The State of US Health, 1990-2016: Burden of Diseases, Injuries, and Risk Factors Among US States

Incorporating machine learning and statistical methods to address maternal healthcare disparities in US: A systematic review

BACKGROUND

Maternal health disparities are recognized as a significant public health challenge, with pronounced disparities evident across racial, socioeconomic, and geographic dimensions. Although healthcare technologies have advanced, these disparities remain primarily unaddressed, indicating that enhanced analytical approaches are needed.

OBJECTIVES

This review aims to evaluate the impact of machine learning (ML) and statistical methods on identifying and addressing maternal health disparities and to outline future research directions for enhancing these methodologies.

METHODS

Following the PRISMA guidelines, the review of studies employing ML and statistical methods to analyze maternal health disparities within the United States was conducted. Publications between January 1, 2012, and February 2024 were systematically searched through PubMed, Web of Science, and ScienceDirect. Inclusion criteria targeted studies conducted within the U.S., peer-reviewed articles published during the period, research covering the postpartum period up to one year post-delivery, and studies incorporating both maternal and infant health data with a focus primarily on maternal outcomes.

RESULTS

A total of 147 studies met the inclusion criteria for this analysis. Among these, 129 (88 %) utilized statistical methods in health sciences to analyze correlations, treatment effects, and public health initiatives, thus providing vital, actionable insights for policy and clinical decisions. Meanwhile, 18 articles (12 %) applied ML techniques to explore complex, nonlinear relationships in data. The findings indicate that while ML and statistical methods offer valuable insights into the factors contributing to health disparities, there are limitations regarding dataset diversity and methodological precision. Most studies concentrate on racial and socioeconomic inequalities, with fewer addressing the geographical aspects of maternal health. This review emphasizes the necessity for broader dataset utilization and methodology improvements to enhance the findings' predictive accuracy and applicability.

CONCLUSIONS

ML and statistical methods show great potential to transform maternal healthcare by identifying and addressing disparities. Future research should focus on broadening dataset diversity, improving methodological precision, and enhancing interdisciplinary efforts.

AI integrations with lung cancer screening: Considerations in developing AI in a public health setting

Lung cancer screening implementation has led to expanded imaging of the chest in older, tobacco-exposed populations. Growing numbers of screening cases are also found to have CT-detectable emphysema or elevated levels of coronary calcium, indicating the presence of coronary artery disease. Early interventions based on these additional findings, especially with coronary calcium, are emerging and follow established protocols. Given the pace of diagnostic innovation and the potential public health impact, it is timely to review issues in developing useful chest CT screening infrastructure as chest CT screening will soon involve millions of participants worldwide. Lung cancer screening succeeds because it detects curable, early primary lung cancer by characterizing and measuring changes in non-calcified, lung nodules in the size-range from 3mm to 15 mm in diameter. Therefore, close attention to imaging methodology is essential to lung screening success and similar image quality issues are required for reliable quantitative characterization of early emphysema and coronary artery disease. Today's emergence of advanced image analysis using artificial intelligence (AI) is disrupting many aspects of medical imaging including chest CT screening. Given these emerging technological and volume trends, a major concern is how to balance the diverse needs of parties committed to building AI tools for precise, reproducible, and economical chest CT screening, while addressing the public health needs of screening participants receiving this service. A new consortium, the Alliance for Global Implementation of Lung and Cardiac Early Disease Detection and Treatment (AGILEDxRx) is committed to facilitate broad, equitable implementation of multi-disciplinary, high quality chest CT screening using advanced computational tools at accessible cost.

Serum vitamin C associated with lipids levels in children and adolescents: a national cross-sectional study

BACKGROUND

The relationship between serum vitamin C (sVC) and blood lipids in adolescents in the US has not been thoroughly studied. This study investigates the correlation between sVC and blood lipids among adolescents using data from the National Health and Nutrition Examination Survey (NHANES).

METHODS

Data from the NHANES 2003-2006 and 2017-2018 cycles, encompassing 4,965 participants aged 12-19 years, were analyzed. sVC served as the independent variable and blood lipids as the dependent variables. Multiple linear regression models assessed the relationship between sVC and blood lipids, with subgroup analyses based on sex, age, and race. Additionally, smooth curve fitting and saturation threshold analysis were employed to explore nonlinear relationships.

RESULTS

Adjusted analyses revealed a positive correlation between sVC and high-density lipoprotein cholesterol (HDL-C) (β = 2.77, 95%CI 2.06-3.47), with no significant association with total cholesterol, low-density lipoprotein cholesterol (LDL-C), or triglycerides. This positive correlation persisted across subgroups divided by age, gender, and race (p < 0.05). The nonlinear relationship between sVC and HDL-C was characterized by an inverted U-shaped curve in adolescents aged 12-15 years, males, females, and non-Hispanic Whites.

CONCLUSIONS

This study confirms a positive association between sVC levels and HDL-C in adolescents, suggesting that higher vitamin C intake/status may be associated with a higher HDL-C in adolescents.

Septo-hypothalamic regulation of binge-like alcohol consumption by the nociceptin system

High-intensity alcohol drinking during binge episodes contributes to the socioeconomic burden created by alcohol use disorders (AUDs), and nociceptin receptor (NOP) antagonists have emerged as a promising intervention. To better understand the contribution of the NOP system to binge drinking, we found that nociceptin-containing neurons of the lateral septum (LSPnoc) displayed increased excitability during withdrawal from binge-like alcohol drinking. LSPnoc activation promoted active avoidance and potentiated binge-like drinking behavior, whereas silencing of this population reduced alcohol drinking. LSPnoc form robust monosynaptic inputs locally within the LS and genetic deletion of NOP or microinjection of a NOP antagonist into the LS decreased alcohol intake. LSPnoc also project to the lateral hypothalamus and supramammillary nucleus of the hypothalamus, and genetic deletion of NOP from each site reduced alcohol drinking. Together, these findings implicate the septo-hypothalamic nociceptin system in excessive alcohol consumption and support NOP antagonist development for the treatment of AUD.

Four-Year Follow-Up from a Prospective, Multicenter Study of Percutaneous 60-Day Peripheral Nerve Stimulation for Chronic Low Back Pain

INTRODUCTION

Chronic low back pain (LBP) is a leading cause of healthcare expenditure and long-term disability associated with complex treatment challenges and the need for progressively invasive interventions. Percutaneous 60-day Peripheral Nerve Stimulation (PNS) is a minimally invasive neurostimulation treatment that has shown efficacy for chronic LBP, providing sustained improvements through 1 year of follow-up after treatment. The present work explores the long-term clinical outcomes of Percutaneous 60-day PNS for chronic LBP approximately 4 years after initial treatment.

METHODS

Follow-up surveys were sent to participants from a prior prospective study who reported clinically meaningful reductions in pain, disability, or pain interference 12 months after Percutaneous 60-day PNS for LBP. The present long-term follow-up survey assessed current levels of LBP, disability, pain interference, and Patient Global Impression of Change (PGIC). Use of medications and other interventions for LBP treatment since completing Percutaneous 60-day PNS was also surveyed.

RESULTS

In total, 23 participants returned completed long-term follow-up surveys. A majority of survey respondents (65%, n = 15/23) reported sustained, clinically meaningful (≥ 30%) relief of back pain compared with baseline an average of 4.7 years after PNS treatment was initiated. On average, these long-term responders reported clinically substantial (≥ 50%) reductions in pain (average 63% reduction), as well as clinically meaningful improvements in disability and quality of life. Furthermore, 70% (n = 16/23) of survey respondents avoided progression to more costly, invasive, and/or destructive LBP pain interventions (i.e., radiofrequency ablation, neurostimulation implant, or lumbar surgery).

CONCLUSIONS

Treatment with Percutaneous 60-day PNS provided clinically meaningful pain relief among a majority of surveyed participants an average of more than 4 years after the short-term treatment. These results demonstrate that Percutaneous 60-day PNS can provide durable outcomes that are often sustained for multiple (4+) years by patients with chronic axial LBP who subsequently avoid the need for more invasive treatment interventions.

CLINICAL TRIAL REGISTRATION

The Clinicaltrials.gov registration number for the initial study is NCT03179202.

Food Insecurity, Health, and Health Care in the US

This JAMA Insights investigates the adverse effects of food insecurity on health and how federal nutrition programs can help mitigate these effects, improving health outcomes and reducing health care utilization.

Trends and disparities in ischemic stroke mortality and location of death in the United States: A comprehensive analysis from 1999-2020

BACKGROUND

Stroke remains the fifth leading cause of mortality in the United States, with significant geographical and racial disparities in outcomes. Understanding trends in location of death for ischemic stroke patients is crucial for improving end-of-life care and addressing healthcare inequities.

