaling 14,771 Canadians aged 18+ years completed an online survey between May 2021 and June 2022. Vaccination status (categorized as unvaccinated or vaccinated (includes partial or fully vaccinated)), perceived importance of, and adherence to, preventive behaviors were assessed across the five survey periods. Logistic regressions showed that a greater proportion of vaccinated individuals considered preventive behaviors to be "very important" for reducing the spread of the virus, with higher odds of endorsing prevention behaviors (OR = 5.0, 95% CI = 4.4-5.7) compared to the unvaccinated. Results also showed that vaccinated individuals were more likely than unvaccinated to adhere to most prevention behaviors (ORs = 0.9-2.2, 95% CI = 0.7-3.2) across all survey periods. Getting vaccinated did not reduce perceived importance of or adherence to preventive behaviors for COVID-19 after vaccine rollout in Canada. The fact that positive (and negative) attitudes and preventive behaviors appear to cluster among vaccinated and unvaccinated individuals, respectively, suggests that targeted interventions are needed among those resistant to prevention policies in general, with previous evidence pointing to autonomy-supportive strategies as being potentially effective.
Prevention science has generated substantial evidence on interventions aimed at preventing substance use and other addictive behaviours. However, less attention has been paid to the conditions that hinder their design, implementation, sustainability, and equitable benefit. To propose a conceptual definition of barriers to prevention, establish criteria for identifying them, and develop a theoretical taxonomy of their main categories, incorporating a gender perspective and examining their specificity across preventive actions. Barriers to prevention should not be understood solely as operational obstacles to programme implementation, but as ecological factors, conditions, or processes that interfere with essential preventive functions and reduce the distribution of preventive protection. When barriers are structural or disproportionately affect specific groups or territories, reductions in coverage, accessibility, acceptability, continuity, equity, or preventive benefit may contribute to maintaining or amplifying prevention failure. We therefore propose a six-category taxonomy and a two dimensional identification model based on the joint presence of functional interference and observable consequences. The framework also considers how barriers may vary according to prevention form, preventive function, intervention package or strategy, mode of delivery, and setting. A more precise conceptualization of barriers to prevention may strengthen theory, improve implementation research, and support public policies that are more sensitive to equity, gender, and the regulation of risk-promoting environments.
People with disabilities experience persistent inequities in preventive care, yet contemporary, nationally representative data on prostate-specific antigen (PSA) testing disparities are limited. To evaluate the association between disability status and self-reported PSA testing among US men aged 55 to 69 years. This cross-sectional study used 2023 data from the Behavioral Risk Factor Surveillance System (BRFSS), a US population-based telephone survey. The analytic sample included 10 508 male respondents aged 55 to 69 years with complete PSA testing and disability data; analyses incorporated BRFSS survey weights to generate nationally representative estimates. Data were analyzed from October 2024 to May 2025. Any disability and disability types (mobility, cognitive, hearing, vision, self-care, independent living) measured using the standard 6-question sequence. The main outcome was self-reported PSA testing, assessed using BRFSS PSA items. Survey-weighted logistic regression was used to estimate adjusted odds ratios (AORs), controlling for sociodemographic factors, insurance, comorbidities, and health behaviors, with multiple imputation for missing covariates. The weighted analytic sample represented 5 058 866 US men aged 55 to 69 years; 29.6% reported at least 1 disability. Overall, 62.7% (95% CI, 61.1%-64.3%) reported prior PSA testing, with lower testing among men with disabilities than among those without (57.2% [95% CI, 54.2%-60.2%] vs 65.1% [95% CI, 63.2%-67.0%]; P < .001). In adjusted survey-weighted models, disability was associated with lower odds of PSA testing (AOR, 0.83; 95% CI, 0.69-0.99). Among disability types, mobility disability was associated with lower testing (AOR, 0.77; 95% CI, 0.62-0.96). In an unweighted sensitivity analysis, the association between any disability and lower PSA testing remained significant (AOR, 0.86; 95% CI, 0.77-0.98). In this nationally representative cross-sectional study of US men aged 55 to 69 years, disability status was associated with lower PSA testing, with the most consistent disparity observed among men with mobility disability. These findings suggest disability, particularly mobility impairment, may be an under-recognized determinant of preventive care and may warrant targeted interventions to improve equitable access to shared decision-making and screening services.
