Nevin Manimala

JMIR Diabetes. 2026 Apr 7. doi: 10.2196/87364. Online ahead of print.

ABSTRACT

BACKGROUND: The prevalence of diabetes in the US necessitates investigations into how to better enable adults with type 2 diabetes to manage their health using easy to access and personally adaptable technologies. The ubiquity of digital content further justifies the need to consider the impact of different digital intervention modalities in diabetes self-care activities.

OBJECTIVE: The purpose of this study is to compare the impact of two digital diabetes self-care education programs delivered separately, and in combination, to adults with type 2 diabetes across various settings in Texas.

METHODS: We conducted a randomized control trial (RCT) in Texas with 188 adults with T2DM to assess whether two different interventions alone (vMMWD or TBES) or in combination (vMMWD followed by TBES) improved multiple outcomes associated with diabetes self-management. We employed several estimation techniques including generalized estimating equations (GEE), to account for multiple factors simultaneously.

RESULTS: All three digital intervention modalities led to significant improvements (p<.05) in diabetes-related confidence, distress, and self-care behaviors, with significant effects from baseline through 6 months and supported by moderate to strong effect sizes for the total population (ranging from .446 to .827 at 3 months and .538 to .888 at 6 months). No statistically significant superiority was observed among the intervention modalities. Higher self-care behaviors were significantly associated with higher baseline confidence and lower distress. Those in the most disadvantaged positions (less education, less financial stability, and no health insurance) showed significantly larger improvement in selfcare behaviors.

CONCLUSIONS: Given the benefits associated with the current study’s interventions, we suggest future work to further develop digital content that can be tailored to individuals with T2DM to help them manage their chronic condition(s) in a cost-effective manner.

CLINICALTRIAL: This trial was registered at ClinicalTrials.gov under ID number NCT06370494.

PMID:41949910 | DOI:10.2196/87364

J Pharm Pract. 2026 Apr 8:8971900261441524. doi: 10.1177/08971900261441524. Online ahead of print.

ABSTRACT

In 2021, North Carolina (NC) authorized pharmacists to initiate hormonal contraceptives. The objectives of this pilot study were to: (1) determine where hormonal contraception (HC) services were provided; (2) evaluate patient characteristics; and (3) describe pharmacist interventions. Pharmacists who completed training and prescribed HC between April 2022 and December 2023 were invited to participate. Participants completed an online survey about pharmacy demographics and descriptive statistics were used to summarize characteristics. De-identified patient encounters were uploaded into a secure website and data was analyzed using descriptive statistics. 1309 pharmacists completed HC training. Seventeen pharmacists (1.3%) participated in the study and completed demographic surveys. Four pharmacists (24%) saw 34 patients during the study period and provided intervention data for 21 patients. Seventy percent of pharmacists worked in independent pharmacies, and 47% of pharmacies were in rural communities. Seventy percent of patients had commercial insurance (50%) or NC Medicaid (20%). Fifty-three percent of patients reported that they had a primary care provider (PCP). Pharmacists prescribed a hormonal contraceptive in 95% of patient encounters, most frequently the combined HC pill (70%). One patient was referred to a primary care clinic due to elevated blood pressure. All pharmacists in this early-adopter pilot study of contraception pharmacists practiced in independent pharmacies. Seventy percent of patients who sought care from a pharmacist were insured, approximately half did not have a primary care provider, and pharmacists initiated HC for 95% of patients. The most common HC prescribed was the combined HC pill.

PMID:41949905 | DOI:10.1177/08971900261441524

Clin Transl Sci. 2026 Apr;19(4):e70537. doi: 10.1111/cts.70537.

