Journal of Medicine, Surgery, and Public Health最新文献

{"title":"Sociodemographic differences in skilled nursing facility discharge among Parkinson’s disease related healthcare utilizers","authors":"Jalal Uddin ,&nbsp;Nicole V. DeVille ,&nbsp;Miguel Fudolig ,&nbsp;Chad L. Cross ,&nbsp;Merrill R. Landers ,&nbsp;Jason D. Flatt","doi":"10.1016/j.glmedi.2026.100226","DOIUrl":"10.1016/j.glmedi.2026.100226","url":null,"abstract":"<div><h3>Background</h3><div>Parkinson’s disease (PD) is a progressive neurodegenerative disorder that often results in increased healthcare utilization and long-term care needs. While national trends have highlighted differences in institutional care utilization, limited research has examined factors associated with discharge to skilled nursing facilities (SNF) among PD healthcare utilizers in Nevada.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of PD-related healthcare utilization records from the Nevada Center for Health Information Analysis (CHIA) between 2013 and 2021 (N = 64,088). Parkinson’s disease and parkinsonism were identified using ICD-9 and ICD-10 codes in any diagnosis position. The primary outcome was discharge to an SNF. Bivariate analyses and multivariable logistic regression models were used to examine associations between SNF discharge and demographic, temporal, geographic, and utilization-related factors. Adjusted odds ratios (aORs) and 95 % confidence intervals (CIs) were estimated.</div></div><div><h3>Results</h3><div>Overall, 13.2 % of PD-related healthcare encounters resulted in discharge to an SNF. In adjusted analyses, older age was associated with higher odds of SNF discharge (aOR = 1.027 per year; 95 % CI: 1.025–1.030; p &lt; 0.001). Inpatient admissions were strongly associated with SNF discharge compared with outpatient encounters (aOR = 5.934; 95 % CI: 5.493–6.410; p &lt; 0.001). Compared with White healthcare utilizers, Black (aOR = 1.599; 95 % CI: 1.457–1.756; p &lt; 0.001) and Native American or Alaskan Native individuals (aOR = 2.389; 95 % CI: 1.864–3.062; p &lt; 0.001) had significantly higher odds of SNF discharge. Residents of rural (aOR = 0.477; 95 % CI: 0.424–0.536) and frontier areas (aOR = 0.547; 95 % CI: 0.491–0.608) were less likely to be discharged to an SNF compared with urban residents (both p &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>This study highlights demographic differences in discharge to an SNF among PD healthcare utilizers in Nevada. Findings underscore the need to address differences in long-term care access options and promote alternative discharge settings especially among racial and ethnic minority communities. Ensuring access to personalized care options could help to improve quality of life and provide support for people with PD.</div></div>","PeriodicalId":100804,"journal":{"name":"Journal of Medicine, Surgery, and Public Health","volume":"8 ","pages":"Article 100226"},"PeriodicalIF":0.0,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Condom use in Indonesia: Interplay with societal norms and human rights","authors":"Aga Natalis","doi":"10.1016/j.glmedi.2026.100225","DOIUrl":"10.1016/j.glmedi.2026.100225","url":null,"abstract":"<div><div>Indonesia faces significant challenges in advancing condom utilization initiatives due to the absence of explicit support from religious institutions. This has complicated HIV/AIDS prevention strategies, particularly adolescent contraceptives provision under Government Regulation No. 28 of 2024. The Indonesian Ulema Council’s opposition to these provisions, based on Islamic principles, contrasts with governmental health objectives aimed at reducing early marriage, infant mortality, and stunting. Despite the country’s commitment to fighting HIV, the epidemic remains critical, with sexual transmission accounting for the majority of new infections. Vulnerable groups – including adolescents, men who have sex with men, transgender individuals, and sex workers – are disproportionately affected by stigma, discrimination, and limited access to health services. This commentary argues that Indonesia’s regulatory framework subordinates’ constitutional health guarantees to moral enforcement, creating institutional barriers that compromise reproductive rights. It calls for legal reforms to decriminalise consensual extramarital relations, ensure universal condom distribution, and implement comprehensive sexuality education, alongside destigmatisation campaigns and mandatory training for healthcare providers to address implicit bias. By recognizing condoms as a human right and dismantling socio-legal barriers, Indonesia can create an inclusive, health-focused framework that empowers informed sexual health decisions. These reforms are essential for addressing the HIV epidemic and promoting reproductive autonomy in Indonesia.