METHODS & FINDINGS

This retrospective study used Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) data to examine ischemic stroke mortality, stratified by urbanization level and race. Age-adjusted mortality rates were calculated using the 2000 US standard population. Age-adjusted ischemic stroke mortality rates increased across all urbanization levels since 2009, with the most pronounced rises in non-metropolitan areas. An increasing proportion of deaths occurred at home, shifting from inpatient medical facilities. Significant disparities were observed in access to specialized end-of-life stroke care, particularly for racial minorities and rural residents. Black/African American individuals and those in rural settings were more likely to die in less specialized environments due to healthcare access barriers.

CONCLUSIONS

The findings highlight a critical shift in the patterns of mortality and end-of-life care preferences among ischemic stroke patients over the past two decades. These findings highlight significant shifts in the patterns of mortality and location of death among ischemic stroke patients over the past two decades, with notable differences across urbanization levels and racial groups. The increasing proportion of home deaths and persistent disparities in location of death suggest a need for further research to understand the underlying factors driving these trends and their implications for end-of-life care quality and access.

Injury caseload, pattern and time of presentation to emergency services in Mozambique: A pragmatic, multicentre, observational study

BACKGROUND

Rapid population growth and urbanisation raise a critical need to better understand the burden of injuries in sub-Saharan Africa. We assessed the pattern of service demand for injuries at emergency department (ED) in urban areas of Mozambique.

METHODS

This prospective, multi-centric, observational study was conducted in EDs in southern (Maputo), central (Beira) and northern (Nampula) of Mozambique. We randomly selected 7809 cases (age ≥1 years) during the seasonally distinct months of April/2016-2017 and October/2017. Data on patients' demographics, nature of injury and clinical outcomes were collected.

RESULTS

Overall, 1881/7809 (26.2 %) emergency cases comprising 518 children (58.5 % male, aged 4.6 ± 2.5 years), 324 adolescents (64.8 % male, 14.7 ± 3.0 years) and 10,39 adults (60.8 % male, 34.5 ± 13.0 years) presented with injury. The arms, legs and head were most affected in both children (518 with 795 injuries) and adults (1039 with 1496 injuries). The diversity of injuries increased with older age. Injury cases predominantly presented during daylight hours (from 0900 to 1900) with age-differentials evident. There were proportionately more injury presentations in the hotter and wetter October than in colder and drier April. The most common mechanisms of injury were falls, physical violence and road traffic injuries. Overall, 9.1 % of injury cases were admitted to hospital and 0.2 % died.

CONCLUSIONS

Injuries corresponded to around one-quarter of all emergency admissions in urban Mozambique, and were predominantly caused by falls, physical violence, and road traffic injuries. Understanding distinctive variations in the pattern and timing of these presentations according to the age, location and season will assist in future planning for more efficient injury prevention and health care services in Mozambique.

Relationship between life's essential 8, vitamin D, and cardiometabolic outcomes

AIMS

To assess the association between cardiovascular health (CVH) and cardiometabolic outcomes and the impact of vitamin D on the relationship. Additionally, we seek to analyze the predictive ability of CVH metrics for cardiometabolic outcomes.

METHODS

This cross-sectional study included 21,913 adult participants of the National Health and Nutrition Examination Survey (2007-2018). Logistic regression models and restricted cubic spline curves were employed to evaluate the association between CVH and cardiometabolic outcomes and analyze the influence of vitamin D on the relationship. Receiver operating characteristic curves were used to assess the predictive ability of CVH metrics for cardiometabolic outcomes.

RESULTS

The study included 21,913 participants, among whom 6193 (28.3%) were classified as having low CVH, 14,080 (64.3%) as having moderate CVH, and 1640 (7.5%) as having high CVH. CVH scores were significantly negatively correlated with cardiometabolic outcomes. Among the CVH metrics, blood glucose and blood pressure had higher predictive values for cardiovascular disease, chronic kidney disease, hypertension, and diabetes. Additionally, there was a significant interaction between CVH and vitamin D.

CONCLUSION

These findings underscore that higher CVH scores, assessed by Life's Essential 8, are associated with lower risks of cardiometabolic outcomes. Improving CVH contributes to reducing the burden of disease and promoting human health.

The Locus Coeruleus: Anatomy, Physiology, and Stress-Related Neuropsychiatric Disorders

The locus coeruleus-norepinephrine (LC-NE) system is involved in mediating a wide array of functions, including attention, arousal, cognition, and stress response. Dysregulation of the LC-NE system is strongly linked with several stress-induced neuropsychiatric disorders, highlighting the LC's pivotal role in the development of these disorders. Located in the dorsal pontine tegmental area, the LC contains noradrenergic neurons that serve as the main source of NE in the central nervous system. Activation of the LC and subsequent release of NE at different levels of the neuroaxis is adaptive, allowing the body to adjust appropriately amid a challenging stimulus. However, prolonged and repeated LC activation leads to maladaptive responses that implicate LC-NE dysfunction in stress-induced neuropsychiatric disorders. As the primary initiator of the stress response, corticotropin-releasing factor (CRF) activates the hypothalamic-pituitary-adrenal axis. Following the discovery of CRF more than four decades ago, numerous studies established that CRF also acts as a neurotransmitter that governs the activity of other neurotransmitters in the brain neurotransmitter system. The LC-NE system receives abundant CRF afferents arising from several brain nuclei. CRF afferents to LC-NE are activated and recruited in the pathogenesis of stress-induced neuropsychiatric disorders. Presented in this review are the CRF neuroanatomical connectivity and physiological characteristics that modulate LC-NE function, which may contribute to the pathogenesis of stress-induced neuropsychiatric disorders. Additionally, this review illustrates the contribution of LC-NE to the apparent sex-dependent differences in stress-induced neuropsychiatric disorders. Hence, the LC-NE system is a promising target for the development of therapeutic strategies for stress-induced neuropsychiatric disorders.

A New Approach To Guide Research And Policy At The Intersection Of Income, Food, Nutrition, And Health

Income distribution, food and nutrition insecurity, and poor diet quality contribute to diet-related disease, which is a major threat to population health and health equity. Based on our review and synthesis of the empirical evidence, we provide a new conceptual model for understanding the interrelationships among income, food security, nutrition security, diet quality, and health. We identify directions for future research and discuss the policy and program implications of the model. Overall, interventions that address income and food security can facilitate, but do not ensure, nutrition security and better diet quality, although they can improve health in other ways. Importantly, even people who are food and nutrition secure and have adequate income frequently have unhealthy diets. Addressing these challenges will require innovative policies to improve nutrition security, diet quality, and health. Such policies should include efforts to increase the availability and accessibility of Food Is Medicine interventions in health care. Health insurance coverage for evidence-based, clinically indicated Food Is Medicine programs is critical to the success of these efforts.

States' Use Of Medicaid Managed Care 'In Lieu Of Services' Authority To Address Poor Nutrition

In response to rising health, economic, and equity burdens of suboptimal nutrition, health care stakeholders are increasingly integrating nutritional supports into health care delivery and financing. In January 2023, federal guidance clarified that states may use "in lieu of services and settings" (ILOS) authority to address health-related social needs, including nutrition, in Medicaid managed care. However, few data are available regarding ILOS implementation. This analysis reviewed ILOS policies based on managed care documents from forty states as of October 1, 2024. Thirty-five states have authorized ILOS to address behavioral health, and fourteen states have authorized ILOS to address general medical needs. Twelve states use ILOS to address health-related social needs; of these, only ten address nutrition. In addition, fewer than half of the forty states provide robust guidance regarding evaluation or establishment of new ILOSs. We examine the policy implications of these findings and provide recommendations to strengthen the role of ILOS in improving nutrition, health care costs, and health equity.

Expansion of Medicare Coverage for Medical Nutrition Therapy

This cohort study assesses changes in the proportion of Medicare beneficiaries who would qualify for medical nutrition therapy under a proposed coverage expansion.

Epidemiology and Risk Determinants of Drug-Induced Liver Injury: Current Knowledge and Future Research Needs

AIMS

Drug-induced liver injury (DILI) is a major global health concern resulting from adverse reactions to medications, supplements or herbal medicines. The relevance of DILI has grown with an aging population, the rising prevalence of chronic diseases and the increased use of biologics, including checkpoint inhibitors. This article aims to summarise current knowledge on DILI epidemiology and risk factors.

METHODS

This review critically appraises available evidence on DILI frequency, outcomes and risk determinants, focusing on drug properties and non-genetic host factors that may influence susceptibility.

