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Mass administration of azithromycin reduced child mortality in parts of sub-Saharan Africa. Promotion of infant growth may be an additional benefit of azithromycin treatment. To investigate whether the provision of mass administration of azithromycin for infants aged 1 to 11 months improves growth outcomes. This cluster randomized clinical trial conducted from December 1, 2020, to December 31, 2024, included 1151 villages in southwestern Mali. Villages were randomized in a 3:4:2 ratio to placebo, twice-yearly azithromycin, or quarterly azithromycin. Participants and study personnel were masked. The prespecified growth substudy, conducted from August 31, 2022, to July 31, 2023, was conducted in 59 villages in the Kita region. Eligible participants were infants aged 1 to 11 months, weighing 3.0 kg or more, with no macrolide allergy or severe illness. Anthropometric data were collected cross-sectionally from children aged 6 to 8 months and 12 to 14 months at 15, 18, 21, and 24 months after village enrollment. Infants received a single oral dose of azithromycin, 20 mg/kg, at each quarterly visit: placebo at all rounds (control); azithromycin at 2 rounds from January to June and placebo at 2 rounds from July to December (twice-yearly azithromycin); or azithromycin at all rounds (quarterly azithromycin). Prespecified outcomes were weight and length; weight-for-age (WA), length-for-age (LA), weight-for-length (WL), and mid-upper-arm circumference (MUAC) z scores; and underweight, stunting, and wasting. Analysis was performed on an intention-to-treat basis. A total of 1205 infants (mean age, 5.7 months [95% CI, 5.6-5.9 months]; 633 boys [52.5%]) were included in the trial at baseline. Among 1789 children (923 boys [51.6%]) assessed for growth, the mean anthropometric indices did not differ between the placebo, twice-yearly azithromycin, and quarterly azithromycin groups: weight, 7.8 kg (95% CI, 7.7-7.9 kg), 7.8 kg (95% CI, 7.7-7.9 kg), and 7.8 kg (95% CI, 7.7-7.9 kg), respectively; length, 70.2 cm (95% CI, 69.9-70.8 cm), 70.6 cm (95% CI, 70.2-70.9 cm), and 70.6 cm (95% CI, 70.1-71.0 cm), respectively; WA z score, -1.12 (95% CI, -1.23 to -0.95), -1.10 (95% CI, -1.19 to -0.98), and -1.12 (95% CI, -1.27 to -1.01), respectively; LA z score, -0.86 (95% CI, -1.06 to -0.70), -0.79 (95% CI, -0.93 to -0.65), and -0.78 (95% CI, -0.98 to -0.63), respectively; WL z score, -0.87 (95% CI, -1.00 to -0.68), -0.89 (95% CI, -1.01 to -0.77), and -0.95 (95% CI, -1.12 to -0.81), respectively; and MUAC z score, -0.30 (95% CI, -0.43 to -0.10), -0.24 (95% CI, -0.37 to -0.12), and -0.26 (95% CI, -0.41 to -0.10), respectively. The proportions of underweight, stunting, and wasting did not differ between groups. In this prespecified analysis of secondary outcomes of a cluster randomized clinical trial of the provision of mass administration of azithromycin for infants aged 1 to 11 months, growth outcomes did not differ between azithromycin and placebo groups. These findings suggest that mass administration of azithromycin to infants is unlikely to promote growth. ClinicalTrials.gov Identifier: NCT04424511.