</div></div>","PeriodicalId":100804,"journal":{"name":"Journal of Medicine, Surgery, and Public Health","volume":"8 ","pages":"Article 100225"},"PeriodicalIF":0.0,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145938935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral health disparities between LGB and non-LGB individuals in the United States","authors":"R. Andrew Yockey","doi":"10.1016/j.glmedi.2025.100223","DOIUrl":"10.1016/j.glmedi.2025.100223","url":null,"abstract":"<div><div>This study examines potential oral health disparities among both heterosexual and sexual minority adults while also investigating sex-based differences in the association between sexual orientation and poor oral health. Pooled data (2007–2016) were used from the National Health and Nutrition Examination Survey for men and women aged 18–59. Multiple logistic regression models were used to examine the association between sexual orientation and self-reported oral health. Data from 20,298 participants were included in this analysis. Compared with non-LGB individuals, LGB individuals had higher odds of reporting poor oral health overall in both the unadjusted (OR = 1.20 95 % CI = 1.04–1.38) and adjusted (OR= 1.21 95 % CI 1.04–1.40) analyses. After stratifying by sex and adjusting for covariates, LGB women had 38 % increased odds of having poor oral health compared with their non-LGB counterparts (OR= 1.38 95 % CI 1.14–1.67). Sexual orientation was not associated with poor oral health in males, with adjusted odds close to null comparing LBG men with their non-LGB counterparts (OR = 0.98, 95 % CI = 0.74–1.29). The findings in this study indicate more work is needed to improve oral health in the LGB community, an often underserved population, and advances health equity promotion. Findings can inform oral health prevention and reduce health disparities among LGB populations.</div></div>","PeriodicalId":100804,"journal":{"name":"Journal of Medicine, Surgery, and Public Health","volume":"8 ","pages":"Article 100223"},"PeriodicalIF":0.0,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanistic basis of multidrug resistance: Current status, challenges, and potential solutions","authors":"Tikam Chand Dakal ,&nbsp;Ramgopal Dhakar ,&nbsp;Malika Ahuja ,&nbsp;Bhana Ram Gadi ,&nbsp;Narendra Kumar Sharma","doi":"10.1016/j.glmedi.2025.100224","DOIUrl":"10.1016/j.glmedi.2025.100224","url":null,"abstract":"<div><div>The emergence of drug-resistant microbes is a significant global health concern, driven by the inappropriate and excessive use of antibiotics across sectors worldwide, which has led to the development of antimicrobial resistance (AMR). The rise of multidrug-resistant organisms has posed substantial challenges for healthcare systems globally, with the history of AMR tracing back to the discovery of penicillin. The improper use of antibiotics in human and animal healthcare, along with their application in agriculture, contributes to the spread of resistance genes, leading to a \"Silent Pandemic\" that could surpass other causes of death by 2050. AMR complicates the effective treatment of infections, affecting both human and animal populations. Bacteria can withstand the effects of antibiotics by employing several strategies, such as forming biofilms and undergoing enzymatic changes. If not addressed, the lack of effective antibiotics could jeopardize common medical procedures and potentially result in millions of deaths each year. The economic impact of AMR is expected to impose enormous financial burdens and projected losses in the trillions of dollars for healthcare systems and agriculture. Adopting a One Health strategy that considers human, animal, and environmental aspects is crucial for effectively tackling AMR. This includes enhancing surveillance systems, advocating stewardship programs, and allocating funding to research and development to discover new antibiotic alternatives. To address AMR and ensure the effectiveness of antibiotics for future generations, it is essential to prioritize raising public awareness, providing education, and fostering international collaboration.