RESULTS

DILI incidence varies across populations, with hospitalised patients experiencing notably higher rates than outpatients or the general population. Increased medication use, particularly among older adults and women, may partly explain age- and sex-based disparities in DILI incidence and reporting. Physiological changes associated with aging likely increase susceptibility to DILI in older adults, though further exposure-based studies are needed for definitive conclusions. Current evidence does not strongly support that women are inherently more susceptible to DILI than men; rather, susceptibility appears to depend on specific drugs. However, once DILI occurs, older age and female sex are associated with greater severity and poorer outcomes. Other less-studied host-related risk factors are also discussed based on available evidence.

CONCLUSIONS

This article summarises existing data on DILI frequency, outcomes, drug properties affecting hepatotoxicity and non-genetic host risk factors while identifying critical knowledge gaps. Addressing these gaps through future research could enhance understanding and support preventive measures.

Supporting Unhealthy Substance use care Through a whole person Approach and user centered INtegration into primary care (SUSTAIN): Study protocol for a type 2 hybrid effectiveness-implementation trial

BACKGROUND

Unhealthy substance use (USU) is common and ranges from use above guideline-recommended levels to severe substance use disorder. USU results in substantial morbidity and mortality yet primary care practices rarely systematically screen, diagnose, and treat USU. Supporting Unhealthy Substance use care Through a whole person Approach and user centered INtegration into primary care (SUSTAIN) tests whether the implementation of a co-designed change package for USU improves patient function. The protocol for SUSTAIN is presented here.

METHODS

SUSTAIN is a cluster randomized controlled implementation trial of a customized approach to identify and treat USU in primary care. The sample includes 24 primary care clinics in two practice-based research networks (PBRNs). In phase one, primary care practice champions and patients with lived USU experience co-design a change package to identify and treat USU. In phase two, we test the effectiveness of the change package versus usual care and evaluate the implementation of the change package. Data will be collected from 24 clinics (50 patients per clinic for total of 1200 patients) through patient surveys and the electronic health record. Patients surveyed must be 18 or older and screen positive for USU using the Tobacco, Alcohol, Prescription medication and other Substance use part one (TAPS-1) tool. Primary outcomes include mental and physical health patient function scales measured using Patient Reported Outcomes Measurement Information System (PROMIS-29-v2). Secondary outcomes are prevalence of USU, recovery, health care utilization, USU screening rates, provision/referral to behavioral health services and prescription of appropriate medications. We will also evaluate implementation outcomes by surveying 96 practice representatives (4 at each clinic) and conduct qualitative interviews with 20 patients and 20 practice leaders to assess their experience with the intervention and its implementation.

CONCLUSIONS

The SUSTAIN trial creates and tests an implementation package approach to address USU in diverse primary care settings. The SUSTAIN change package aims to transform how primary care practices care for individuals with USU to improve patient outcomes and enhance community well-being.

North Carolina's FarmsSHARE: Farmers, Food Hubs, And Community-Based Organizations Sustain Healthy Food Programs

The North Carolina FarmsSHARE program distributes healthy, locally sourced food to low-income households across nearly 100 counties in the state through the Department of Agriculture's Local Food Purchase Assistance Cooperative Agreement. In this article, we present insights from a cross-sectional survey of stakeholders who were involved in implementing the program. We explore measures of satisfaction, perceived value, economic impact, quality of food, and community relationships within each stakeholder group (farmers, food hubs, and community-based organizations). We also discuss FarmsSHARE's impact on local farms, businesses, and food systems. In 2024, FarmsSHARE connected 217 local farms, 16 food hubs, and 117 community-based organizations that worked together to distribute more than 72,000 healthy food boxes. Our findings suggest that FarmsSHARE is strengthening collaborations and local food systems, specifically through partnerships with farms owned by members of racial and ethnic minority groups, and improving access to nutritionally tailored healthy food boxes for low-income households. These insights can be used to guide efforts to integrate local food within the Food Is Medicine paradigm to address nutrition insecurity and promote more equitable food systems within communities.

Plant-Based Culinary Medicine Intervention Improves Cooking Behaviors, Diet Quality, and Skin Carotenoid Status in Adults at Risk of Heart Disease Participating in a Randomized Crossover Trial

Background: Culinary medicine (CM) interventions in teaching kitchens have emerged as novel approaches for influencing dietary behaviors, but their efficacy, content, and delivery vary. Objective: The effects of a virtual vegan CM intervention on behavioral determinants, cooking competencies, diet quality, and skin carotenoid status were assessed. Methods: This analysis from a 9-week randomized crossover study evaluated behavioral survey assessments, Whole Plant Food Density (WPFD) as a diet quality indicator utilizing Automated Self-Administered 24 h Dietary Recall data, and skin carotenoid status (SCS) via pressure-mediated reflection spectroscopy at multiple timepoints. Adults at ≥5% atherosclerotic cardiovascular disease (ASCVD) risk followed a vegan diet pattern that was high or low in extra virgin olive oil (EVOO) for 4 weeks each with weekly virtual cooking classes, separated by a 1-week washout period. Qualitative feedback was collected for thematic analysis. Results: In 40 participants (75% female; body mass index, 32 ± 7 kg/m2; age, 64 ± 9 years mean ± SD), perceived control over trajectory of heart disease, knowledge of lifestyle behaviors for heart health, and confidence in cooking skills and preparing a variety of plant-based foods improved post intervention (all p ≤ 0.001). WPFD increased by 69-118% from baseline. Greater SCS changes occurred after high-EVOO (+51.4 ± 13.9 mean ± SEM, p < 0.001) compared to low-EVOO (+6.0 ± 16.4, p = 0.718) diets. Conclusions: A virtual vegan CM intervention improved dietary behaviors and quality, which was associated with reductions in CVD risk factors. SCS is influenced by EVOO intake, warranting consideration when used to estimate fruit and vegetable intake. The potential impacts of CM on behaviors and health outcomes warrant continued research efforts in medical and public health settings.

Association of Dietary Live Microbe Intake With Mortality: Results From the National Health and Nutrition Examination Survey, 1999-2018

BACKGROUND

The association between dietary intake of live microbes and mortality remains unclear.

OBJECTIVE

This study aims to investigate the relationship between dietary live microbial intake and all-cause and cause-specific mortality among adults in the United States.

DESIGN

This is a cross-sectional study of adults aged 20 years or older who participated in the 1999-2018 National Health and Nutrition Examination Survey.

PARTICIPANTS AND SETTING

The study utilized data from adults aged 20 years and older with complete dietary and mortality data from the National Health and Nutrition Examination Survey from 1999 to 2018.

MAIN OUTCOME MEASURES

Deaths from any cause are defined as all-cause mortality. The International Statistical Classification of Diseases, 10th Revision, and the National Center for Health Statistics classifications of heart disease (054-064) and malignant neoplasms (019-043) were used to identify disease-specific causes of death.

STATISTICAL ANALYSES PERFORMED

Cox proportional hazard regression was utilized to examine the associations between the consumption of dietary live microbes and all-cause and cause-specific mortality. Restricted cubic spline regression modeling was used to assess potential linear associations between dietary live microorganism intake and mortality. In addition, stratified analyses and sensitivity analyses of the association of dietary live microorganism intake with all-cause and cardiovascular deaths were performed to validate the robustness of the results.

RESULTS

The study included 31 836 participants, of whom 4160 died, including 1109 cardiovascular deaths and 915 cancer deaths. The study found that consuming live microbes from the diet was linked to a lower rate of all-cause and cardiovascular mortality, respectively (hazard ratio 0.80, 95% CI 0.72 to 0.89; P < .001; hazard ratio 0.79, 95% CI 0.65 to 0.95; P = .014). However, there was no significant association observed between microbial intake and cancer mortality (hazard ratio 0.93, 95% CI 0.75 to 1.17; P = .545). Restricted cubic spline demonstrates a linear association between dietary live microorganism intake and all-cause and cardiovascular mortality (P < .001). Furthermore, sensitivity analyses indicated that a high intake of live dietary microorganisms was associated with a lower risk of all-cause mortality and cardiovascular mortality (P < .05).

CONCLUSIONS

The study found that consuming live microbes through diet was linked to a lower rate of all-cause and cardiovascular mortality but not cancer mortality.

Avoidable Mortality Across US States and High-Income Countries

Importance

Although there are increasing differences in health policy and population health across US states over the past decade, little is known about how US states compare with other countries on avoidable mortality.

Objective

To compare trends in avoidable mortality across US states and countries in the European Union (EU) and the Organisation for Economic Co-operation and Development (OECD).