Accidents and injuries are the leading causes of preventable death among adolescents and are often related to substance use. About 60% of US high school students have tried alcohol and 22% report current alcohol use. Preventing and reducing adolescent alcohol use would contribute to substantial health benefits and prevent major health morbidity and mortality. Advances in interactive narrative learning technologies hold promise for designing games for health that effectively deliver age-appropriate and personalized behavior change interventions. The Interactive Narrative System for Patient-Individualized Reflective Exploration (INSPIRE) is designed to serve as an extension to clinical preventive care, engaging adolescents in a theoretically grounded alcohol prevention intervention by leveraging the dual mechanisms of interactive narrative and 3D game technologies. This pre-post study aims to examine the impact of INSPIRE on adolescents' self-efficacy to avoid risky alcohol-related behavior and knowledge about alcohol risk. A total of 44 adolescents in high school (aged 14-16 years; mean 15.16, SD 0.95; n=22, 50% female) were recruited using convenience sampling from an after-school program in the San Francisco Bay Area. The largest proportion of participants identified as Hispanic or Latine (n=15, 34%), followed by White, Asian, and multiple racial or ethnic backgrounds. Participants completed two 20-minute web-based interactive narrative episodes. We compared pretest and posttest data to examine changes in adolescents' self-efficacy and knowledge using a combination of questionnaire and computer interaction trace log data. Self-efficacy was measured using a 24-item scale (α=.95; 0-10 rating). Knowledge was assessed using 10 multiple-choice items derived from in-game content. Pre-post changes were analyzed using Wilcoxon signed-rank tests (α=.05), with rank-biserial correlation effect sizes and 95% CIs. Approximately 25% (n=11, 95% CI 14.6%-39.4%) of study participants reported having consumed alcohol at least once, and 23% (n=10, 95% CI 12.8%-37.0%) reported alcohol use within the past year. Self-efficacy scores significantly increased from 7.97 (SD 2.24) at pretest to 8.72 (SD 1.58) at posttest, with a mean difference of 0.75 (95% CI 0.59-0.91; P<.001; r=0.89). Knowledge scores also significantly increased from 5.09 correct (median 5.0, IQR 4.0-6.0) at pre-test to 6.11 correct (median 7.0, IQR 5.0-8.0) at posttest, with a mean increase of 1.02 (95% CI 0.31-1.74; Wilcoxon signed-rank test, P<.001; r=0.57). Reflection tool clustering revealed 4 behavioral strategy endorsement profiles. As a first of its kind interactive narrative intervention, INSPIRE offers an innovative theoretically grounded model for supporting adolescent health behavior change. This study enhances our understanding of how to use innovative learning technologies to reduce risky alcohol use. Extending prior research in the field through using personalized narrative adaptations, this study indicates that through reinforcing goals and decisions to avoid risky behavior, adolescents can enhance their self-efficacy beliefs to avoid risky alcohol use and increase their knowledge about alcohol risk. Implications of these outcomes include the potential to facilitate the generalization of preventive behaviors to real-life situations.