</div></div>","PeriodicalId":100804,"journal":{"name":"Journal of Medicine, Surgery, and Public Health","volume":"8 ","pages":"Article 100224"},"PeriodicalIF":0.0,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145938934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social and political activism in scientific medical journals: Belief-based evidence or evidence-based beliefs?","authors":"Jagdish Khubchandani,&nbsp;Andrew Yockey,&nbsp;Kavita Batra","doi":"10.1016/j.glmedi.2025.100222","DOIUrl":"10.1016/j.glmedi.2025.100222","url":null,"abstract":"<div><div>Scientific medical journals are increasingly becoming focal points in social and political discussions. The rise of mass and social media, access to technology, global health emergencies, rapidly changing policy climates, societal divisions, and economic upheavals have expanded the reach of journal publications beyond just scientific circles and into the wider public conversation. This editorial delves into the intricate role of activism within journals dedicated to medicine, surgery, and public health. We characterize activism as the act of taking explicit moral, social, or political stances that go beyond merely reporting evidence neutrally, and we investigate its possible advantages and disadvantages for scientific integrity, clinical practice, and public trust. Also, given the varying political and social landscapes globally, we discuss the implications of activism in scientific medical journals for clinicians, researchers, authors, the general public, and journal editors. In conclusion, we assert that while activism may not necessarily be incompatible with scientific publishing, it should be approached with a significant purpose, grounded in facts, and after careful consideration of its nature/ scope to prevent undermining the fundamental mission of scientific journals (i.e., to advance reliable, objective, and clinically relevant knowledge or publish science that improves public health).</div></div>","PeriodicalId":100804,"journal":{"name":"Journal of Medicine, Surgery, and Public Health","volume":"7 ","pages":"Article 100222"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145750160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variations in interest to participate in health research: Insights from the Florida Statewide Registry for Aging Studies (FSRAS).","authors":"Jennifer E Akpo, Caitlin Murphy, Dawn Gardier, John E Ebireri, Trudy Gaillard, Lori A Bilello, Fern J Webb","doi":"10.1016/j.glmedi.2025.100211","DOIUrl":"10.1016/j.glmedi.2025.100211","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;There is low participation in health research, particularly among racial and ethnically diverse groups. The persistent barriers contributing to low participation include mistrust, lack of information, cultural differences, and access issues. An understanding of the factors influencing willingness to participate across various types of research is important to improving participation and ensuring diverse, representative participation in health research.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The study utilized data collected through the Florida Statewide Registry for Aging Studies (FSRAS), which included 481 participants aged 25 years and older. We performed descriptive statistics, bivariate analysis, and multivariate logistic regression. The primary outcome variable was interest in participating in a general health research study, as well as specific studies, including taking medication, providing a blood sample, undergoing overnight hospital stays, participating in a genetic study, accessing medical records, and using medical equipment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The final analysis included 481 FSRAS participants, predominantly female (78 %), Black/African American (52 %), aged 25-64 years (78 %), and college-educated (57 %). Most resided in South Florida (53 %) and were U.S.