Neurosurgical training is uniquely constrained by prolonged duration, limited case volumes, and high-stakes decision-making that demands simultaneous mastery of technical skills, clinical judgment, professionalism, and communication. Traditional assessment systems often detect late deficits and provide insufficiently granular feedback for early, individualized remediation. We implemented an integrated educational performance framework in an Accreditation Council for Graduate Medical Education (ACGME) osteopathic-recognized neurosurgery residency consisting of: (1) a point-based quarterly promotion system capturing required clinical, scholarly, and professional activities; (2) a resident-generated multiple-choice question and quiz program linked to didactic content and in-service exam domains; (3) simulation-enhanced technical training using cadavers, three-dimensional (3D)-printed models, and virtual reality; and (4) a predictive analytics dashboard that synthesizes longitudinal performance signals to identify strengths and emerging risks early. Across trainees, quarterly point totals and quiz performance provided actionable early markers of engagement and knowledge acquisition. Residents falling ≥10% below quarterly point thresholds on two consecutive quarters were reliably identified for goal-oriented success plans, enabling targeted remediation or, when necessary, determination of inability to meet program requirements. Quiz participation and scores are tracked with bi-monthly examinations and annual in-service performance, allowing topic-specific coaching and peer-mentoring by high performers. Simulation interventions demonstrated measurable skill acquisition and procedural efficiency improvements consistent with prior published program outcomes. A novel combined point-quiz-simulation framework, strengthened by predictive analytics, creates a closed-loop competency system that detects deficits early, amplifies strengths, and aligns resident and faculty actions to program mission, milestones, and patient-centered outcomes. This approach is feasible, transferable, and may help address regional neurosurgical access gaps by accelerating the development of safe, independent surgeons while preserving wellness and professionalism. A core finding of this manuscript is that measurable structure improves resident function.

Whether dedicated tertiary heart-failure programmes in low- and middle-income countries can approach guideline-directed medical therapy (GDMT) targets, and whether temporal trends reflect prescribing optimisation or case-mix shift, remains unresolved. We characterise four-pillar GDMT adoption in an eastern Indian tertiary centre with systematic robustness testing. Repeated cross-sectional analysis in a prospective HFrEF registry (2022-2024 primary cohort, n&#xa0;=&#xa0;319 patients). Half-yearly adoption assessed by Cochran-Armitage trend tests (Benjamini-Hochberg FDR), MI-adjusted logistic regression (m&#xa0;=&#xa0;20), and Bayesian regression. Robustness: delta-adjusted MI, tipping-point, FMI, sacubitril-valsartan target-dose, E-value, time-by-diabetes interaction, quarterly ITS at &#x2265;&#xa0;8 bins. Four-pillar composite rose from 48.6% (H12022) to 76.3% (H2 2024); MI-adjusted OR per half-year 1.24 (95% CI 1.05-1.47; p&#xa0;=&#xa0;0.013). SGLT2 inhibitor drove the composite (OR 1.51; 1.22-1.86; p&#xa0;<&#xa0;0.001); RAAS-i 1.24, MRA 1.11 and beta-blocker 0.98 not significant. Bayesian regression concurred (SGLT2i posterior probability 0.972; four-pillar 0.896). SGLT2i trend was robust to delta-adjusted MI, tipping-point beyond +/- 50&#xa0;mL/min/1.73&#xa0;m^2, and unmeasured confounding (E-value point 1.76; CI lower 1.44). Time-by-diabetes interaction was null; sacubitril-valsartan target-dose attainment 20.0%. Quarterly ITS at &#x2265;&#xa0;8 bins returned non-significant level and slope changes at every feasible policy event. Tertiary specialist care approached but did not reach the four-pillar prescription ceiling (76.3%; residual 23.7-percentage-point gap). The SGLT2i trend was robust to MNAR, unmeasured confounding, and diabetes case-mix shift; quarterly ITS at &#x2265;&#xa0;8 bins detected no policy-event association. Sacubitril-valsartan target-dose attainment (20.0%), single-centre design, and fragile non-SGLT2i E-values constrain generalisability.