For more than 10 years, the US Preventive Services Task Force has recommended annual lung cancer screening (LCS), but adherence to annual screening remains low. To test 2 multilevel, patient-centered interventions to increase adherence to guideline-concordant annual LCS. A pragmatic 2 × 2 factorial randomized clinical trial was conducted at Kaiser Permanente Washington among patients who completed LCS with normal findings from November 21, 2022, to April 5, 2024. The date of last follow-up was July 4, 2025. Data were analyzed from July to December 2025. The 4 arms included usual care, health communication, Stepped Reminders, or both interventions. The health communication intervention addressed patient screening knowledge barriers with print and video messaging. The Stepped Reminders intervention pended LCS scan orders for primary care physicians (PCPs) and sent outreach to patients to remind them to schedule scans. Both interventions were facilitated by a system-level LCS coordinator with electronic health record registry to deliver interventions. The primary outcome was completion of screening low-dose computed tomography (LDCT) or chest CT 9 to 15 months after index LDCT. All participants eligible for annual screening were included in the modified intent-to-treat analysis. Participants were censored due to lung cancer diagnosis, death, early LDCT or chest CT, or disenrollment from the health plan. Among 1837 trial participants, the mean (SD) age was 66.3 (6.5) years; 897 (48.8%) were female and 940 (51.2%) were male; 17 (1.0%) were American Indian or Alaska Native, 47 (2.7%) were Asian, 55 (3.1%) were Black, 10 (0.6%) were Native Hawaiian or Other Pacific Islander, 1560 (88.7%) were White, 37 (2.1%) were multiracial, and 32 (1.8%) were another race; and 875 (47.6%) were currently using tobacco. A total of 459 were randomized to the usual care group, 460 to the health communication group, 460 to the Stepped Reminders group, and 458 to the both interventions group. Adherence to annual screening was 4.7 percentage points lower in those who received the health communication intervention relative to those who did not (59.2% [476 of 804] vs 63.3% [516 of 815]; relative risk, 0.93; 95% CI, 0.86-1.00; P = .04) and 27.7 percentage points higher in those who received the Stepped Reminders intervention relative to those who did not (75.5% [604 of 800] vs 47.4% [388 of 819]; relative risk, 1.59; 95% CI, 1.47-1.72; P < .001). The Stepped Reminders intervention improved screening rates significantly more among participants currently using tobacco (received Stepped Reminders, 281 [73.0%]; did not receive Stepped Reminders, 160 [41.2%]; risk difference, 32.3 percentage points; 95% CI, 25.9-38.8) compared with former users (received Stepped Reminders, 323 [77.8%]; did not receive Stepped Reminders, 228 [52.9%]; risk difference, 24.1 percentage points; 95% CI, 18.1-30.0) (P for interaction = .03). In this randomized clinical trial, appropriately timed multilevel reminders directed to PCPs to order and patients to schedule LDCT scans were effective at improving annual LCS adherence in programs led by PCPs. ClinicalTrials.gov Identifier: NCT05747443.
Chickenpox (varicella) is a common childhood viral illness that is usually self-limiting; however, it may be complicated by secondary bacterial skin infections, particularly in pediatric populations. These secondary infections contribute significantly to morbidity, prolonged hospital stays, and increased healthcare utilization. The present study aims to determine the incidence of secondary skin infections among children affected with chickenpox and to identify associated risk factors. A descriptive observational study was conducted among children diagnosed with chickenpox over a period of 1 year. Clinical evaluation was performed to identify signs of secondary skin infections, and relevant demographic and clinical data were collected. The incidence of secondary skin infections was calculated, and common bacterial pathogens and clinical outcomes were analyzed. The findings indicate that a notable proportion of children with chickenpox develop secondary skin infections, most commonly impetigo, cellulitis, and abscesses, with Staphylococcus aureus and Streptococcus pyogenes being the predominant pathogens. Factors such as poor hygiene, scratching of lesions, malnutrition, and delayed medical care were found to increase the risk of infection. Early recognition and appropriate management of secondary skin infections are essential to reduce complications. Preventive strategies, including health education and varicella vaccination, play a crucial role in minimizing the incidence and severity of these infections. Résumé Contexte:La varicelle est une maladie virale fréquente de l’enfance, généralement bénigne et spontanément résolutive. Cependant, elle peut être compliquée par des infections cutanées bactériennes secondaires, en particulier chez les enfants. Ces infections secondaires contribuent de manière significative à la morbidité, à la prolongation de la durée d’hospitalisation et à l’augmentation de l’utilisation des ressources de santé. La présente étude vise à déterminer l’incidence des infections cutanées secondaires chez les enfants atteints de varicelle et à identifier les facteurs de risque associés.Méthodologie:Une étude observationnelle descriptive a été menée auprès d’enfants diagnostiqués avec la varicelle sur une période d’un an. Une évaluation clinique a été réalisée afin d’identifier les signes d’infections cutanées secondaires, et des données démographiques et cliniques pertinentes ont été recueillies. L’incidence des infections cutanées secondaires a été calculée, et les principaux agents pathogènes bactériens ainsi que les issues cliniques ont été analysés.Résultats:Les résultats indiquent qu’une proportion notable d’enfants atteints de varicelle développe des infections cutanées secondaires, les plus fréquentes étant l’impétigo, la cellulite infectieuse et les abcès. Les principaux agents pathogènes identifiés étaient Staphylococcus aureus et Streptococcus pyogenes. Des facteurs tels qu’une mauvaise hygiène, le grattage des lésions, la malnutrition et un recours tardif aux soins médicaux ont été associés à un risque accru d’infection.Conclusion:La reconnaissance précoce et la prise en charge appropriée des infections cutanées secondaires sont essentielles pour réduire les complications. Les stratégies de prévention, notamment l’éducation sanitaire et la vaccination contre la varicelle, jouent un rôle crucial dans la réduction de l’incidence et de la gravité de ces infections.