ABSTRACT

Pharmacogenomics (PGx) offers patients personalized treatment by guiding medication selection and dosing based on their genetic profiles. However, widespread clinical implementation remains limited, in part due to patient and provider concerns about cost and willingness to pay (WTP). This study evaluated whether an outpatient clinical consultation that educates patients on their PGx results influences their WTP for PGx testing. As part of the PROTECT-Rx trial at the University of Chicago, high-risk patients received free PGx testing and a virtual consultation at the Personalized Therapeutics Clinic (PTC). Patients completed pre- and post-visit surveys assessing PGx knowledge and WTP. Of 129 patients who had completed a PTC visit as of 1/2025, 76 completed both the PTC visit and surveys. WTP for PGx testing increased significantly from 68% pre-visit to 83% post-visit (p = 0.029). After controlling for social vulnerability, patients who had at least one cautionary or high-risk PGx result were nearly 3 times more likely to report higher willingness-to-pay (OR 2.76, p = 0.037). A single PGx consultation with review of personal results significantly increases patients’ WTP for testing, particularly among those with actionable PGx results. Understanding individual risk and the relevance of PGx enhances perceived value, suggesting that patient education is an important component in the broader adoption of pharmacogenomic testing.

PMID:41949895 | DOI:10.1111/cts.70537

Lupus. 2026 Apr 8:9612033261441392. doi: 10.1177/09612033261441392. Online ahead of print.

ABSTRACT

ObjectiveTo determine the long-term outcomes of patients with moderate-severe pediatric systemic lupus erythematosus (pSLE) treated with systematic administration of combination rituximab (RTX) and cyclophosphamide (CYC) at our institution.MethodsPatients with moderate-severe pSLE treated with the combination RTX/CYC therapy between 2013 and 2023 at a single center were included. Steroid exposure, Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores, and Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage indices were collected as primary outcomes. We also reviewed the literature of the use of RTX/CYC therapy in pSLE.ResultsEleven patients received RTX/CYC therapy in our cohort. Six of 11 patients (55%) were Black. All patients achieved sustained low disease activity as defined by SLEDAI score less than 4 and prednisone dose less than 8 mg/day. There was no statistically significant change in the SLICC/ACR damage index over time. Positive clinical outcomes were observed in all racial groups. Two of 11 patients (18%) required hemodialysis, with one requiring a transplant. Other adverse effects included anaphylaxis and cytopenias. Several reports of use of RTX/CYC therapy were identified in our literature search. Our cohort had a more racially diverse cohort compared to other studies identified in our literature review.ConclusionsOur study supports the use of rituximab and cyclophosphamide use in patients with pSLE and demonstrates its efficacy among a racially diverse cohort over the long-term follow-up period. Our study has important limitations, and larger, prospective randomized clinical trials would allow for improved protocol evaluation and comparison.

PMID:41949877 | DOI:10.1177/09612033261441392

JAMA Netw Open. 2026 Apr 1;9(4):e265775. doi: 10.1001/jamanetworkopen.2026.5775.

NO ABSTRACT

PMID:41949868 | DOI:10.1001/jamanetworkopen.2026.5775

JAMA Netw Open. 2026 Apr 1;9(4):e265648. doi: 10.1001/jamanetworkopen.2026.5648.

ABSTRACT

IMPORTANCE: Risk-reducing bilateral salpingo-oophorectomy is recommended to substantially lower ovarian cancer risk in women carrying BRCA1 or BRCA2 pathogenic variant (PV). The use of hormone replacement therapy (HRT) after risk-reducing bilateral oophorectomy (RRBO), although generally recommended, remains debated due to concerns about its possible role in breast cancer (BC) risk.

OBJECTIVE: To assess the possible association between HRT use and BC incidence after RRBO in women harboring a limited range of germline BRCA PVs.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective multicenter cohort study was conducted at 3 medical centers, including both referral and primary care facilities, in Israel. Cancer-free women (aged ≥18 years) with BRCA1 PV or BRCA2 PV, with no prior mastectomy, who underwent RRBO between January 1, 2000, and December 31, 2024, and who had at least 1 year of follow-up after RRBO were included.