Design, Setting, and Participants

Retrospective, population-based, repeated cross-sectional study comparing changes in avoidable mortality among decedents aged 0 to 74 years in 50 US states (and Washington, DC) and 40 high-income countries between 2009 and 2021. Data analysis was conducted from May to July 2024.

Main Outcomes and Measures

Avoidable mortality comprising both preventable deaths related to prevention and public health and treatable deaths related to timely and effective health care treatment.

Results

Between 2009 and 2019, total avoidable mortality increased in all US states (median [IQR], 29.0 [20.1 to 44.2] deaths per 100 000 people), while it decreased in most comparator countries (-14.4 [-28.4 to -8.0]). During this period, variation in avoidable mortality widened across US states (2009: median [IQR], 251.1 [228.4 to 280.4]; 2019: 282.8 [249.1 to 329.5]), but narrowed in comparator countries (2009: 201.5 [166.2 to 320.8]; 2019: 187.1 [152.0 to 298.2]). During the COVID-19 pandemic (2019-2021), avoidable mortality increased for all US states (median [IQR], 101.5 [64.7 to 143.1]) and comparator countries (25.8 [9.1 to 117.7]). The states and countries that experienced the greatest increase in avoidable deaths during the COVID-19 period were those with the highest baseline avoidable mortality (Pearson ρ = 0.86; P < .001). Health spending and avoidable mortality have a consistent, negative, and significant association among comparator countries (2019: Pearson ρ = -0.7; P < .001) but no statistically significant association within US states (2019: Pearson ρ = -0.12; P = .41).

Conclusions and Relevance

This cross-sectional study found that the stark contrast in avoidable mortality trends between all US states compared with EU and OECD countries suggests that broad, systemic factors play a role in worsening US population health. While other countries appear to make gains in health with increases in health care spending, such an association does not exist across US states, raising questions regarding US health spending efficiency.

Optimal dietary patterns for healthy aging

As the global population ages, it is critical to identify diets that, beyond preventing noncommunicable diseases, optimally promote healthy aging. Here, using longitudinal questionnaire data from the Nurses' Health Study (1986-2016) and the Health Professionals Follow-Up Study (1986-2016), we examined the association of long-term adherence to eight dietary patterns and ultraprocessed food consumption with healthy aging, as assessed according to measures of cognitive, physical and mental health, as well as living to 70 years of age free of chronic diseases. After up to 30 years of follow-up, 9,771 (9.3%) of 105,015 participants (66% women, mean age = 53 years (s.d. = 8)) achieved healthy aging. For each dietary pattern, higher adherence was associated with greater odds of healthy aging and its domains. The odds ratios for the highest quintile versus the lowest ranged from 1.45 (95% confidence interval (CI) = 1.35-1.57; healthful plant-based diet) to 1.86 (95% CI = 1.71-2.01; Alternative Healthy Eating Index). When the age threshold for healthy aging was shifted to 75 years, the Alternative Healthy Eating Index diet showed the strongest association with healthy aging, with an odds ratio of 2.24 (95% CI = 2.01-2.50). Higher intakes of fruits, vegetables, whole grains, unsaturated fats, nuts, legumes and low-fat dairy products were linked to greater odds of healthy aging, whereas higher intakes of trans fats, sodium, sugary beverages and red or processed meats (or both) were inversely associated. Our findings suggest that dietary patterns rich in plant-based foods, with moderate inclusion of healthy animal-based foods, may enhance overall healthy aging, guiding future dietary guidelines.

The Long Arc of Substance Use Policy Innovation in Medicaid: Looking Back, Looking Forward

Policy Points The role of Medicaid in financing, organizing, and delivering substance use disorder (SUD) treatment has grown tremendously over time owing to expansions of eligibility and a push toward more uniformity in benefits. Current innovations in SUD treatment focus on expanding the delivery system to create a comprehensive continuum of care, using more value-based payment to reward quality care, and integrating SUD treatment with other systems (e.g., housing, employment, and the criminal legal system). Many of the promising innovations in delivery have not yet been rigorously studied, and implementation of effective models is often stymied because of the lack of flexibility in program requirements and variation in needs and resources across communities. Although policymakers can justifiably laud the great strides Medicaid has made in raising the standards for SUD treatment, there is a huge remaining gap in access to services amidst an unprecedented overdose crisis and looming turmoil in the program.

Association between compound dietary antioxidant index and all-cause and cancer mortality in patients with chronic obstructive pulmonary disease: results from NHANES 1999-2018

Objective

Chronic obstructive pulmonary disease (COPD) is one of the most important causes of death in the world, and its core is chronic inflammation. Antioxidants play a positive role in the onset and prognosis of chronic respiratory diseases. In maintaining human health, the composite dietary antioxidant index (CDAI) plays an important function. Therefore, the purpose of the current study was to investigate the relationship between CDAI and all-cause and cancer mortality in individuals with COPD.

Methods

A prospective cohort study was conducted by investigating NHANES data between 1999-2018. The study included people who satisfied the inclusion and exclusion criteria. In this study, the association between CDAI and all-cause and cancer mortality was investigated using weighted Cox regression. The relationship between them is illustrated by drawing constrained cubic spline curves (RCS). Finally, subgroup analysis is used to further verify.

Results

The study included 1,534 participants. CDAI was associated with COPD patients mortality, and after adjusting for multiple factors, we observed a 5% reduction in the risk of all-cause mortality (HR = 0.95, 95% CI: 0.92-0.97) was associated with a 9% lower risk of cancer mortality for each one-unit increase in CDAI (HR = 0.91, 95% CI: 0.85-0.98). After adjusting for multiple factors, high CDAI was associated with a reduced risk of mortality, with patients in the high CDAI group having 35% lower all-cause mortality than those in the low CDAI group (HR = 0.65, 95% CI: 0.50-0.85), the high CDAI group had a 61% lower risk of cancer mortality (HR = 0.39,95% CI: 0.23-0.68). Subgroup analysis and sensitivity analysis showed a consistent association between CDAI and COPD mortality.

Conclusion

Our study highlights the inverse association between CDAI and all-cause and cancer mortality in patients with COPD. Further prospective studies are needed to confirm the role of CDAI in mortality risk in patients with COPD.

Ketamine rescues anhedonia by cell-type- and input-specific adaptations in the nucleus accumbens

Ketamine is recognized as a rapid and sustained antidepressant, particularly for major depression unresponsive to conventional treatments. Anhedonia is a common symptom of depression for which ketamine is highly efficacious, but the underlying circuits and synaptic changes are not well understood. Here, we show that the nucleus accumbens (NAc) is essential for ketamine's effect in rescuing anhedonia in mice subjected to chronic stress. Specifically, a single exposure to ketamine rescues stress-induced decreased strength of excitatory synapses on NAc-D1 dopamine receptor-expressing medium spiny neurons (D1-MSNs). Using a cell-specific pharmacology method, we establish the necessity of this synaptic restoration for the sustained therapeutic effects of ketamine on anhedonia. Examining causal sufficiency, artificially increasing excitatory synaptic strength onto D1-MSNs recapitulates the behavioral amelioration induced by ketamine. Finally, we used opto- and chemogenetic approaches to determine the presynaptic origin of the relevant synapses, implicating monosynaptic inputs from the medial prefrontal cortex and ventral hippocampus.

The association between overall, healthy, and unhealthy plant-based diet indexes and risk of all-cause and cause-specific mortality: a systematic review and dose-response meta-analysis of prospective cohort studies

Background: recent dietary guidelines recommend a diet that mainly includes plant-based foods and a moderate amount of animal products. Therefore, we hypothesized that plant-based diet indices (overall plant-based diet index (oPDI), healthy plant-based diet index (hPDI), and unhealthy plant-based diet index (uPDI)) might be associated with risk of all-cause and cause-specific mortality. Methods: a systematic review was conducted using PubMed, Web of Science, Scopus, and Embase databases until December 2024. Meta-analysis was performed utilizing random-effects models to calculate relative risk (RR) with the corresponding 95% confidence intervals (95% CIs). Results: from 436 initial records, 25 prospective studies met the inclusion criteria. The findings of our study indicated a modest inverse association between the adherence to oPDI and risk of all-cause mortality (RR [95% CI]: 0.89 [0.83-0.94]; n = 15 studies) as well as mortality related to cardiovascular diseases, chronic heart disease, and total cancer. Also, adherence to hPDI was found to reduce risk of all-cause (RR [95% CI]: 0.86 [0.82-0.90]; n = 21 studies), cardiovascular disease, chronic heart disease, total-cancer, and prostate cancer mortality, whereas uPDI was associated with higher risk of all-cause (RR [95% CI]: 1.20 [1.13-1.27]; n = 19 studies), cardiovascular disease, chronic heart disease, and total-cancer mortality. Our dose-response meta-analysis showed a monotonic inverse association between adherence to oPDI and hPDI and a positive linear association between adherence to uPDI and risk of all-cause mortality. Conclusion: our findings highlight the importance of evaluating the quality of plant-based foods as either healthy or unhealthy in relation to the risk of all-cause and cause-specific mortality.