Immigrants without US citizenship, or noncitizens, disproportionately endure poverty, labor exclusions, and inadequate health care access-structural drivers of adverse cancer outcomes. While screening is critical for preventing cancer deaths, and cancer is the leading cause of death among noncitizens, little is known about citizenship status and its potential influence on cancer screening. To examine cancer screening inequities associated with citizenship status, evaluate whether these inequities vary across states, and determine whether structural factors mediate these inequities. This cross-sectional study used nationally representative data from the National Health Interview Survey (2010-2023). Eligibility for cancer screening and the timing and types of tests considered appropriate were determined using US Preventive Services Task Force guidelines. Data were analyzed from May to August 2025. Citizenship status: noncitizen (regardless of documentation), naturalized, or US-born. Outcomes included colorectal, cervical, or breast cancer screening. Potential mediators included socioeconomic and health care factors (eg, poverty-to-income ratio and insurance), whereas clinical factors (eg, cancer history) were considered confounders. Mediation analysis using nonlinear multiple additive regression tree models was performed to evaluate associations between citizenship status and cancer screening and to identify mediators. The sample included 131 501 participants eligible for colorectal (3687 [5.1%] noncitizen, median [IQR] age, 61.1 [55.0 to 67.0] years, 39 040 [47.8%] male), cervical (6812 [10.2%] noncitizen, median [IQR] age 41.1 [30.0-52.0]), or breast (1815 [5.1%] noncitizen, median [IQR] age 60.8 [55.0-66.0]) cancer screening. In 2023, noncitizens had significantly lower colorectal (43.6%; 95% CI, 38.7%-48.4% vs 75.5%; 95% CI, 74.6%-76.5%), cervical (57.1%; 95% CI, 53.1%-61.0% vs 71.6%; 95% CI, 70.3%-72.8%), and breast (73.0%; 95% CI, 66.4%-78.7% vs 80.1%; 95% CI, 78.8%-81.3%) cancer screening rates than US-born citizens. These citizenship-based disparities were observed throughout the study period and were present in many states. Noncitizens had significantly lower odds of receiving colorectal (OR, 0.35; 95% CI, 0.32-0.38), cervical (OR, 0.41; 95% CI, 0.38-0.44), and breast (OR, 0.57; 95% CI, 0.52-0.62) cancer screenings than US-born citizens, with socioeconomic and health care factors jointly mediating these inequities (proportion mediated, colorectal cancer: 56.6%; 95% CI, 49.1%-64.2%; cervical cancer: 39.6%; 95% CI, 32.3%-47.0%; breast cancer: 97.1%; 95% CI, 87.1%-107.1%). In this nationally representative study, noncitizens had lower rates of cancer screenings, an inequity largely explained by socioeconomic barriers and inadequate health care access. Efforts to increase cancer screening and reduce preventable cancer mortality among noncitizens should focus on improving their health care access.