Osteopathic medical care has been associated with better long-term outcomes in an intention-to-treat analysis of data from a retrospective cohort study involving chronic low back pain (CLBP). The beneficial outcomes attributable to osteopathic medical care were mediated by physician empathy and osteopathic manipulative treatment (OMT) in the subset of patients who consistently utilized osteopathic physicians compared with those who utilized allopathic physicians. This study utilized data from the previously reported study to conduct a per-protocol analysis to determine the outcomes of osteopathic medical care utilizing a pragmatic research design in which patients consistently received osteopathic or allopathic medical care during long-term follow-up. A retrospective cohort study was conducted utilizing patients with CLBP selected from the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION) from September 2016 through August 2024. Patients were followed at quarterly encounters after enrollment to determine whether they consistently received care for low back pain from either osteopathic or allopathic physicians. Data pertaining to pain, function, pain impact, health-related quality of life (HRQOL), and the frequency of chronic widespread pain (CWP) and CLBP recovery were measured at quarterly encounters for up to 36&#xa0;months. Both unadjusted and adjusted results were measured over time. The latter were computed utilizing generalized estimating equations (GEEs) with covariates including sociodemographic and clinical characteristics. The clinical relevance of treatment-group differences was measured utilizing Cohen's d statistic. There were 1,078 patients in the study, including 132 (12.2&#x202f;%) and 946 (87.8&#x202f;%) treated by osteopathic and allopathic physicians, respectively. A total of 5,836 encounters were completed over 36&#xa0;months, including 818 (14.0&#x202f;%) and 5,018 (86.0&#x202f;%) in the osteopathic and allopathic medical care groups, respectively. The adjusted means (95&#x202f;% confidence intervals [CIs]) for patients treated by osteopathic vs. allopathic physicians were 6.0 (5.6-6.3) vs. 6.4 (6.2-6.7) for low back pain intensity (p=0.002); 13.5 (12.2-14.9) vs. 15.3 (14.4-16.2) for back-related disability (p<0.001); 30.2 (28.3-32.0) vs. 31.8 (30.7-33.0) for pain impact (p=0.03); 38.6 (37.3-40.0) vs. 37.2 (36.4-38.0) for physical function (p=0.01); 52.7 (50.9-54.5) vs. 54.3 (53.1-55.6) for depression (p=0.02); and 56.4 (54.9-58.0) vs. 58.0 (56.9-59.1) for sleep disturbance (p=0.01). These results all favored osteopathic medical care and the results for low back pain intensity (Cohen's d=0.23), back-related disability (Cohen's d=0.27), and physical function (Cohen's d=0.21) exceeded the threshold for clinical relevance. Osteopathic medical care was also associated with greater CLBP recovery (odds ratio [OR], 2.07; 95&#x202f;% CI, 1.28-3.35; p=0.003), although recovery was infrequently reported during follow-up. This per-protocol analysis found better outcomes in pain, function, pain impact, and HRQOL, including physical function, depression, and sleep disturbance, among patients treated by osteopathic physicians compared with allopathic physicians over 36&#xa0;months of follow-up after adjusting for sociodemographic and clinical characteristics. The findings for low back pain intensity, back-related disability, and physical function were also clinically relevant. Osteopathic medical care was associated with greater recovery from CLBP, although recovery was infrequently reported.

To analyze the use of antimicrobials in the pediatric and neonatal population at a national level in order to identify consumption patterns, assess treatment appropriateness, and detect potential areas for improvement in therapeutic management. We designed a retrospective, cross-sectional, multicenter observational study that included neonatal (<1&#x202f;month) and pediatric (<15&#x202f;years) inpatients with at least one active prescription of systemic antibacterials or antifungals. The study consists of two phases. The first phase involves the analysis of antimicrobial consumption through quarterly data collection, expressed as pediatric and neonatal defined daily doses (DDD) per 100 patient-days. A temporal trend analysis will be performed using segmented regression and calculation of the average quarterly percent change with 95% confidence intervals, identifying change points through the Monte Carlo permutation method. The second phase focuses on evaluating prescription appropriateness based on indication, antimicrobial selection, timing of administration, dose, frequency, route of administration, treatment duration, monitoring of efficacy and adverse effects, and documentation in the medical record. The review will be conducted by a hospital pharmacist and an infectious diseases specialist, with interobserver verification in 25% of cases. A sample size of 379 patients (270 pediatric and 109 neonatal) has been estimated for this phase. Differences between variables will be analyzed using Student's t-test, Mann-Whitney U test, Chi-squared test, or Fisher's exact test as appropriate. Inter-rater agreement will be assessed using Cohen's Kappa coefficient, and factors associated with differences in appropriateness will be analyzed through binary logistic regression and generalized lineal mixed models. This study will allow the identification of antimicrobial consumption patterns and the evaluation of prescription appropriateness in pediatric and neonatal populations, providing objective and comparable information across centers. The findings will help strengthen Antimicrobial Stewardship Programs, serve as a solid basis for future research, and support the development of targeted national strategies, ultimately improving patient safety and helping to curb the progression of antimicrobial resistance.