EXPOSURES: HRT use after RRBO.

MAIN OUTCOMES AND MEASURES: First diagnosis or incidence of invasive BC. BC diagnoses were ascertained through pathology reports and diagnostic codes used in the electronic health records; some were confirmed via participant interviews. HRT use was assessed through medical records, pharmacy dispensing data, clinic visits, and telephone interviews. Cox proportional hazards regression models, with HRT modeled as a time-varying covariate, evaluated the associations with BC risk while adjusting for potential confounders.

RESULTS: A total of 919 women (mean [SD] age at RRBO, 47.6 [8.9] years) were included, of whom 496 had BRCA1 PV and 423 had BRCA2 PV. During a mean (SD) follow-up of 8.8 (6.2) years, 144 women (16%) were diagnosed with invasive BC. Overall, 381 participants (42%) had ever used and 538 (58%) had never used HRT following RRBO. Ever use of HRT was not associated with increased BC risk (combined estrogen-progestin: hazard ratio [HR], 1.06 [95% CI, 0.67-1.68]; estrogen only: HR, 0.89 [95% CI, 0.48-1.63]). In duration of use analyses, each year of estrogen-only HRT was associated with a reduction in BC risk overall (HR, 0.90; 95% CI, 0.81-0.99) and a reduction among participants with BRCA1 PV (HR, 0.87; 95% CI, 0.77-0.98).

CONCLUSIONS AND RELEVANCE: In this cohort study of women with BRCA PV who received HRT after RRBO, estrogen-only HRT was not associated with an increased risk of BC and was associated with a lower risk of BC among women with BRCA1 PV. Combined estrogen-progestin HRT was not associated with BC risk modification.

PMID:41949865 | DOI:10.1001/jamanetworkopen.2026.5648

JAMA Netw Open. 2026 Apr 1;9(4):e265683. doi: 10.1001/jamanetworkopen.2026.5683.

ABSTRACT

IMPORTANCE: The COVID-19 pandemic and associated lockdowns resulted in changes to the way children learned, developed, and accessed health care.

OBJECTIVE: To evaluate changes in rates and rate trends of new neurodevelopmental diagnoses for children in Ontario, Canada, before, during, and after the COVID-19 pandemic.

DESIGN, SETTING, AND PARTICIPANTS: This population-based retrospective cohort study used administrative data from ICES to assess new neurodevelopmental diagnoses from March 14, 2015, to December 31, 2024, among 291 896 children aged 6 years or younger in Ontario.

EXPOSURES: The COVID-19 pandemic period, defined as March 14, 2020, to November 30, 2022, and the postpandemic period, defined as December 1, 2022, to December 31, 2024.

MAIN OUTCOMES AND MEASURES: Monthly rate of new neurodevelopmental diagnoses per 1000 child-months, defined as the total number of children with a neurodevelopmental diagnosis divided by the total number of child-months. Interrupted time series analysis using data before, during, and after the pandemic was performed to evaluate changes in rate levels or slopes between study periods.

RESULTS: A total of 291 896 children received a neurodevelopmental diagnosis during the study period. Of 1 481 844 children at risk, 130 418 received a diagnosis in the prepandemic period (mean [SD] age, 2.5 [1.6] years; 79 573 boys [61.0%]); of 1 115 791 children at risk, 86 383 received a diagnosis during the pandemic period (mean [SD] age, 2.4 [1.6] years; 52 943 boys [61.3%]); and of 1 014 792 children at risk, 75 095 received a diagnosis in the postpandemic period (mean [SD] age, 2.7 [1.6] years; 45 030 boys [60.0%]). In the prepandemic period, rates of neurodevelopmental diagnoses increased monthly (slope = 0.04; 95% CI, 0.03-0.05; P < .001). In the first month of the pandemic, rates of neurodevelopmental diagnoses decreased by 0.91 per 1000 child-months (95% CI, -1.56 to -0.25 per 1000 child-months; P = .01) compared with the expected rate in the absence of the pandemic. Rates recovered and remained stable, with no statistically significant differences in slopes between the prepandemic period and either during or after the pandemic.