Irving Roy Rathgeb, Jr., MD was a young physician and surgeon who was born in Highland (Ulster County), New York on 7 March 1913. His father, Irving Roy Rathgeb, Sr. was a co-owner of the Rathgeb Knitting Mills which specialized in the production of sweaters. Rathgeb was an excellent student in primary and high school and later attended Colgate and Cornell universities. In 1934 he entered the Long Island College of Medicine from where he received his MD degree in 1938. Graduating in the upper third of his class, he obtained an internship at the Norwegian Hospital in Brooklyn, New York. Because of his desire to become a surgeon, he was then accepted into the Department of Surgery at the St Louis Railway Company Hospital in Texarkana, Texas. Soon thereafter he joined the Texas National Guard while still continuing his training in surgery at the hospital and was commissioned as a First Lieutenant. He was assigned to the 111th Medical Regiment, 36th Infantry Division. Completing his residency in surgery at the hospital he was transferred to the US Army Medical Corps as a Captain. Once the US entered World War II, the 36th Infantry Division was transferred overseas and Rathgeb promoted to the rank of Major. The functions of the 111th Medical Regiment, of which Rathgeb was an essential part, was to serve as an evacuation hospital. This entailed the collecting and evacuating of the wounded soldiers from the front lines and taking them to medical facilities well behind the battle lines. This was a very high-risk responsibility since it regularly placed Rathgeb and his fellow medical personnel in the line of fire. In 1942 the 111th Regiment was temporarily posted to Eritrea in Eastern Africa. In early 1943 they were ordered to Cairo, Egypt in preparation for the allied invasion of Italy. On 23 March Rathgeb and seven of his medical team boarded a military plane for a flight to Cairo. About 50 miles south of Cairo, the plane encountered a severe sandstorm, and eventually crashed into a mountain peak and fell into a canyon. Initial search parties were unable to find the crash site and thus it was provisionally concluded that the plane might have crashed into the Red Sea. Rathgeb's family and the families of others on the flight were told that they were missing in action. After many months the crash site was found and the deceased victims of the accident removed and buried in a common grave in Suez, Egypt. Five years later in 1948, Rathgeb's remains and those of seven of his military companions were transferred to a common burial plot in the Zachary Taylor National Cemetery in Louisville, Kentucky. In 2026 a slide rule bearing Rathgeb's name neatly printed and black ink both inside and outside of the rule's leather case was found in a desk drawer whose content had once belong to Duncan W. Clark, MD. Clark had graduated from the Long Island College of Medicine in 1936, two years before Rathgeb. Following his graduation, he had a close relationship with the medical school and its successor, SUNY Downstate Health Sciences University. He served as Assistant Dean, Dean, Professor and Chair of the Department of Preventive Medicine and Community Health and later as Professor Emeritus. Clark passed away in 2007 at the age of 96. How Rathgeb's slide rule came into his possession is not known. However, its discovery enabled others many decades later to come to know Rathgeb as a remarkable and brilliant physician and surgeon whose great leadership abilities and surgical care contributions were never fully realized because he had given his life while serving others.
To analyze the association between painful temporomandibular disorders (TMD), sleep bruxism, and anxiety symptoms in adolescents. A cross-sectional study was conducted with 497 adolescents aged 14-19 years. Data were collected on sociodemographic characteristics, painful temporomandibular disorders, sleep bruxism, and anxiety symptoms. Associations between categorical variables were assessed using Pearson's chi-square test, and binary logistic regression was performed to evaluate factors associated with painful temporomandibular disorders, with a significance level of 5%. The prevalence of painful TMD was 29.6%, anxiety symptoms were present in 78.9% of the sample, and clinically defined sleep bruxism was identified in 4.4% of the participants. In the adjusted model, adolescents with anxiety symptoms were 2.7 times more likely to have painful TMD (95% CI 1.5-4.8), and those with sleep bruxism were 6.5 times more likely to have painful TMD (95% CI 2.5-17.2). The highest estimated probability of painful TMD (74.7%) was observed among adolescents presenting both anxiety symptoms and sleep bruxism. Painful temporomandibular disorders were significantly associated with anxiety symptoms and sleep bruxism in adolescents, whereas no significant associations were observed with the sociodemographic factors examined. These findings highlight the importance of early identification of the co-occurrence of painful temporomandibular disorders, sleep bruxism, and anxiety symptoms in adolescents, supporting preventive strategies and multidisciplinary care aimed at reducing chronic pain and its psychosocial impact.