-born (61 %). A majority of participants (82 %) reported good/excellent health. Trust in research was generally high or medium (88 %). In contrast, only 14 % reported cultural beliefs influenced willingness to participate. Participants with low trust in research were significantly less likely to express interest in general research participation (OR=0.188, 95 % CI=0.068-0.523), studies involving medical records (OR=0.366, 95 % CI=0.151-0.890), and medication use (OR=0.199, 95 % CI=0.015-0.972). Those with medium trust were less likely to express interest in studies involving blood samples (OR=0.589, 95 % CI=0.364-0.955), genetic samples (OR=0.616, 95 % CI=0.382-0.995), and medical equipment (OR=1.933, 95 % CI=1.035-3.611). Participants in fair (OR=0.359, 95 % CI=0.158-0.813) and good health (OR=0.423, 95 % CI=0.229-0.780) were less likely to participate in studies accessing medical records. Those in good health were also less likely to participate in medication studies (OR=0.298, 95 % CI=0.108-0.824). Conversely, participants in poor health were more likely to participate in genetic research (OR=10.214, 95 % CI=1.023-101.984). Regionally, participants from Central Florida were more likely to report interest in general research (OR=3.098, 95 % CI=1.725-5.565), and those from North Florida were more likely to report interest in research involving overnight hospital stays (OR=2.891, 95 % CI=1.256-6.656).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Trust in research, along with key sociodemographic factors such as education, race/ethnicity, health status, and geographic location, significantly influenced willingness to participate in health research. These","PeriodicalId":100804,"journal":{"name":"Journal of Medicine, Surgery, and Public Health","volume":"7 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12774470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145919561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Platelet-rich plasma administration to reduce surgical interventions and improve functional outcomes in patients who have failed physical therapy","authors":"Steven M. Hadley Jr. ,&nbsp;Rachel Bergman ,&nbsp;John J. Peabody ,&nbsp;Nathan Repasky ,&nbsp;Sarah J. Westvold ,&nbsp;Ryan Filler ,&nbsp;Milap Patel ,&nbsp;Anish R. Kadakia","doi":"10.1016/j.glmedi.2025.100220","DOIUrl":"10.1016/j.glmedi.2025.100220","url":null,"abstract":"<div><div>The benefit of platelet-rich plasma (PRP) injections for foot and ankle conditions remains controversial. No studies have evaluated validated Patient Reported Outcomes Measurement Information System (PROMIS) measures of physical function (PF) and pain interference (PI) following PRP. Because PROMIS is validated in foot and ankle and exhibits improved reliability and generalizability compared to other commonly used patient-reported metrics, this study aimed to investigate functional outcomes measured by PROMIS following PRP for foot and ankle pathologies. This investigation was a retrospective study of all 81 patients who underwent PRP therapy for any foot and ankle pathology at a single institution (2018–2023). All patients had PRP for any foot and ankle pathology after failing 6–8 weeks of physical therapy and prior to any surgical intervention. 81 patients were contacted via phone and email up to five attempts to complete surveys containing PROMIS, as well as additional questions regarding ability to increase activity compared to pre-injection baseline and whether PRP injection was worth out-of-pocket costs. PROMIS was developed for a US population mean score of 50. Higher PF indicates better physical function, whereas higher PI designates more pain. Primary outcome was PROMIS PF and PI. Secondary outcomes were ability to increase activity compared to pre-injection baseline, self-reported pain resolution, whether surgery was pursued, and whether patients believed PRP was worth out-of-pocket costs. Mean follow-up was 28 months. Across all pathologies, mean PROMIS PF and PI were 49.1 ± 7.3 and 51.6 ± 8.5, respectively. Patients with plantar fasciitis (N = 4) had highest average PF (58.2 ± 6.0) and lowest average PI (42.9 ± 5.4). Insertional Achilles tendinosis (N = 6) and non-insertional Achilles tendinosis (N = 7) exhibited average PFs of 50.8 ± 5.3 and 50.2 ± 4.4, respectively, and PIs of 46.4 ± 7.2 and 49.7 ± 5.7, respectively. Average PF and PI by pathology were, respectively, peroneal tendinosis 45.8 ± 3.8 and 56.0 ± 8.3, posterior tibialis tendinosis 49.0 ± 4 and 50.8 ± 10.4, and ankle arthritis 48.0 ± 9.5 and 53.5 ± 7.2. 