The Inflation Reduction Act (IRA) implemented annual out-of-pocket spending caps to the Medicare Part D prescription medication benefit in 2024; the caps were lowered to $2000 in 2025. It remains unclear how this policy affected medication access. To evaluate changes in prescription medication fills in the Medicare population after the implementation of the IRA. This study used data from an all-payer pharmacy database (Symphony Health Metys) to evaluate changes in quarterly prescription fills for medications reimbursed by Medicare and commercial insurance from 2022 to 2025. Using an event study, difference-in-differences framework, changes in per-capita prescriptions for medications before and after the Medicare annual out-of-pocket spending caps were implemented in 2024 were compared. Because out-of-pocket caps are most relevant for patients using expensive medications, medications were stratified based on monthly cost: low (<$100), medium ($100-$829), high ($830-$6999), and very high (&#x2265;$7000). Quarterly per-capita fills by medication. Among 3053 medications covering 92.9% of gross Medicare Part D spending in 2023, 1534 (50.2%) were low cost, 882 (28.9%) were medium cost, 455 (14.9%) were high cost, and 182 (6.0%) were very high cost. After the spending caps were implemented, average medication use increased in Medicare compared with medication use in commercial insurance, with larger increases for higher-cost medications. In pre-post difference-in-differences analyses, there was no change in Medicare vs commercial use of low-cost, medium-cost, or high-cost medications. Very-high-cost medication use increased by 22.7% (95% CI, 6.0% to 42.0%; P&#x2009;=&#x2009;.01). Use of medications in Medicare increased over time in event-study analyses, although CIs were wide; by the fourth quarter of 2025, the use of medications in Medicare compared with commercial insurance increased from baseline by 4.1% (95% CI, -3.4% to 12.3%) for low-cost medications, 20.7% (95% CI, -10.7% to 63.0%) for medium-cost medications, 23.1% (95% CI, 2.7% to 47.4%) for high-cost medications, and 35.9% (95% CI, -4.1% to 92.3%) for very-high-cost medications. This study found that medication use increased after implementation of Medicare annual out-of-pocket cost caps, particularly among the highest-cost medications. These results suggest that the policy substantially improved patient access to high-cost medications for Medicare-insured patients.

Youth suicide rates have increased over the last three decades, translating into an increase in related pediatric emergency department (ED) visit demands. However, these trends shifted during the pandemic. We describe demographic and clinical characteristics of pediatric patients who were evaluated for suicide-related pediatric ED visits for four consecutive years surrounding the COVID-19 pandemic. We conducted a retrospective analysis using electronic health records of patients ages 10-17 years with encounters between January 1, 2019 and December 31, 2022 from one urban pediatric ED setting. We examined trends in quarterly rates of positive Ask Suicide-Screening Questionnaire (ASQ) screenings and encounters. We performed an interrupted time series (ITS) regression analysis to evaluate pandemic-attributable trend changes. There were no significant changes in rates and trends of positive ASQ screening pre/post pandemic. There were changes in admission rates of patients with positive ASQs immediately after compared to before the pandemic began (&#x3b2;&#xa0;=&#xa0;19.21, p&#xa0;=&#xa0;0.002). A stratified ITS analysis showed a downward trend in the quarterly rate of positive ASQ screenings for encounters in patients ages 10-13 pre-pandemic (&#x3b2;&#xa0;=&#xa0;-1.44, p&#xa0;=&#xa0;0.026) and an increase of 5.02 percentage points (p&#xa0;=&#xa0;0.037) at the onset of the pandemic. There were no significant differences among 14- to 17-year-olds, males, and females in pre- and post-pandemic ASQ positivity. The oscillations in mental health visits during the years post-pandemic differed from those in the pre-pandemic period and may suggest a readjustment during the relaxation of restrictions.

