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2MM Rewind December 8th, 2025
Vitamin D Levels During Pregnancy and Dental Caries in Offspring
1. In this cohort of maternal-child pairs, lower maternal vitamin D levels, especially in the second and third trimesters, are associated with an increased risk of early childhood caries (ECC).
Evidence Rating Level: 1 (Excellent)
Early childhood caries (ECC) is a common and serious public health issue, affecting more than half of young children worldwide and up to 70%of Chinese preschoolers. ECC can impair chewing, appearance, learning, and overall health, creating significant burdens for families and society. Since tooth mineralization begins in mid-pregnancy and continues through late pregnancy, maternal vitamin D plays a crucial role in the development of healthy enamel. Low vitamin D levels in pregnancy can lead to enamel defects and increase a child’s risk of cavities, yet past studies have shown mixed results. This cohort study aims to clarify the relationship between maternal vitamin D levels in each trimester and the incidence of dental caries in children. Plasma levels of 25 (OH)D2 and 25 (OD)D3 were measured using liquid chromatography-tandem mass spectrometry, and vitamin D deficiency was defined as a total 25 (OH)D level below 20 ng/mL. The study included 4109 mother-child pairs (median [IQR] maternal age, 29 [27.0-32.0] years; 39-week median gestation; 51.6% male), and by their last dental exam, 960 children (23.4%) aged 1-6 years had ECC. Higher maternal 25(OH)D levels were associated with lower odds of ECC across all trimesters (first trimester odds ratio [OR], 0.98 [95% CI, 0.97-0.99]; second trimester OR, 0.98 [95% CI, 0.97-0.99]; third trimester OR, 0.99 [95% CI, 0.98-1.00]). When vitamin D was assessed categorically, maternal vitamin D insufficiency, deficiency, and severe deficiency were generally associated with an increased risk of ECC compared to sufficient maternal vitamin D levels; however, some associations weakened after correction for the false discovery rate (FDR). In summary, an inverse relationship between maternal vitamin D levels and ECC was demonstrated, suggesting that routine vitamin D screening and supplementation in pregnancy may help prevent cavities in children.
1. This randomized controlled trial found that arthroscopic subacromial decompression does not provide meaningful long-term benefit for subacromial pain syndrome.
Evidence Rating Level: 1 (Excellent)
Arthroscopic subacromial decompression (ASD) has long been one of the most frequently performed orthopedic procedures for persistent shoulder pain, despite growing evidence suggesting minimal short or medium-term clinical benefit. This study provides the 10-year follow-up of the FIMPACT (Finnish Subacromial Impingement Arthroscopy Trial), a randomized, placebo-controlled trial, designed to determine whether ASD offers any long-term advantage over placebo surgery or structured exercise therapy for patients with subacromial pain syndrome. A total of 210 adults aged 35–65 with over three months of refractory symptoms were enrolled, undergoing either ASD, diagnostic arthroscopy (placebo surgery), or a supervised physiotherapy program. Shoulder pain at rest and on arm activity, assessed using a 100-point visual analogue scale (VAS), were the primary outcomes, with a minimally important difference defined as 15 points. At the 10-year follow-up, all groups demonstrated substantial and sustained symptom improvement from baseline, with most gains occurring by year five and stabilizing thereafter. However, no significant differences were detected between ASD and placebo surgery for either primary outcome (VAS pain at rest: mean difference −1.5; 95% CI: −8.6, 5.6; pain on arm activity: −3.2; 95% CI: −13.0, 6.5). Similarly, ASD showed no meaningful advantage over exercise therapy (pain at rest: −4.0; 95% CI: −11.0, 3.0; pain on activity: −9.4; 95% CI: −19.0, 0.3), with all estimates falling below the clinically relevant threshold. Secondary outcomes, including functional scores, health-related quality of life, satisfaction, and adverse events, likewise demonstrated no significant between-group differences. Sensitivity analyses confirmed the robustness of the findings. Overall, the study indicates that ASD confers no long-term clinical benefit beyond placebo surgery or targeted physiotherapy in managing subacromial pain syndrome over 10 years. These results, consistent across short-, medium-, and long-term follow-ups, underscore the need for de-implementation of ASD in routine care and reinforce exercise-based management as an effective, less invasive alternative.
1. In this randomized controlled trial, breast density notification was associated with increased anxiety and confusion without helping women feel more informed.