75 % (N = 35/47) of patients increased activity following PRP. 23 % (N = 11/47) had complete resolution of pain after PRP. 83 % (N = 39/47) did not pursue surgery following PRP. 77 % (N = 36/47) agreed that PRP was worth the out-of-pocket cost. Most patients who received PRP for various foot and ankle pathologies scored population mean PROMIS scores, increased activity, avoided surgery, and believed PRP was worth out-of-pocket costs. While our results may suggest a potential role for PRP to be offered as a reasonable nonoperative treatment option for foot and ankle pathology, further studies with larger samples are needed to evaluate PROMIS after PRP.</div></div>","PeriodicalId":100804,"journal":{"name":"Journal of Medicine, Surgery, and Public Health","volume":"8 ","pages":"Article 100220"},"PeriodicalIF":0.0,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145652048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coxsackievirus A16 caused hand-foot-mouth disease in a young male: A case report","authors":"Majd Oweidat ,&nbsp;Marwan Alkum ,&nbsp;Diaa Qaisiya ,&nbsp;Majd Nemer Zawahrah ,&nbsp;Bisan Hamza Ragabi ,&nbsp;Safwat Zidat","doi":"10.1016/j.glmedi.2025.100219","DOIUrl":"10.1016/j.glmedi.2025.100219","url":null,"abstract":"<div><div>Hand–foot–and–mouth disease (HFMD) is typically a pediatric illness, yet adults may be affected and overlooked. We report an immunocompetent 24-year-old man with a 3-day prodrome of fever, myalgia, sore throat, and headache, followed by intensely pruritic palmoplantar lesions with sparse oral disease. Examination revealed numerous 2–4 mm painless erythematous macules and papules on the palms, fewer on the soles and peri-oral skin, and a single tender soft-palate ulcer. Differential diagnoses included herpes simplex, varicella zoster, erythema multiforme, secondary syphilis, drug eruption, and scabies. Stool polymerase chain reaction confirmed Coxsackievirus A16. Supportive care consisted of antihistamines, non-steroidal anti-inflammatory drugs, topical calamine–zinc oxide, and oral hyaluronic acid gel. Pruritus resolved by day 2; mucocutaneous lesions regressed without complications and were nearly resolved with palmar desquamation by day 9. This case highlights an adult, pruritus-predominant, minimally vesicular phenotype with scant oral involvement and no childcare exposure. Clinicians should consider HFMD in adults with palmoplantar eruptions and emphasize symptomatic management and hygiene counseling to limit transmission.</div></div>","PeriodicalId":100804,"journal":{"name":"Journal of Medicine, Surgery, and Public Health","volume":"7 ","pages":"Article 100219"},"PeriodicalIF":0.0,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145465708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification of potential confounding factors for the evaluation of clinical outcomes in alpha-1-antitrypsin deficiency-associated liver disease","authors":"Heiner Wedemeyer ,&nbsp;Frank Tacke ,&nbsp;Christoph Berg ,&nbsp;Christian M. Lange ,&nbsp;Pavel Strnad ,&nbsp;Andreas Hahn ,&nbsp;Thomas Welsh ,&nbsp;Daniela Skalt ,&nbsp;Stephanie Sussmann ,&nbsp;Robert Kudernatsch","doi":"10.1016/j.glmedi.2025.100217","DOIUrl":"10.1016/j.glmedi.2025.100217","url":null,"abstract":"<div><h3>Background</h3><div>Alpha-1-Antitrypsin deficiency (AATD) is a common but only rarely recognized genetic condition predisposing to e.g., liver disease. Systematic identification and classification of confounding factors is needed for the evaluation of clinical outcomes in adults with AATD-associated liver disease.</div></div><div><h3>Methods</h3><div>A stepwise systematic review was performed to identify relevant guidelines and recommendations, systematic reviews and meta-analyses, and observational studies and randomized clinical trials. Five experts with large long-term experience recruited via purposeful sampling were consulted for validation via open requests and a joint workshop. A list was consented and categorized by clinical relevance and type of influence. Relations were visualized in a directed acyclic graph.</div></div><div><h3>Results</h3><div>Cirrhosis and fibrosis stage, genotype, sex, diabetes, obesity were categorized as very important; age, alcohol and metabolic syndrome were consented to be relevant but less important factors affecting distinct stages of liver disease. Adjusting for diabetes, obesity, alcohol consumption, and metabolic syndrome as confounders; stratifying or testing for interactions with sex and age as potential effect modifiers; and including cirrhosis, fibrosis stage, and genotype as prognostic factors to improve outcome prediction in AATD studies is suggested. Presented results require cautious interpretation due to varying evidence levels of included literature.