A Review of the Effects of Flavonoids on NAD(P)H Quinone Oxidoreductase 1 Expression and Activity

Cancer is a significant cause of death worldwide. It has been suggested that the consumption of flavonoids decreases the risk for cancer by increasing phase II enzymes, such as Nicotinamide Adenine Dinucleotide Phosphate Hydrogen (NAD(P)H) quinone oxidoreductase 1 (NQO1), glutathione S-transferases, and Uridine 5'-diphospho- (UDP)-glucuronosyltransferases that assist in removing carcinogens from the human body. Flavonoids are bioactive compounds found in a variety of dietary sources, including fruits, vegetables, legumes, nuts, and teas. As such, it is important to investigate which flavonoids are involved in the metabolism of carcinogens to help reduce the risk of cancer. Therefore, the objective of this narrative review was to investigate the effects of commonly consumed flavonoids on NQO1 mRNA expression, protein, and activity in human cell and murine models. PubMed was used to search for peer-reviewed journal articles, which demonstrated that selected flavonoids (e.g., quercetin, apigenin, luteolin, genistein, and daidzein) increase NQO1, and therefore, increase the excretion of carcinogens. However, more research is needed regarding the mechanisms by which flavonoids induce NQO1. Furthermore, it is suggested that future efforts focus on providing precise flavonoid recommendations to decrease the risk factors for chronic diseases.

Health implications of established and emerging stressors: design of the prospective New Jersey Population Health Cohort (NJHealth) Study

INTRODUCTION

Some stressors, like the death of a partner, are common and rigorously studied, while others, such as those related to climate change or social media, are just emerging and in need of systematic research. The New Jersey Population Health Cohort (NJHealth) Study aims to characterise established and emerging stressors and delineate the pathways through which they influence health, especially among groups likely to experience chronic exposure to stressors including immigrants, people of colour, multigenerational families and low-income families.

METHODS AND ANALYSIS

A prospective cohort, the NJHealth Study is recruiting 8000 NJ residents aged 14 and older using probabilistic and purposive methods to include members of multigenerational families, marginalised racial/ethnic and low-income populations, and recent immigrant groups. Building on ecosocial, life course and stress process models, the NJHealth Study employs multimodal data collection to comprehensively measure stress-related factors at individual and societal levels. Interviews include self-assessments of individual and societal stressors, potential stress buffers and amplifiers, and health and well-being outcomes, including cognitive function, activity limitations and self-reported health. In addition, salivary DNA, fasting plasma, health assessments and actigraphy data are collected from selected participants; and existing electronic health records, health insurance claims, social service and employment data, and vital records are linked. NJ's socioeconomic and demographic diversity make it an exceptional setting for the study. Strong community and stakeholder engagement supports effective translation of research findings into practical policy and programme applications.

ETHICS AND DISSEMINATION

The study was approved by the WCGIRB (Study #1321099) (formerly Western IRB). Informed consent is obtained from participants for each source of participant-level data as well as linked administrative and clinical records. Findings will be reported to study participants, funding bodies, governmental and policy stakeholders, presented at scientific meetings and submitted for peer-review publication.

A Systematic Review of Regenerative Medicine Therapies for Axial Spine Pain of Facet Joint Origin

PURPOSE OF REVIEW

This review aims to assess the effectiveness of mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP) injections in treating axial spinal pain originating from the facet joints. A systematic evaluation of available evidence on these biological therapies was conducted to determine their clinical utility.

RECENT FINDINGS

Recent studies emphasize the therapeutic promise of intraarticular biologics, including MSCs, PRP, and alpha-2-macroglobulin, in managing facet joint-related axial spinal pain. Emerging evidence suggests improvements in pain relief, physical function, and quality of life following these treatments. Based on our search criteria, 20 publications were identified and considered for inclusion. Of these, 4 randomized controlled trials (RCTs) and 6 observational studies met the inclusion criteria. Among the RCTs, 3 trials involved lumbar facet joints, and one trial involved cervical facet joints using PRP. Among the observational studies, 4 studies used PRP, with 3 focusing on the lumbar spine and one study, with 2 publications, on the cervical spine, and only 2 studies evaluated stem cell treatments. The summary of evidence utilizing various criteria, including Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) evidence synthesis, the evidence for PRP injections in facet joints is Level II, or moderate, and Level IV, or limited, overall, with low certainty. For PRP, the recommendation is moderate, and for MSCs, the recommendation is weak.

Paradigm shift in early detection: Lung cancer screening to comprehensive CT screening

Large-scale lung cancer screening implementation combined with improvements in early detection techniques for three major tobacco-related diseases presents a rare opportunity to markedly improve population health outcomes for millions of people. Chest CT enables routine detection of early lung cancer as well as characterizing coronary calcium and detecting early emphysema in the course of lung cancer screening. Integrated preventive care centered on comprehensive chest CT screening has the potential to bring large benefits across co-morbid diseases with a common etiology. The current one-disease/ silo paradigm of medical practice is an obstacle to maximizing chest CT screening's benefits. The large potential for improved health outcomes across the world demands careful public health, quality assurance, and health policy considerations. A systematic analysis of imaging and health data from ongoing chest CT screening could accelerate this paradigm shift through sustained optimization of screening detection, quantitation and management for the three most lethal tobacco-related co-morbidities. To coordinate this effort to advance progress with implementing the full benefit of comprehensive chest CT screening, a new multi- disciplinary professional and advocacy consortium has been developed to foster collaboration to realize the future of multi-disease chest CT screening.

Can a New Commission Make America Healthy Again?

This JAMA Forum discusses the recently formed Make America Healthy Again commission and suggests a few key policies that align with ongoing federal programs and initiatives.

Association of oxidative balance score with incident cardiovascular disease in patients with type 2 diabetes: findings of the UK Biobank study

BACKGROUND & AIMS

To clarify how dietary and lifestyle factors work on diabetes-related cardiovascular disease (CVD), we investigated whether the increased risk of CVD in patients with type 2 diabetes mellitus (T2DM) could be offset by an increase in diet and/or lifestyle with antioxidant potential.

RESEARCH DESIGN AND METHODS

A total of 7,658 individuals from UK Biobank (UKB) with T2DM but no diagnosed CVD were included in this study. We screened combinations of 16 nutrients and/or 4 lifestyles to calculate the Oxidative Balance Score (OBS), dietary OBS (DOBS), and lifestyle OBS (LOBS). Cox proportional hazards (CPH) regression models and mediation statistical models were performed.

RESULTS

After adjusting for covariates, CPH regression models showed inverse associations between both OBS and LOBS and CVD. The highest tertile of LOBS was significantly associated with a lower risk of CVD compared to the lowest tertile, with hazard ratios and 95% CIs as follows: Atherosclerotic Cardiovascular Disease (ASCVD) 0.81 (0.68-0.97), Coronary Artery Disease (CAD) 0.79 (0.67-0.93), Atrial Fibrillation (AF) 0.56 (0.45-0.70) and CVD mortality 0.67(0.51-0.88). Correspondingly, the results of associations between the highest tertile of OBS and risks of CVDs above were ASCVD 0.80 (0.64-0.99), CAD 0.83(0.68-1.01), AF 0.73 (0.57-0.92) and CVD mortality 0.68 (0.50-0.92). No associations between DOBS and CVDs were observed [ASCVD 0.83 (0.66-1.05), CAD 0.86 (0.70-1.05), AF 0.77 (0.60-1.00), and CVD mortality 0.79 (0.57-1.10)]. These results were consistent in stratified analyses. Additionally, we identified a mediating role for C-reactive protein (CRP) and white blood cell count (WBC) in the observed relations, with indirect effect and mediation estimates as follows: CRP - 0.003 6.0% (OBS and CAD), -0.008 17.2%, -0.003 11.7%, and - 0.010 14.5% (OBS/DOBS/LOBS and CVD mortality); WBC - 0.006 14.3%, -0.006 12.6%, -0.006 13.4%, -0.005 23.3% (OBS and CVDs), -0.008 11.8%, -0.008 11.9%, -0.008 11.8%, and - 0.005 5.3% (LOBS and CVDs).

CONCLUSION

Sustained adherence to diets and lifestyles with high antioxidant potential may significantly reduce the risk of CVD in individuals with T2DM.