To determine the frequency, type, and severity of acute-phase reaction (APR) following zoledronate (ZOL) infusion, identify associated clinical risk factors, and compare treatment-naïve patients with those receiving ZOL as sequential therapy. A secondary objective was to assess recall bias through a 90-day retest. A prospective study was conducted at a single bone clinic. Patients who received 5 mg ZOL were invited to complete questionnaires at 3 and 7 days post-infusion. Symptom frequency and severity were analyzed, and clinical factors were assessed using multivariate logistic regression. Symptoms with intensity ≥ 8 on a 0-10 Numerical Rating Scale (NRS) were considered severe. The mean age of the 1,150 patients was 66.9 ± 8.5 years, 97% were women. At least one symptom was reported by 867 (75%) patients. The most common were general and musculoskeletal symptoms (61 and 58%), followed by gastrointestinal (23%), ocular (13%), and fever (8%). Severe symptoms were reported by 22%. While 94% expressed willingness to repeat treatment, severe symptoms were significantly associated with treatment decline: 68% of those who declined versus 19% among those willing to continue (p < 0.001). A 90-day retest revealed systematic under-recall of mild general, musculoskeletal, and gastrointestinal symptoms (McNemar p < 0.05), whereas fever, ocular, and severe symptoms remained stable over time. First-time infusion was significantly associated with all symptoms and severity, whereas older age predicted a lower risk of general, gastrointestinal, fever, and severe symptoms. Among first-infusion patients (n = 704), prior bisphosphonate was associated with a reduced frequency and severity of symptoms. Preventive analgesics were associated with lower risk of general and musculoskeletal symptoms. This real-life study shows a high frequency of APR when symptoms are assessed shortly after ZOL infusion with mild symptoms systematically underestimated over time. First infusion, younger age, and lack of prior bisphosphonate exposure were the main risk factors identified. These findings support improving pre-infusion counseling in higher-risk patients to reduce anxiety and support long-term adherence to osteoporosis treatment.
Medicare Advantage (MA) costs 22% more than original Medicare (OM) for a given individual ($83 billion in annual excess public costs). However, MA may improve type 2 diabetes (T2D) outcomes compared with OM by providing financial protections (eg, annual out-of-pocket spending caps) and supplemental benefits (eg, healthy food assistance) that OM cannot. To determine whether MA coverage is associated with better T2D outcomes than OM. A longitudinal cohort study using target trial emulation principles for design and analysis in adults aged 18 years or older receiving OM or MA with T2D, followed up before and after Medicare coverage in community-based health centers (January 2021 to June 2024) across 44 states. Analyses were conducted from September 2025 to May 2026. MA or OM coverage. Hemoglobin A1c (HbA1c) (primary outcome), systolic blood pressure (SBP) and diastolic blood pressure (DBP), low-density lipoprotein (LDL) cholesterol, food insecurity, housing instability, and transportation barriers at 12 months after Medicare coverage (primary time point) and at 6, 18, and 24 months. Statistical analysis accounted for pre-Medicare coverage factors that may influence selection of MA vs OM using targeted minimum loss estimation. Covariates were age, sex, race and ethnicity, comorbidities, income, Social Vulnerability Index, pre-Medicare insurance, Medicaid coverage, and pre-Medicare coverage values for HbA1c, SBP, DBP, LDL cholesterol, body mass index, food insecurity, housing instability, and transportation barriers. In this study in 34 648 adults (19 054 in OM, 15 594 in MA) with T2D, followed up before and after Medicare coverage, the mean (SD) age was 65.24 (9.73) years and 53.42% were women. Twelve months after Medicare coverage, MA was not associated with better HbA1c (mean difference, 0.01; 95% CI, -0.04 to 0.05, P = .74), SBP (-0.15; 95% CI, -0.54 to 0.24; P = .44), DBP (0.06; 95% CI, -0.15 to 0.27; P = .58), or LDL cholesterol (-0.41; 95% CI, -1.24 to 0.42; P = .33), with similar results at other time points. MA was also not associated with a lower risk of food insecurity (relative risk [RR], 1.00; 95% CI, 0.94-1.05), housing instability (RR, 1.00; 95% CI, 0.91-1.09), or transportation barriers (RR, 1.00; 95% CI, 0.93-1.07) at 12 months or any other time point. In this study, when accounting for factors that may drive MA selection, MA was not associated with better T2D outcomes or fewer health-related social needs than OM. Given substantially higher spending for MA, it is important to ensure this spending is being used effectively to improve health.