We present the rare case of a 29-year-old patient with uterine adenosarcoma who received fertility-sparing treatment, subsequently conceived spontaneously, and gave birth to a healthy infant. In August 2022, the nulliparous patient presented with acyclic uterine bleeding. Diagnostic hysteroscopy and targeted resection of a polyp located at the cervicouterine junction revealed uterine adenosarcoma without sarcomatous overgrowth (FIGO stage T1a). Imaging confirmed no residual tumor or metastasis. A fertility-sparing management strategy was chosen, avoiding hysterectomy but involving close oncological surveillance with quarterly MRI scans. During follow-up, a concurrent diagnosis of symptomatic endometriosis introduced therapeutic challenges. The patient spontaneously conceived in 2023 and delivered a healthy infant by cesarean section at term in 2024. Subsequent hysteroscopy and imaging in 2025 showed no evidence of recurrence, therefore fertility-preserving management was continued. A short narrative of the patient's perspective on her initial diagnosis, possible fertility loss, and the emotional turmoil of pregnancy after uterine adenosarcoma is presented. Treating young patients diagnosed with uterine adenosarcoma poses a challenge to the treating physician due to the lack of guidelines and evidence regarding fertility-preserving treatment of this rare tumor. This report adds to the limited literature on successful pregnancy after uterine adenosarcoma and discusses indications and limitations of fertility-sparing treatment. Fertility preservation may be possible in selected early-stage uterine adenosarcoma cases without high-risk features such as sarcomatous overgrowth or myometrial invasion, with thorough counseling and strict follow-up. Further research is needed to develop standardized protocols and improve management in this context.

This study was to explore how serum ghrelin levels modulate the relationship between interleukin-6 (IL-6) and outcomes of antidepressant treatment, specifically focusing on 12-week remission and 24-month relapse in patients with depressive disorders. This investigation involved the analysis of baseline serum levels of ghrelin and IL-6 among 1086 patients enrolled in a naturalistic study of stepwise antidepressant therapy. Remission was determined by a Hamilton Depression Rating Scale (HAMD) score of 7 or less at 12&#xa0;weeks. Those who responded (HAMD score&#x2009;&#x2264;&#x2009;14) at this juncture were subsequently monitored for relapse (HAMD score&#x2009;>&#x2009;14) quarterly over a 24-month period. The study employed logistic regression models, adjusted for various sociodemographic and clinical factors, to evaluate the interaction between these biomarkers and treatment outcomes. Findings revealed that while serum ghrelin levels did not independently affect treatment outcomes, they significantly influenced the association between elevated IL-6 levels and the risks of non-remission at 12&#xa0;weeks and relapse at 24&#xa0;months. Specifically, high IL-6 levels correlated with poorer outcomes predominantly in the presence of lower ghrelin levels, with these interactions reaching statistical significance in relapse outcomes post-adjustment. The study highlights the complex interplay between IL-6 and ghrelin in shaping the efficacy of antidepressant treatments, demonstrating divergent influences on remission and relapse. These results emphasize the importance of incorporating multiple biomarkers into predictive models to tailor antidepressant strategies more effectively. Continued research is needed to dissect the underlying dynamics of these biomarker interactions.