The effectiveness of cervical medial branch radiofrequency neurotomy using a perpendicular approach with a three-tined probe: A single-arm, retrospective cohort study

Background

Cervical medial branch radiofrequency neurotomy (CMBRFN) with a parallel approach has been proven to be an effective treatment for zygapophyseal joint-mediated cervical pain. Technological advancements in radiofrequency probe design have allowed for a perpendicular approach to electrode placement. However, the effectiveness of the perpendicular approach remains to be fully understood.

Objectives

Evaluate the effectiveness of CMBRFN with a perpendicular approach (pCMBRFN) in patients with confirmed zygapophyseal joint-mediated cervical pain.

Methods

This single-arm, retrospective cohort study included patients identified between 2016 and 2022 who underwent pCMBRFN after demonstrating ≥80 % pain relief with two consecutive diagnostic medial branch blocks (MBB). Primary outcomes were ≥50 % patient-reported numeric rating scale (NRS) pain relief and minimal clinically important difference (MCID) on the Pain Disability Quality-Of-Life Questionnaire-Spine (PDQQ-S) at 3 months post-procedure. Secondary outcomes were mean patient-reported retrospective percentage pain relief and duration of relief after a successful pCMBRFN in individuals who presented for repeat pCMBRFN upon return of their symptoms.

Results

A total of 52 participants (63.5 % female; mean age 55.9 ± 10.9 years; mean BMI 26.8 ± 5.2 kg/m2) were analyzed. At 3 months post-procedure, ≥50 % NRS pain reduction and MCID on PDQQ-S were both reported by 34 patients (65.4 % [95%CI 51.8-76.9]). Of the 34 patients with successful treatment response, 15 had return of symptoms after an average of 8.8 ± 2.5 months with a reported mean percentage pain relief of 86.0 ± 14.9 %.

Conclusion

Within this cohort, pCMBRFN demonstrated effectiveness by reducing pain and disability in over 65 % of patients with confirmed cervical zygapophyseal joint-mediated pain at 3 months. Patients with successful treatment outcomes whose index symptoms eventually returned reported an average pain reduction of 86 % lasting approximately 9 months. Larger prospective studies with long-term follow-up are needed to confirm these results.

Does cannabis use substitute for opioids? A preliminary exploratory survey in opioid maintenance patients

Various studies showed that people with substance use disorder use cannabis to reduce withdrawal or dose of their main drug. Using a questionnaire about their cannabis use, 118 participants in an opioid maintenance treatment (OMT) in Germany were examined regarding this strategy. 60% reported to use cannabis. Of those, 72% were using cannabis in the suggested way. Cannabis was used to substitute for, e.g., heroin (44.8%) and benzodiazepines (16.4%). We also asked for an estimation of how good cannabis was able to substitute for several substances (in German school grades (1 till 6)); heroin average grade: 2.6 ± 1.49. Besides that we asked about the idea of cannabis as "self-medication", e.g., to reduce pain (47%) and about negative consequences from cannabis use. Our results suggest to consider the use of cannabis by patients in OMT rather as a harm reduction strategy to reduce the intake of more dangerous drugs.

Economic and clinical burden of major depressive disorder with insomnia symptoms in commercially and Medicaid-insured adults in the United States: A retrospective matched cohort study

BACKGROUND

Insomnia is a common symptom of major depressive disorder (MDD). Presence of insomnia symptoms in MDD (MDDIS) has been associated with worse depression severity and outcomes. This study assessed the economic and clinical burden of MDDIS in the United States.

METHODS

Commercially and Medicaid-insured adults from Merative® MarketScan® Databases (01/2016-06/2021) with ≥1 MDD diagnosis (index date) were included in the MDDIS cohort if they had ≥1 insomnia diagnosis within 12 month afterwards or in the other MDD cohort if they had no insomnia diagnoses/treatments; patients without MDD diagnoses/treatments (random index date) were included in the non-MDD cohort. Cohorts were propensity score-matched. Healthcare resource utilization (HRU), costs, and treatment patterns 12 months post-index were compared between MDDIS and each control cohort using linear and Poisson regressions.

RESULTS

In both commercially (N = 52,280; mean age: 44 years; 67 % female) and Medicaid-insured (N = 15,653; mean age: 41 years; 73 % female) populations, the MDDIS cohort had significantly higher HRU and cost than the other MDD and non-MDD cohorts. Mean total all-cause healthcare cost difference between the MDDIS and other MDD cohort was $5842 (commercial) and $5152 (Medicaid); between the MDDIS and non-MDD cohort, it was $14,266 (commercial) and $11,314 (Medicaid). MDDIS compared to other MDD was associated with higher use of antidepressants, particularly agents with sedative effect.

LIMITATIONS

Data were subject to incompleteness that might lead to measurement biases.

CONCLUSIONS

MDDIS compared to other MDD and non-MDD was associated with significantly higher economic and clinical burden, highlighting the need for effective treatments for this population.

General medication adherence scale in patients with chronic illnesses: Persian translation and psychometric evaluation

ObjectivesThis study was conducted with the aim of determining the validity and reliability of the Persian version of "General Medication Adherence Scale (GMAS)" in chronic patients in Iran.MethodologyThe study was conducted among patients with chronic diseases in five hospitals of Iran. In this study, after cultural validation, using the steps of Content, Response Reaction, and Internal structure evaluations, the research sample was increased to 150 individuals for exploratory factor analysis (EFA) and 313 chronic patients for confirmatory factor analysis (CFA) to confirm the construct validity. Cronbach's alpha coefficient was used to assess internal consistency, and test-retest method was used to evaluate the reliability of the tool.FindingsThe results of EFA and CFA confirmed the tool with three factors and 11 items. The R2 index in the above model was estimated at 0.99, indicating that 99% of the variation in medication adherence scores in research units was explained by GMAS with 11 items. The main indices of the model in factor analysis were all above 0.9, indicating a good fit for the model.DiscussionOverall, the study results showed that the Persian version of GMAS has acceptable and practical characteristics for evaluating medication adherence, and it can be used as a valid tool in various related fields.

Individual- and environmental-level determinants of fruit and vegetable intakes in rural Georgia

OBJECTIVE

To investigate the ways in which food insecurity, food acquisition behaviors, and perceived and objective food access influence fruit and vegetable intakes among rural Georgians.

DESIGN

A population-based survey was merged with USDA's Food Access Research Atlas, and multilevel modeling was used to determine individual-level (eg, food insecurity, food acquisition behaviors, perceived access) and environmental-level (eg, census tract food access) predictors of fruit and vegetable intakes.

SETTING

Twenty-four rural census tracts in 6 counties in Georgia, USA.

PARTICIPANTS

One thousand four hundred and seventy-four adults.

RESULTS

Residing in a low food access census tract was not associated with fruit or vegetable intake. Food insecurity had negative effects on both fruit and vegetable intakes. Perceived access to fresh fruits and vegetables was positively associated with fruit intake, and obtaining fresh fruits and vegetables from community or home gardens was positively associated with both fruit and vegetable intakes.

CONCLUSIONS

Findings are unique from previous research on census tract-level fruit and vegetable determinants, underscoring the need for a better understanding of influences on fruit and vegetable intakes among rural populations. Interventions to increase fruit and vegetable consumption in rural areas should prioritize food security.

Evaluating prognostic block selection criteria in cervical medial branch radiofrequency neurotomy: A retrospective cohort study

Background

Considerable variability exists in the literature record regarding patient selection criteria for cervical medial branch radiofrequency neurotomy (CMBRFN). Few prior studies have assessed the correlation between different prognostic block paradigms and treatment outcomes for this procedure.

Objectives

Examine the association between various prognostic block selection criteria and CMBRFN success rates.

Methods

Retrospective cohort study of consecutive patients from two Canadian musculoskeletal pain management clinics who underwent first-time CMBRFN between 2016 and 2022 with a three-tined cannula utilizing a perpendicular approach. Patients were categorized according to prognostic block paradigms (single vs. dual), block type (medial branch block [MBB] vs. intraarticular block [IAB]), and percentage pain relief after blocks. Six block criteria were established: 1 = MBB/MBB≥80 %; 2 = MBB/MBB 50-79 %; 3 = IAB/MBB≥80 %; 4 = IAB/MBB 50-79 %; 5 = MBB≥80 %; 6 = MBB 50-79 %. Treatment success was evaluated at 3 months post-CMBRFN as the proportion of participants with (1) ≥50 % NRS pain score reduction (the primary outcome) and (2) ≥17-point score decrease (the minimal clinically important difference [MCID]) on the Pain Disability Quality-of-Life Questionnaire - Spine (PDQQ-S). Logistic regression analyses were used to explore associations between block criteria and CMBRFN treatment success.