National organizations recommend antiviral treatment for hospitalized children with influenza; however, use in this setting has recently declined. Studies of oseltamivir effectiveness in children are limited by misclassification bias, unknown symptom onset date, and incomplete capture of antiviral use prior to admission. To assess the association between oseltamivir receipt and intensive care unit (ICU) admission and hospital length of stay (LOS) among pediatric influenza-associated hospitalizations. This cohort study used data that were obtained from the Influenza Hospitalization Surveillance Network (FluSurv-NET), which conducts US population-based surveillance for laboratory-confirmed influenza hospitalizations for all ages across 13 states. The study data include seasons 2014 to 2015 through 2022 to 2023, excluding 2020 to 2021. Participants included children aged younger than 18 years who were hospitalized with laboratory-confirmed influenza and for whom a respiratory symptom onset date was available. These data were analyzed from October 2024 through May 2026. Oseltamivir receipt as a time-dependent exposure. The primary outcome was time from symptom onset to ICU admission. Secondary outcome was time from admission to discharge (LOS). Adjusted Cox proportional hazard models (aHR) with oseltamivir receipt as a time-dependent exposure were used. After exclusions, 6044 influenza cases were included in the primary ICU analysis, of whom 4240 (70.2%) received oseltamivir, and 7103 cases were included in the secondary LOS analysis, of whom 5746 (80.9%) received oseltamivir. In the ICU analysis, the median (IQR) age was 3 (1-7) years, 3382 (56%) were male and 3721 (44%) were female, and 2937 (49%) had 1 or more medical comorbidity-the most common of which was asthma in 1547 children (26%). In adjusted models, compared with untreated children, oseltamivir treatment reduced the hazard of ICU admission (aHR, 0.69; 95% CI, 0.60-0.80) and shortened LOS (analyzed as hazard of hospital discharge; aHR, 1.13; 95% CI, 1.06-1.21). In this cohort of children hospitalized with influenza, oseltamivir treatment was significantly associated with a reduced risk of ICU admission by 31% and decreased hospital LOS. These findings demonstrate the benefits of oseltamivir receipt and support current national recommendations for oseltamivir treatment as soon as possible in children hospitalized with suspected or laboratory-confirmed influenza.
This study aimed to evaluate the use of apple juice (AJ), an agro-industrial by-product rich in sugars, as a low-cost substrate for the production of Vishniacozyma victoriae, a biocontrol yeast, and to assess the performance of the fresh and lyophilized biomass under semi-commercial postharvest conditions. A Central Composite Design was used to optimise culture medium composition for improve biomass production. Biomass production was then evaluated under different cultivation modes, batch and semicontinuous reactors at laboratory scale. The biomass was preserved by lyophilization using protective formulations and later applied in two commercial packinghouses. In organic Packinghouse A, the control percentages exceeding 50% and, in some cases, reaching 100% control for the decays caused by Penicillium expansum, Botrytis cinerea and Alternaria-Cladosporium spp. The antagonistic yeast was able to colonize the surface of the fruit during the postharvest period. Apple juice is a suitable substrate for the cost-effective production of biocontrol yeast. Semicontinuous cultivation enhanced biomass yield, and both fresh and lyophilized formulations were effective in reducing postharvest decay in pears and apples under semi-commercial conditions.
The bilirubin-to-albumin (BA) ratio may reflect the balance between circulating bilirubin and albumin-related binding capacity, but its association with lung cancer risk remains unclear. We analyzed data from the Korean Cancer Prevention Study-II, a nationwide prospective cohort. After excluding participants with baseline cancer or missing key variables, 81,746 men and 49,421 women were included. Total, indirect, and direct BA ratios were calculated and standardized per 1-standard deviation increase. Sex-specific associations with lung cancer risk were assessed using Cox proportional hazards models, quartile analyses, restricted cubic splines, and causal survival forest models. In Cox models, higher total and direct BA ratios were inversely associated with lung cancer risk in men, whereas higher total and indirect BA ratios were positively associated with risk in women. Restricted cubic spline analyses supported inverse dose-response patterns for total and direct BA ratios in men. Causal survival forest analyses showed statistically significant positive average treatment effects for lung cancer-free survival probability only in men across 5-, 10-, and 13-year horizons. BA ratio showed sex-specific associations with lung cancer risk, with more consistent inverse associations among men.