The burden of dengue disease in Germany is a growing public health concern. While travellers to dengue-endemic countries are at increased risk of contracting a dengue infection, data describing dengue-related healthcare utilization and outcomes in Germany are limited. This study investigated the healthcare burden of dengue disease in travellers returning to Germany. A retrospective analysis (InGef research database) was used to estimate dengue incidence using anonymized representative data from the German Statutory Health Insurance from approximately 7 million insured persons/year during 2015-2023. Outpatient and inpatient healthcare use and dengue associated costs were investigated. From 2015-2023, among 10&#x2009;151&#x2009;240 insured persons, 887 dengue episodes were recorded. Patients had a median age of 33&#xa0;years (interquartile range 26-46) and 52% were male. Each year, 103-182 episodes were reported (COVID-19 pandemic period [2020-22]: 10-62). Excluding the pandemic years, incidence was 1.4-2.5/100000 persons, with an estimated total of 1453-2639 cases/year in Germany. Of the 37% hospitalized persons, 4% required intensive care. Mean hospital stay was 3.3&#xa0;days; most patients were discharged after 1 overnight stay and no dengue related deaths were reported. Overall, 41% of patients took sick leave during their episode (mean sick leave for hospitalized patients: 8.8 working days); 38% of those not hospitalized took sick leave lasting 6.9 working days on average. Patients with dengue had 2-fold increased healthcare visits, resulting in a 162% increase in costs (mean costs/episode/quarter: 930&#x20ac;) compared with the pre-index period, with these costs mainly driven by outpatient care (23%) and hospitalization (64%). Hospitalized patients had a 4-fold rise in costs (quarterly costs/episode: 1700&#x20ac;; inpatient care accounting for 80%) compared with the pre-index period. Dengue virus infection in travellers returning to Germany impacted the healthcare system in Germany, leading to high costs, hospitalizations and physician visits, and considerable sick leave.

To assess the effectiveness of professionally-applied and self-applied nonrestorative strategies for arresting root caries. A systematic search was conducted to include randomized controlled trials evaluating the clinical effectiveness between nonrestorative strategies (professional or self-applied strategies) and controls in arresting root caries. The search was conducted on PubMed, Cochrane Central Register of Controlled Trials, Web of Science, Embase, and Scopus. Gray literature was searched in ClinicalTrials.gov and Google Scholar. Risk of bias (RoB) was assessed via RoB 2.0. Network Meta-analyses (NMAs) for effectiveness assessment, Surface Under the Cumulative Ranking (SUCRA) for treatment effectiveness ranking, and Confidence in Network Meta-Analysis (CINeMA) for the evidence certainty were conducted. Seventeen studies reporting root caries arrest rates of nonrestorative strategies were included. Fifteen of them were eligible for NMA, with two at low risk of bias and thirteen raised some concerns. The total number of participants and active root caries lesions at baseline that were used for quantitative analysis were 2869 and 5233, respectively. Professionally-applied strategies that were superior to positive control included quarterly 5% sodium fluoride (NaF) varnish, 5% NaF varnish with casein phosphopeptide-amorphous calcium phosphate (CPP&#x2011;ACP), 40% chlorhexidine (CHX) varnish, and annual applications of 38% silver diamine fluoride (SDF) with or without potassium iodide (KI). Among self&#x2011;applied strategies, daily use of 5000 ppm fluoride dentifrice, 1450 ppm fluoride dentifrice containing 1.5% arginine, and 1400 ppm fluoride dentifrice combined with a 250 ppm amine fluoride and potassium fluoride (AmF/KF) mouthrinse were more effective than negative control. By SUCRA rankings, the annual 38% SDF plus KI was the most effective professionally applied strategy, while the daily 1400 ppm dentifrice plus a 250 ppm fluoride (AmF/KF) mouthrinse ranked highest among self&#x2011;applied strategies. The certainty of evidence ranged from low to moderate. Annual professional application of 38% SDF with or without KI, quarterly applications 5% NaF with or without CPP-ACP, or 40% CHX can arrest root caries with statistically better outcomes compared with positive controls. Daily self-application of 5000 ppm fluoride dentifrice, 1450 ppm fluoride dentifrice containing 1.5% arginine, or 1400 ppm fluoride dentifrice with 250 ppm fluoride mouthrinse can arrest root caries, with statistically better outcomes compared with negative controls. However, given the low to very low certainty of the evidence, these findings should be interpreted with caution. This review provides evidence to inform the selection of optimal treatments and oral hygiene measures for patients with root caries.