Results

A total of 171 consecutive patients (58.5 % female; 58.0 ± 12.1 years of age; BMI 28.7 ± 6.0 kg/m2) were included. 60.8 % (95%CI: 53.3-67.8 %) and 61.4 % (95%CI: 53.9-68.7 %) of patients reported ≥50 % NRS and ≥17-point PDQQ-S reduction, respectively. After controlling for demographic factors, there were no statistically significant differences in the odds of treatment success amongst individuals selected by various prognostic block paradigms.

Conclusion

Over 60 % of patients who underwent CMBRFN reported clinically significant magnitudes of improvement in pain and disability at three months post-CMBRFN, regardless of prognostic block selection criteria. These findings suggest that multiple block strategies might be employed to determine eligibility for CMBRFN. Larger, prospective studies including long-term outcome assessments are needed to further evaluate these findings.

The effectiveness of thoracic medial branch radiofrequency neurotomy using a three-tined electrode: A single-arm, retrospective cohort study

Background

Thoracic medial branch radiofrequency neurotomy (TMBRFN) is used to treat chronic thoracic facet joint pain, but research on its technique and effectiveness is still needed. The current International Pain and Spine Intervention Society Practice Guidelines do not describe a technique for TMBRFN.

Objectives

Evaluate the effectiveness of TMBRFN in patients with thoracic facet joint pain.

Methods

Single-arm, retrospective cohort study of consecutive patients from two Canadian musculoskeletal pain management clinics who underwent first-time TMBRFN between 2016 and 2022. The primary outcome was the proportion of patients with ≥50 % reduction in numerical rating scale (NRS) pain score at 3-months post-procedure. Secondary outcomes included the proportion of patients who achieved a ≥17-point reduction on the Pain Disability Quality-Of-Life Questionnaire-Spine (PDQQ-S) at 3-months, as well as mean patient-reported percentage pain relief and duration of relief after a successful index TMBRFN in individuals who reported a return of their index symptoms.

Results

18 consecutive patients (50.0 % male; mean age 60.9 ± 15.3 years; mean BMI 30.3 ± 6.9 kg/m2) were analyzed. At 3 months post-procedure, 10 patients (55.6 % [95%CI 33.7-75.4]) reported ≥50 % NRS pain reduction and 9 (50.0 % [95%CI 29.0-71.0]) reported ≥17-point PDQQ-S reduction. Of the 10 patients with successful treatment responses, 4 had a return of symptoms after an average of 9.3 ± 2.2 months with a reported retrospective mean percentage pain relief of 70.0 ± 34.6 %.

Conclusion

Within this cohort, approximately 60 % of patients experienced improvement in pain and disability at 3 months following TMBRFN. Among patients whose index symptoms returned after successful treatment, the average reported pain relief was 70 % for close to 9 months. Larger, prospective studies with long-term outcomes are needed to better elucidate the safety and effectiveness of TMBRFN.

2025 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

BACKGROUND

The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2025 AHA Statistical Update is the product of a full year's worth of effort in 2024 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. This year's edition includes a continued focus on health equity across several key domains and enhanced global data that reflect improved methods and incorporation of ≈3000 new data sources since last year's Statistical Update.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Healthy snack availability at a large Hispanic-serving university in South Florida

Objective: To audit the snack food environment and evaluate the availability of healthy items campus-wide, investigating high-traffic areas and the ways in which the placement and content of snack outlets may vary across different building types and distance to other food sources. Participants: All snack food vending machines (VM) and convenience stores (CS). Methods: A cross-sectional snack food audit was conducted between June 2019 and January 2022. VMs and CS were rated on the availability and healthfulness of foods and beverages. Frequency and distributions of snacks, healthy snacks, VM scores, building types, enrolled students, and distance to food were analyzed and differences were evaluated. Results: The campus-wide offerings of unhealthy foods in VM ranged from 84-92%, with clusters of buildings with fewer than five healthy items. CS ranked among the least healthy. Conclusions: The snack environment at this large Hispanic-serving university contains predominantly very unhealthy choices. A policy on snack foods is needed to promote healthy eating habits and prevent obesity.

Efficacy of Steroid Facet Joint Injections for Axial Spinal Pain and Post Radiofrequency Ablation Neuritis: A Systematic Review

PURPOSE OF REVIEW

Chronic axial spinal pain is a leading cause of disability and healthcare spending in the United States. A common source of axial spinal pain is the facet joint. Current treatments for facet joint-mediated pain include conservative treatments and interventions such as intra-articular facet joint injections (FJI), medial branch blocks (MBB), and radiofrequency ablation (RFA). While facet joint interventions are one of the most common spinal procedures, current scientific literature demonstrates conflicting results regarding the use of corticosteroids in these interventions.

RECENT FINDINGS

A systematic review was conducted to determine the efficacy of local corticosteroid usage in facet joint interventions for treating chronic axial spinal pain. Separate literature searches were performed using PubMed, Google Scholar, Embase, and Cochrane Library to evaluate the use of local corticosteroids in intra-articular FJI, MBB, and for the prevention of post-neurotomy neuritis (PNN). Inclusion criteria included a randomized clinical trial (RCT) or control trial while unique inclusion criteria was used for the differing uses of local corticosteroids. The exclusion criteria for studies included (i) studies written in a non-English language; (ii) articles without full-text access or abstract-only papers; (iii) and studies focused on non-human subjects. Final literature searches were conducted in August 2024. Two studies with 131 patients, four studies with 440 patients, and two studies with 203 patients were selected for the assessment of local corticosteroid use on intra-articular FJI, MBB, and PNN, respectively. A quality assessment tool recommended by The Cochrane Collaboration was used to assess bias risk in included studies. Results were synthesized through a meta-analysis to evaluate intra-articular FJI while a literature analysis was completed to investigate MBB and PNN. This study found that the use of corticosteroid intra-articular FJI and MBB provides significant improvement in pain relief and functionality from baseline for the treatment of lower back pain and chronic axial spinal pain, respectively. However, the use of corticosteroids post-RFA has not been proven to reduce the occurrence of PNN. Limitations to the studies used included blinding bias, absence of placebo groups, subjective inclusion criteria, limited generalizability and small sample sizes.

A multi-level implementation strategy to increase adoption of chiropractic care for low back pain in primary care clinics: a randomized stepped-wedge pilot study protocol

INTRODUCTION

Limited adoption of first line treatments for low back pain (LBP) in primary care settings may contribute to an overreliance on pain medications by primary care providers (PCPs). While chiropractic care typically includes recommended nonpharmacologic approaches (e.g., manual therapy, exercise instruction, advice on self-care), implementation strategies to increase adoption of chiropractic care for LBP in primary care clinics are understudied, particularly in underserved communities.

METHODS

We will use a stepped-wedge cluster randomized controlled pilot trial design to evaluate the feasibility of a multi-level implementation strategy to increase adoption of chiropractic care for LBP in primary care clinics at community health centers. Key barriers and facilitators identified by site champions and other key stakeholders will help us to develop and tailor implementation strategies including educational materials and meetings, developing a network of local chiropractors, and modifying the electronic health record to facilitate referrals. Three primary care clinics will be randomized to receive the implementation strategy first, second, or third over a fourteen-month study period. At our first clinic, we will have a four-month pre-implementation period, a two-month implementation deployment period, and a subsequent eight-month follow-up period. We will stagger the start of our implementation strategy, beginning in a new clinic every two months. We will evaluate the proportion of patients with LBP who receive a referral to chiropractic care in the first 21 days after their index visit with PCP. We will also evaluate adoption of other guideline concordant care (e.g., other nonpharmacologic treatments) and non-guideline concordant care (e.g., opioids, imaging) over the study period.

DISCUSSION

LBP is currently the leading cause of disability worldwide. While there are several treatment options available for individuals with LBP, patients in underserved populations do not often access recommended nonpharmacologic treatment options such as chiropractic care. The results from this study will inform the development of practical implementation strategies that may improve access to chiropractic care for LBP in the primary care context. Furthermore, results may also inform policy changes needed to expand access to chiropractic care in underserved communities. CLINTRIALS.GOV NCT#: NCT06104605.