This study aims to investigate the therapeutic potential of NMN in alleviating type 2 diabetes-induced myocardial fibrosis.The experiment was comprised of control group, diabetic group, DM + NMN intervention group, and DM + NMN+3-TYP group. Blood glucose level, tibia length, cardiac function, myocardial interstitial fibrosis and ROS level were evaluated. The expression of SIRT3, GSK3β, ac-GSK3β, downstream fibrosis-related proteins and the interaction between SIRT3 and GSK3β were analyzed. Diabetic mice exhibited pronounced myocardial interstitial fibrosis alongside significant alterations in cardiac structure and function. Additionally, the protein expression levels of ac-GSK3β/GSK3β, p-Smad3/t-Smad3, α-SMA, and Collagen I were elevated, while SIRT3 expression was reduced. NMN effectively ameliorated these changes. The therapeutic benefits of NMN were effectively inhibited by 3-TYP. NMN effectively combats diabetes-induced myocardial fibrosis, potentially through upregulating SIRT3 expression. This upregulation may enhance the interaction between SIRT3 and GSK3β, thereby reducing the acetylation of GSK3β. Through this mechanism, NMN ultimately suppresses Smad3 phosphorylation.
A Gram-negative, facultatively anaerobic, non-motile, and non-spore-forming rod-shaped bacterium, designated strain NGMCC 1.201702T, was isolated from grapevine rootstock in a vineyard in the Xinjiang Uygur Autonomous Region, China. This isolate represents the first reported member of the genus Borborobacter recovered from a plant-associated environment. Before this study, the genus was known only from arsenic-contaminated aquifer sediment. A comprehensive polyphasic taxonomic study was conducted to determine its precise taxonomic position. Strain NGMCC 1.201702T showed the highest 16S rRNA gene sequence similarity to Borborobacter arsenicus KCTC 52625T (98.29%), while digital DNA-DNA hybridization (23.50%) and average nucleotide identity (79.70%) values with this closest relative were well below species demarcation thresholds. The sole respiratory quinone was ubiquinone-10. The major cellular fatty acids (> 10%) were C18:0, cyclo-C19:0 ω8c and Summed feature 8 (C18:1 ω7c and/or C18:1 ω6c). The polar lipid profile consisted of phosphatidylethanolamine, phosphatidylcholine, phosphatidylglycerol, diphosphatidylglycerol, phosphatidylmonomethylethanolamine, an unidentified aminophospholipid, an unidentified aminolipid, two unidentified phospholipids (PL1-2), and four unidentified lipids (L1-4). The genomic DNA G + C content was 61.32%. Qualitative screening assays showed positive reactions for indolic compounds and siderophore production. Genome analysis identified genetic features potentially associated with stress adaptation and iron/tryptophan metabolism, providing additional ecological context for this plant-associated isolate. Based on phenotypic, phylogenetic, genomic, and chemotaxonomic evidence, strain NGMCC 1.201702T represents a novel species of the genus Borborobacter, for which the name Borborobacter xinjiangensis sp. nov. is proposed. The type strain is NGMCC 1.201702T (= CGMCC 1.61957T = JCM 37105T).
The greater palatine foramen (GPF) is a critical anatomical landmark for palatal nerve block anesthesia, periodontal surgery, and soft tissue graft harvesting. Population-specific morphometric data are needed for safe clinical practice. However, standardized CBCT-based GPF morphometric data with reliability analysis are lacking for the Saudi population. This retrospective cross-sectional study evaluated 68 CBCT scans of adult Saudi patients (18-65 years) from King Saud Dental University Hospital. Three primary variables were measured using Planmeca Romexis software: the distance from the GPF to the midline maxillary suture (GPF-MMS), the anteroposterior (AP) diameter, and the lateromedial (LM) diameter. Data were analyzed using R (version 4.5.3). Descriptive statistics, normality testing, and sex-based comparisons were performed. The mean GPF-MMS distance was 15.25 ± 1.26 mm (95% CI: 14.95-15.56). The mean AP diameter was 5.34 ± 0.97 mm (95% CI: 5.11-5.58), and the mean LM diameter was 2.43 ± 0.54 mm (95% CI: 2.30-2.56). All three measurements were significantly larger in males than females (GPF-MMS: p=0.003, d=0.820; AP: p=0.006, d=0.742; LM: p=0.005, r=0.341). Inter-rater reliability was excellent for GPF-MMS (ICC=0.920) and good for AP and LM diameters (ICC=0.808 and 0.873, respectively). GPF-MMS distance, AP diameter, and LM diameter in Saudi adults were 15.25 mm, 5.34 mm, and 2.43 mm, respectively. Males had significantly larger measurements across all three variables. Population-specific and sex-adjusted reference values should be applied when planning palatal nerve block anesthesia and soft tissue graft harvesting in Saudi patients.