Reported eruption times of primary teeth in term and preterm infants are largely based on detection of visible tooth structure at the gingival level by parents, paediatricians, or dentists. Furthermore, there is a lack of quantitative data on primary tooth eruption velocity in the literature. This study aimed to compare eruption timing, eruption velocity, and maximum crown length by modelling longitudinal crown eruption trajectories in term and preterm infants. This retrospective longitudinal cohort study included 100 infants (51 preterm, 49 full-term) who were followed from the first weeks after birth with quarterly assessments over four years. A total of 626 serial maxillary plaster casts were obtained as part of a prospective clinical trial registered at clinicaltrials.gov (NCT00408746). The crown length of 1,885 primary teeth (central and lateral incisors, canines, first molars) was measured by one investigator on digitised casts using Blender software. Intrarater reliability was evaluated using intraclass correlation coefficients (ICC). Timing and velocity of eruption were estimated using a non-linear asymptotic growth model. Measurement reliability was excellent (ICC = 0.996). Comparing chronological age revealed that preterm infants had a mean eruption delay of 2.7 months compared to full-term infants, with a significant delay observed for canines (4.5 months). However, when corrected age (chronological age minus days born before 37 gestational weeks) was used, a mean delay of only 1.4 months with no significant differences was found. Model-derived eruption preceded commonly reported clinical eruption ages by 6.2 months in preterm and 7.7 months in full-term infants. The model-estimated maximum crown lengths were slightly smaller in preterm infants, though these differences were not statistically significant. Eruption velocity followed a non-linear pattern, with preterm infants showing a tendency towards higher eruption rates, suggesting catch-up growth. Based on our model, eruption timings reported in the literature likely correspond to clinical observations made when primary teeth have attained about half of their final crown height. Consequently, crown exposure through gingiva appears to occur on average about six months prior to clinically visible eruption. Although preterm infants show a delay in tooth eruption when assessed by their chronological age, this difference resolves after correction for prematurity.

The Alabama Genomic Health Initiative (AGHI), funded by the state of Alabama, aims to provide genomic testing, interpretation, and counseling free of charge to Alabama residents. A 14-member Community Advisory Board (CAB) was convened in 2021 to provide community insight on integrating genomic medicine into clinical care and assessing future perspectives. The CAB was comprised of members from diverse ethnic backgrounds and represented a wide range of age groups, with balanced gender representation from two Alabama counties. The CAB met quarterly, and the team explored the perceptions of members related to genomic medicine through qualitative inquiry with exploratory quantitative findings. Self-administered pre- and post-surveys, completed prior to the first CAB meeting (pre) and after meeting five (post), were utilized to evaluate positive and negative views towards the future of genomic medicine. Five meetings were conducted in a focus group format, and transcripts were coded and analyzed to identify emerging themes. Ten of fourteen (71%) CAB members completed both surveys. Results indicate there was a slight shift in responses related to the future of genomic medicine from pre to post-test, but no significant changes were noted. Eleven of fourteen (80%) CAB members attended four out of five meetings. The prominent themes included barriers to genomic testing, strategies for recruitment, and recommendations for sharing test results. Members believed that participation in the CAB facilitated acquiring new knowledge and insight on genomic medicine.