Healthful vs. Unhealthful Plant-Based Restaurant Meals

Background: Vegan/vegetarian (VEG) restaurants and VEG options in omnivore (OMNI) restaurants may serve unhealthful plant-based food that may be more harmful than a typical American diet. Methods: A sample of 561 restaurants with online menus were analyzed over a 3-year period. Each plant-based menu entrée was counted, up to a maximum of ten entrées per restaurant, meaning that a restaurant customer could select from ten or more healthful plant-based choices. Entrées containing refined grains (e.g., white rice and refined flour), saturated fat (e.g., palm oil and coconut oil), or deep-fried foods were counted as zero. Results: We evaluated 278 VEG and 283 OMNI restaurants. A full menu (10 or more plant-based entrées) was available in 59% of the VEG, but only 16% of the OMNI (p < 0.0001). Zero healthful options occurred in 27% of OMNI, but only 14% of VEG (p = 0.0002). The mean healthy entrée count for all restaurants was 3.2, meaning that, on average, there were only about three healthful plant-based choices of entrées on the menu, significantly more in VEG (4.0 vs. 2.4 p < 0.0001). The most common entrée reduction was for refined grains (e.g., white flour in veggie-burger buns or white rice in Asian entrées, n = 1408), followed by fried items (n = 768) and saturated fat (n = 318). VEG restaurants had a significantly higher frequency of adequate VEG options (≥7 options, 24% vs. 13%, p = 0.0005). Conclusions: Restaurants listed as VEG have a slightly higher number of healthful entrées than OMNI restaurants, which offer more limited vegan/vegetarian options. Given the published relationship between unhealthful dietary patterns, chronic illness, and mortality, we propose that detailed nutrition facts be publicly available for every restaurant.

Oral Citrate Supplementation Mitigates Age-Associated Pathologic Intervertebral Disc Calcification in LG/J Mice

Despite the high prevalence of age-dependent intervertebral disc calcification, there is a glaring lack of treatment options for this debilitating pathology. We investigated the efficacy of long-term oral K3Citrate supplementation in ameliorating disc calcification in LG/J mice, a model of spontaneous age-associated disc calcification. K3Citrate reduced the incidence of disc calcification without affecting the vertebral bone structure, knee calcification, plasma chemistry, or locomotion in LG/J mice. Notably, a positive effect on grip strength was evident in treated mice. FTIR spectroscopy of the persisting calcified nodules indicated K3Citrate did not alter the mineral composition. Mechanistically, activation of an endochondral differentiation in the cartilaginous endplates and nucleus pulposus (NP) compartment contributed to LG/J disc calcification. Importantly, K3Citrate reduced calcification incidence by Ca2+ chelation throughout the disc while exhibiting a differential effect on NP and endplate cell differentiation. In the NP compartment, K3Citrate reduced the NP cell acquisition of a hypertrophic chondrocytic fate, but the pathologic endochondral program was unimpacted in the endplates. Overall, this study for the first time shows the therapeutic potential of oral K3Citrate as a systemic intervention strategy to ameliorate disc calcification.

Multi-ancestry meta-analysis of genome-wide association studies discovers 67 new loci associated with chronic back pain

This multi-ancestry meta-analysis of genome-wide association studies (GWAS) investigated the genetic factors underlying chronic back pain (CBP) in a sample from the Million Veteran Program comprised of 553,601 Veterans of African (19.2%), European (72.6%), and Hispanic (8.2%) ancestry. The results revealed novel (N = 67) and known (N = 20) genome-wide significant loci associated with CBP, with 43 independent variants replicating in a non-overlapping contemporary meta-GWAS of the spinal pain dorsalgia phenotype. The most significant novel variant was rs12533005 (chr7:114416000, p = 1.61 × 10-20, OR = 0.96 (95% CI: 0.95-0.97), EA = C, EAF = 0.39), in an intron of the FOXP2 gene. In silico functional characterization revealed enrichment in brain and pituitary tissues. Mendelian randomization analysis of 62 variants for CBP-MVP revealed 48 with causal links to dorsalgia. Notably, four genes (INPP5B, DRD2, HTT, SLC30A6) associated with these variants are targets of existing drugs. Our findings more than double the number of previously reported genetic predictors across all spinal pain phenotypes.

Fork in the road: therapeutic and pathological actions for fibro-adipogenic progenitors following musculoskeletal injury

Musculoskeletal injuries are a substantial source of global disability through weakness and loss of function, which can be attributable, in part, to deficits in skeletal muscle quality. Poor muscle quality, resulting from fibrotic pathology or fatty infiltration, strongly predicts lower rates of patient recovery following injury and higher rates of re-injury. The cellular sources of fibrosis and fatty infiltration within skeletal muscle are mesenchymal fibro-adipogenic progenitors (FAPs), which are central effectors to support muscle homeostasis, regeneration and growth. However, following acute or chronic musculoskeletal injury, FAPs can promote fibro/fatty pathology within muscle that is likely to limit recovery and repair. Given their indispensable role within skeletal muscle, FAPs have emerged as a compelling cellular target to promote tissue recovery following acute and chronic injury. This review provides insight into the aetiology of FAP activity following various musculoskeletal injuries, in addition to signalling components that effect FAP differentiation. Contrasting pathology with therapeutic potential, insight into disease- and injury-specific FAP activation further cements their role as crucial effectors to improve muscle function and enhance patient outcomes.

Elderly vulnerability to temperature-related mortality risks in China

The elderly face elevated mortality risk due to rising temperature. Previous assessments of temperature-related mortality, however, lack a comprehensive analysis of distinct impacts of temperature change across different timescales and characteristics. Using a longitudinal survey of 27,233 elderly Chinese citizens from 2005 to 2018, we establish connections between rising temperatures, temperature variability, and extreme heat with increased mortality risk, assessed through four annual metrics that combine temperature and humidity. The intensity and prolonged duration of extreme heat are found to have the greatest impact on mortality risk. Furthermore, by identifying heterogeneous impacts based on location, sex, age, obesity, income, and diet, we reveal the pathways through which temperature metrics are likely to influence mortality risk. Our study highlights the compound effects of rising temperatures for elderly populations, and it could be expanded to other countries and regions experiencing similar challenges due to an aging population experiencing warming conditions.

Prescription of potentially inappropriate medications in older adults: data from a dental institution

OBJECTIVES

The objectives of this study were to determine the types and frequency of potentially inappropriate medications (PIMs) prescribed to geriatric patients while considering the patients' age groups and their American Society of Anesthesiologists (ASA) physical status.

STUDY DESIGN

We performed a 5-year retrospective chart review of patients aged 65 years and above who were seen in a dental institution. Patients' medical history, PIM prescriptions, and prescribers' specialty and professional status were analyzed.

RESULTS

Out of 10,675 geriatric patients identified, 6.2% (n = 662) received PIM prescriptions. Of those, 77% received one PIM whereas the others (23%) received anywhere between 2 and 6; the majority (73.7%) of these 662 patients fell within an ASA III physical status. Nonsteroidal anti-inflammatory drugs (NSAIDs) were the most prescribed PIM (provided to 60.1% of subjects) followed by opioids (provided to 32.5% of subjects). Both NSAIDs and opioids were largely provided by providers in oral and maxillofacial surgery followed by those in restorative dentistry and periodontics. Benzodiazepines were mostly prescribed by endodontics providers, whereas tricyclic antidepressants, muscle relaxants, and anticonvulsants were mostly prescribed by oral medicine providers. Residents prescribed opioids at similar rates to the faculty (P = .78) but exceeded the faculty in prescribing benzodiazepines (P < .001).

CONCLUSION

PIMs were prescribed at low percentages to geriatric patients; however, most prescriptions were provided to patients classified with ASA III status. Further efforts are indicated, at institutional and national levels, to monitor/limit PIMs provided to geriatric population. (Oral Surg Oral Med Oral Pathol Oral Radiol YEAR;VOL:page range).

Factors associated with patient no-show rates in an academic pain management practice

OBJECTIVES

Chronic pain is a debilitating, multifactorial condition. The purpose of this study was to examine patient characteristics of those who did not show up for their scheduled first pain medicine appointment in order to identify factors that may improve access to care.

METHODS

This was a retrospective analysis of 810 patients from a single-center academic pain management clinic between January 1, 2022, and December 31, 2023.

RESULTS

Overall no-show rate was 57%. There was a mean of 133 days (4.3 months) from scheduling to the appointment date. Patients age ≤ 30 years had the highest no-show rate (69%), and those ≥81 years had the lowest (49%). Hispanic and Caucasian patients had similar no-show rates (59% and 57%, respectively) and Asian patients had lower rate (41%). Referral from another specialty had a significantly lower no-show rate (36% vs. 89%, p < 0.001). The presence of referral (p < 0.001) was a significant predictor of lower no-show rates. Of the 191 patients with low back pain, internal medicine (38.7%) was the most referring specialty.

DISCUSSION

High no-show rates were present particularly among younger patients. Having a referral from another specialty was an independent predictor of lower no-show rates.