Evidence Rating Level: 1 (Excellent)
High breast density, present in about 25–40% of women undergoing mammography, increases breast cancer risk and makes cancers harder to detect. Many countries, including the US and Australia, are notifying women of their breast density to inform them of this risk and the potential need for additional screening. However, the long-term benefits and harms of such notification remain unclear. This trial examines how telling women about dense breasts affects their psychological responses and intentions to use health services, and whether written versus video information changes these effects. A three-arm randomized controlled trial was employed to assess the goals of the study most effectively. Women aged ≥40 with dense breasts (BI-RADS C or D) were invited to participate and randomized, with primary outcomes assessed via online questionnaires eight weeks after screening. Randomization was blinded, and all outcomes were self-reported, including psychological responses and intentions to use health services. A total of 3107 women were randomized, with 2401 included in the analysis (mean age [SD] 57.4 [9.9] years). Women who were notified of their dense breasts reported higher levels of anxiety (control: 18.0%; intervention 1: 20.8%, odds ratio 1.30, 95% confidence interval (CI) 1.08 to 1.57 (P=0.005); intervention 2: 20.5%, odds ratio 1.28, 1.07 to 1.54 (P=0.007)) and confusion (intervention 1: 11.5%, odds ratio 1.92, 1.58 to 2.33 (P<0.001); intervention 2: 9.0%, odds ratio 1.76, 1.46 to 2.13 (P<0.001)) compared to the control group. Furthermore, the intervention group reported greater intentions to discuss results with their general practitioner (intervention 1: relative risk ratio 2.08, 95% CI 1.59 to 2.73; intervention 2: relative risk ratio 1.71, 1.31 to 2.25) and seek advice on supplemental screening (intervention 1: relative risk ratio 2.61, 1.80 to 3.79; intervention 2: relative risk ratio 2.29, 1.58 to 3.33) compared to the control group. Compared to the control group, there was no significant increase in women feeling informed to make decisions about their breast health for either intervention 1 (OR 0.83, 0.68 to 1.01; P=0.059) or intervention 2 (OR 0.80, 0.66 to 0.97; P=0.022). Overall, notifying women of dense breast status increased anxiety and confusion, did not make them feel more informed, and prompted most to seek guidance from their general practitioners.
1. In this cohort of adolescents and young adults (AYAs), getting palliative care from a specialist palliative physician is associated with significantly less aggressive end-of-life treatment.
Evidence Rating Level: 2 (Good)
Adolescents and young adults (AYAs) between the ages of 15-39 years with cancer have unique medical, psychosocial, and financial needs and often experience high symptom burden and intensive end-of-life care. Although early palliative care can improve quality of life and reduce aggressive end-of-life interventions, many AYAs receive limited palliative support because of stigma and misconceptions. Building on Canada’s 2017 Action Plan to improve access to palliative care, this retrospective cohort study aims to examine how frequently AYAs in Ontario receive palliative care services and how such improvement influences the intensity of their medical care at the end of life. The intensity of end-of-life care was assessed using indicators such as chemotherapy in the last 14 days, ICU admission, hospitalizations, and location of death (hospital, ICU, palliative care unit, community, or other). A total of 1981 AYAs were included, with 76% receiving palliative care in the last 90 days of life, and 89% of these encounters involved specialist palliative care physicians. Compared with generalist or no palliative care, specialist involvement was associated with greater admission rates (58% vs 57% vs 47%, p=0.0004), but lower use of mechanical ventilation (12% vs 36% vs 33%, p<0.0001), fewer hospital deaths (42% vs 64% vs 56%, p<0.0001), and fewer ICU deaths (12% vs 38% vs 38%, p<0.0001). Palliative care use among AYAs with cancer in Ontario has increased; however, many still receive highly intensive end-of-life care. However, specialist palliative care is associated with less aggressive interventions and increased deaths at home or in palliative care units. These findings underscore the need to strengthen and expand AYA-focused specialist palliative care to improve the quality of end-of-life care in this population.
Hospital-Level Care at Home for Adults Living in Rural Settings: A Randomized Clinical Trial
1. In this randomized clinical trial, home hospital care was both feasible and safe for rural patients needing hospital-level care.
Evidence Rating Level: 1 (Excellent)
Almost 20% of Canadians live in remote areas where it is difficult to access their nearest hospital. Furthermore, it is predicted that this lack of access will intensify as more rural hospitals are closing, and those receiving care there may encounter a potentially unsafe environment. Home hospital provides services traditionally offered in brick-and-mortar (BAM) hospitals. Previous studies have demonstrated that home hospital care enhances patient experiences while reducing mortality, costs, and readmissions. However, most programs have been done in urban areas with easier access to resources. To address gaps in rural settings, this study aims to evaluate whether rural home hospital (RHH) can deliver comparable outcomes to usual inpatient care. Eligible participants were randomized to either the RHH group vs the BAM group. In both groups, study staff administered surveys at admission, discharge and again 30 days post-discharge. A total of 165 individuals were enrolled (mean [SD] age 64.4 [17.2] years), with 82 randomized to the home group and 83 to the control group. Individuals in the home hospital group spent significantly less time being sedentary compared to those in the hospital care group (mean [SD], 78.0% [10.4%] vs 86.0% [7.2%]; mean difference, -8.0%, 95% CI, -12.8% to -3.3%; P<.001), and took more daily steps on average (mean [SD] 834.1 [1219.6] vs 120.4 [206.0]; mean difference 713.7 steps; 95% CI, 290.2 to 1137.2; P<.001). Between the RHH and control groups, the total mean [SD] length of stay did not significantly differ (6.7 [5.0] days for home hospital vs 5.4 [4.4] days for controls). Notably, patients in the home hospital group were transferred home relatively late in their acute care episode (mean [SD] day of transfer, 4.2 [4.3] of 6.7 days). Home hospital patients reported more positive experiences than those in the BAM group (mean [SD] Picker experience score 13.4 [2.6] vs 11.0 [3.0]; 95% CI, 1.0-3.8; P<.001). Overall, patient activity and experience improved with home care, while costs and readmission were unchanged.
Image: PD
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