CONCLUSIONS AND RELEVANCE: This population-based cohort study showed no significant differences in rates of new neurodevelopmental diagnoses among children aged 6 years or younger from prepandemic rates in the pandemic and postpandemic periods. The rapid deployment of virtual care may have helped maintain health care access, facilitating diagnoses during the pandemic and postpandemic periods.

PMID:41949864 | DOI:10.1001/jamanetworkopen.2026.5683

JAMA Netw Open. 2026 Apr 1;9(4):e265695. doi: 10.1001/jamanetworkopen.2026.5695.

ABSTRACT

IMPORTANCE: A long-acting monoclonal antibody (nirsevimab) for use in infants aged 7 months or younger and an antenatal respiratory syncytial virus (RSV) vaccine (RSVpreF) became available in Washington state in 2023.

OBJECTIVE: To estimate the combined population-level impact of nirsevimab and antenatal RSV vaccine on the relative rate of RSV-associated hospitalizations and emergency department (ED) visits among infants during the first 2 respiratory seasons of use.

DESIGN, SETTING, AND PARTICIPANTS: This difference-in-diferrences cohort study used data from the Washington state syndromic surveillance program on RSV-associated hospitalizations and ED visits among infants from July 1, 2022, to June 30, 2025.

EXPOSURE: Introduction of nirsevimab for infants and antenatal RSVpreF.

MAIN OUTCOMES AND MEASURES: A difference-in-differences analysis was conducted to estimate mean relative changes in the rate of RSV-associated hospitalizations and ED visits between the period before and the period after introduction of RSV prevention products for children aged 7 months or younger (treatment group) beyond that for children aged 8 to 24 months (comparison group) using negative binomial models. Relative changes were estimated separately for July 1, 2023, to June 30, 2024, and July 1, 2024, to June 30, 2025, vs July 1, 2022, to June 30, 2023.

RESULTS: During July 2022 to June 2025, there were 16 775 RSV-associated hospitalizations and ED visits among children aged 24 months or younger in Washington state (median age, 10 months [IQR, 4-19 months]; 9228 male [55%]). The median age increased from 9 months (IQR, 3-19 months) during 2022-2023 to 12 months (IQR, 6-21 months) during 2024-2025. During the first year of limited use of RSV prevention products (2023-2024), estimates did not indicate a significant decrease in the rate of RSV-associated hospitalizations and ED visits among children aged 7 months or younger beyond temporal trends also observed for children aged 8 to 24 months (ratio of relative rates, 0.92 [95% CI, 0.80-1.03]). In the second year of use (2024-2025), there was an estimated 43.0% (95% CI, 32.0%-52.1%) relative decrease in the rate of RSV-associated hospitalizations and ED visits among children aged 7 months or younger beyond that for children aged 8 to 24 months. Relative changes were similar across racial groups, except for Native Hawaiian or Other Pacific Islander children. The estimated impact in 2024-2025 was 1.77 times (95% CI, 1.17-2.66 times) higher for White vs Native Hawaiian or Other Pacific Islander children.

CONCLUSIONS AND RELEVANCE: In this cohort study of children aged 24 months or younger, nirsevimab and antenatal RSVpreF vaccine were associated with a reduced burden of RSV-associated hospitalization and ED visits among infants aged 7 months or younger. Results support continued use of these products in the state. Increased coverage will likely be associated with additional decreases in severe disease burden, particularly among populations at increased risk.

PMID:41949863 | DOI:10.1001/jamanetworkopen.2026.5695

JAMA Psychiatry. 2026 Apr 8. doi: 10.1001/jamapsychiatry.2026.0181. Online ahead of print.