Elagolix and Myfembree are gonadotropin-releasing hormone (GnRH)-pathway therapies used for endometriosis, but their post-marketing safety reporting patterns remain incompletely characterized. Because spontaneous reporting databases are susceptible to reporting bias and differential market exposure, comparative analyses require cautious interpretation. We analyzed quarterly data from the FDA Adverse Event Reporting System (FAERS) from 2015Q3 to 2026Q1. Deduplicated female reports with endometriosis-related indications were identified and classified as elagolix, Myfembree, or other endometriosis-related reports. The primary analysis consisted of drug-specific case-noncase disproportionality analyses for elagolix and Myfembree separately within the female endometriosis reporting background. A direct elagolix-versus-Myfembree head-to-head analysis was performed as a secondary analysis. Reporting odds ratios (RORs), proportional reporting ratios (PRRs), and information components (ICs) were calculated at the preferred term (PT) level. Sensitivity analyses included serious-report-only, healthcare-professional-only, physician-only, complete-age, reporter-type-stratified, overlapping-market-period, and bootstrap analyses. A total of 4,428 deduplicated female endometriosis-related reports were included, comprising 1,744 elagolix reports, 280 Myfembree reports, and 2,404 other endometriosis-related reports. Serious reports accounted for 31.2% of elagolix reports and 26.8% of Myfembree reports. In drug-specific case-noncase analyses, elagolix showed robust disproportionality signals for hot flush, night sweats, and suicidal ideation. Myfembree showed distinct reporting signals for reproductive and bleeding-related PTs, including heavy menstrual bleeding and intermenstrual bleeding. In the secondary head-to-head analysis, selected PTs including hot flush, nausea, headache, depression, arthralgia, and suicidal ideation showed higher reporting signals for elagolix, whereas alopecia showed a lower reporting signal for elagolix. Sensitivity analyses using alternative algorithms, reporter-type restrictions, overlapping-market-period restriction, complete-age restriction, and bootstrap validation generally supported the direction of the main selected reporting patterns, although some estimates were limited by small cell counts. Elagolix and Myfembree showed distinct post-marketing reporting signal profiles among female endometriosis-related FAERS reports. Elagolix was characterized mainly by vasomotor and selected neuropsychiatric reporting signals, whereas Myfembree was characterized mainly by reproductive and bleeding-related reporting signals. These findings represent hypothesis-generating reporting differences rather than clinical incidence rates or causal risk estimates. Further pharmacoepidemiologic studies with denominator data and adjustment for patient-level confounding are needed to clarify comparative safety profiles.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and continuous glucose monitors (CGMs) can each improve glycemic control. This retrospective cohort study evaluates the effect of a CGM in patients with type 2 diabetes (T2D) already receiving GLP-1 RAs. This study analyzed IQVIA's US medical and pharmacy claims data between January 2019 and December 2023. Two distinct cohorts of patients with T2D were included. The first comprised patients initiating a GLP-1 RA (GLP-1 RA cohort). The second comprised patients on a GLP-1 RA who subsequently started using a CGM (GLP-1 RA + CGM cohort). Propensity score matching of clinical and demographic factors was used to control confounding between groups. Changes in glycated hemoglobin (HbA1c) were assessed quarterly over 12 months; mixed-effects logistic regression was used to assess the impact of time and CGM use. A subgroup analysis was performed based on the duration of GLP-1 RA exposure prior to CGM initiation. The final matched sample included 13&#x2009;221 patients. Both cohorts showed HbA1c reduction, but the GLP-1 RA + CGM cohort demonstrated a faster and more substantial decrease. At 12 months, 31% of GLP-1 RA + CGM patients versus 44% of GLP-1 RA-only patients had HbA1c >9%, while 23% versus 20% achieved HbA1c <7%, respectively. Regression modeling confirmed significantly greater odds for HbA1c reduction with CGM use, which held true across subgroups. Adding CGM to GLP-1 RA therapy accelerates and enhances glycemic improvement compared with GLP-1 RA alone, regardless of prior GLP-1 RA duration. These findings support combined use to optimize T2D management and reduce time with poor glycemic control.