</div></div><div><h3>Conclusions</h3><div>The results obtained through a transparent and reproducible systematic approach aid future studies to improve design and analytical strategies for AATD-associated liver diseases. They enable a precise and accurate estimation of treatment effects with reduced risk of bias. In practice, this enhances the evidence base for innovative therapies for adults with AATD-associated liver disease.</div></div>","PeriodicalId":100804,"journal":{"name":"Journal of Medicine, Surgery, and Public Health","volume":"7 ","pages":"Article 100217"},"PeriodicalIF":0.0,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145527856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Towards personalized diabetes management: Identifying stability for efficient care using primary care data","authors":"Sukainah A. Alfaraj ,&nbsp;Rimke C. Vos ,&nbsp;Marco Spruit ,&nbsp;Rolf H.H. Groenwold ,&nbsp;Dennis Mook-Kanamori","doi":"10.1016/j.glmedi.2025.100218","DOIUrl":"10.1016/j.glmedi.2025.100218","url":null,"abstract":"<div><div>Type 2 diabetes mellitus (T2DM) is largely managed in primary care, where Dutch guidelines recommend quarterly follow-ups. Many T2DM individuals maintain long-term glycaemic control and may not need such frequent visits. We conducted a retrospective cohort study using routinely collected data from the Extramural Leiden University Medical Center Academic Network (ELAN) linked to Statistics Netherlands to identify those with stable diabetes and predict ongoing control. We examined 47,801 adults with T2DM aged 40–79 years and formed two cohorts: the metformin cohort, which included individuals newly starting metformin (n = 21,307), and the random-time cohort, which included individuals using any glucose-lowering medication at a random point in their disease course (n = 22,245). Stability was defined as maintaining glycated hemoglobin (HbA1c) ≤ 53 mmol/mol (7 %) for one year without additional diabetes medication or dose adjustment. Logistic regression models were used to examine whether first-year stability predicted glycaemic control in the second year. Additional models adjusted for demographic and clinical factors, including age, sex, body mass index, blood pressure, High-Density Lipoprotein (HDL) cholesterol, eGFR, smoking, migration status, and household income. Models performance was evaluated with the area under the receiver operating characteristic curve (AUC), and continuous variables were standardized to allow comparison across measures. All analyses were performed using R (version 4.2.1). In the metformin cohort, 23 % of participants achieved glycaemic stability during the first year of follow-up. Among the individuals who achieved stability in the first year, 82 % maintained this stable glycaemic control throughout the second year. First-year stability was strongly associated with continued control during the second year (odds ratio [OR] 89, 95 % confidence interval [CI] 81–99) with excellent discrimination (AUC 0.89). Adding other predictors increased the AUC only slightly to 0.91. Findings were similar in the random time cohort: 46 % were stable in the first year, and 80 % of these remained stable in the second year. First-year stability alone was a strong predictor (OR 25, 95 % CI 23–26) with an AUC of 0.84, rising modestly to 0.85 with additional predictors. One year of stable glycaemic control is a powerful indicator of future stability and could support a more tailored approach to diabetes follow-up. Reducing visit frequency for well-controlled individuals may help optimize primary care resources, reduce unnecessary workload, and lessen the burden of frequent clinic visits. These findings could inform updates to follow-up recommendations and support the use of remote monitoring and self-management to individualize diabetes care.</div></div>","PeriodicalId":100804,"journal":{"name":"Journal of Medicine, Surgery, and Public Health","volume":"7 ","pages":"Article 100218"},"PeriodicalIF":0.0,"publicationDate":"2025-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145362177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}