ABSTRACT

IMPORTANCE: Early diagnosis of attention-deficit/hyperactivity disorder (ADHD) is often recommended, but it is unknown whether age at diagnosis is associated with educational outcomes.

OBJECTIVE: To estimate whether age at ADHD diagnosis is associated with school performance, completed degrees, educational enrollment, and school dropout.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study used national registry data for individuals born in Finland between January 1, 1990, and December 31, 1999, followed up until age 20 years. Individuals were born without a diagnosis of intellectual disability (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] codes F70-F79). Analyses were conducted from May 2024 to December 2025.

EXPOSURES: Age at ADHD diagnosis, identified by the first clinical diagnosis (International Classification of Diseases, Ninth Revision code 314; ICD-10 code F90; or medication purchase).

MAIN OUTCOMES AND MEASURES: Grade point average (GPA; range, 4 [failing] to 10 [excellent]) at the end of compulsory education (approximately 16 years of age), completed degrees in upper secondary education (vocational or academic), enrollment in tertiary education, and school dropout at age 20 years.

RESULTS: The study sample included 580 132 individuals (51.2% male). Of these, 12 208 males (2.1%) and 3753 females (0.7%) had a first ADHD diagnosis between ages 4 and 20 years: mean (SD) age for males was 11.3 (4.1) years and for females was 14.4 (4.6) years. ADHD diagnosis at any age was associated with worse educational outcomes and greater likelihood of vocational than academic upper secondary education. After adjusting for sociodemographic covariates, if a diagnosis was received by age 16 years, younger age was associated with higher GPA for males (range, 7.12 [95% CI, 6.99-7.26] at age 4 years to 6.52 [95% CI, 6.46-6.58] at age 16 years) and females (range, 7.64 [95% CI, 7.49-7.78] at age 6 years to 6.95 [95% CI, 6.82-7.07]) at age 12 years, higher probability of completing an academic upper secondary degree for males (range, 20.77% [95% CI, 15.41%-26.12%] at age 4 years to 5.29% [3.78%-6.80%] at age 15 years) and females (range, 31.04% [95% CI, 15.60%-46.47%] at age 4 years to 12.01% [95% CI, 7.80%-16.21%] at age 14 years), and lower probability of school dropout for males (range, 9.16% [95% CI, 4.89%-13.42%] at age 4 years to 29.52% [95% CI, 25.85%-33.19%] at age 16 years) and females (range, 9.57% [95% CI, 4.49%-14.65%] at age 6 years to 27.16% [95% CI, 19.75%-34.57%] at age 13 years). However, after educational track choices (ages 17-20 years), older age at diagnosis was associated with higher and more academic education.

CONCLUSIONS AND RELEVANCE: In this cohort study, earlier age at ADHD diagnosis was associated with better school performance, more academic education, and lower school dropout rates than diagnoses closer to age 16 years. The findings suggest that individuals who are diagnosed closer to age 16 years could benefit from targeted support to prevent school dropout.

PMID:41949840 | DOI:10.1001/jamapsychiatry.2026.0181

J Occup Environ Med. 2026 Apr 8. doi: 10.1097/JOM.0000000000003733. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the role of PM2.5 speciation chemical mixtures in association with cardiovascular disease (CVD) risk factors during pregnancy.

METHODS: PM2.5 chemical mixtures are identified using novel statistical method. Logistic regression analyses were conducted to assess mixtures associated with CVD risk factors after controlling for known risk factors.

RESULTS: Direct Association between a PM2.5 chemical mixture and hyaline disease as well as association between some mixtures and preeclampsia, hyaline disease and gestational diabetes through interaction with race and ethnicity have been identified. The results also emphasized the need for new statistical methods for environmental health study especially when dealing with spatial-temporal data.

CONCLUSION: The study highlights the importance of considering chemical mixtures in exposure assessment and the need for more refined methodologies in future environmental health investigations.

PMID:41949838 | DOI:10.1097/JOM.0000000000003733