Nevin Manimala

J Am Acad Orthop Surg. 2026 Apr 1;34(7):e970-e984. doi: 10.5435/JAAOS-D-25-00057. Epub 2025 Sep 8.

ABSTRACT

INTRODUCTION: Existing literature lacks clarity on how geography may affect gender disparities among pediatric orthopaedic surgeons. This study compares the academic productivity of pediatric orthopaedic attendings based on their sex and region.

METHODS: Faculty lists from the 45 Pediatric Orthopaedic Society of North America fellowship programs were accessed in February 2024. Data on sex, training history, fellowship director status, institution, publication counts, and H-indices were collected from program websites and Scopus. The attending publication rate was calculated by dividing the total number of publications completed as an attending by the number of years in practice. Results were displayed using (mean ± SD). Categorical variables were analyzed using Pearson chi square. Mann-Whitney U and one-way analysis of variance were used for nonparametric and parametric data, respectively. Analyses were done using GraphPad Prism 10, with significance set at P < 0.05.

RESULTS: Four hundred one pediatric orthopaedic surgeons (302 male, 99 female) from 45 fellowship programs were analyzed. Female surgeons had fewer publications, lower H-indices, and lower publication rates than male surgeons. In the Northeast, male attendings had higher publication counts, rates, and H-indices. Men also had higher H-indices than women in the Midwest and Southwest. Among male pediatric orthopaedic attendings, those in the Northeast exhibited the highest publication counts, rates, and H-indices. However, no regional differences were observed among female pediatric orthopaedic surgeons.

CONCLUSION: Notable gender disparities persist among pediatric orthopaedic surgeons in the United States, reflecting systemic barriers that limit women’s research opportunities. Male faculty outnumber female faculty across fellowship programs and have higher publication counts, rates, and H-indices. Regional differences were most notable in the Northeast, where male attendings had markedly higher publication counts, rates, and H-indices. H-index disparities were also present in the Midwest and Southwest. Targeted strategies are needed to improve research access and support for women trainees and faculty.

PMID:41860572 | DOI:10.5435/JAAOS-D-25-00057

JAMA Netw Open. 2026 Mar 2;9(3):e262645. doi: 10.1001/jamanetworkopen.2026.2645.

ABSTRACT

IMPORTANCE: Health care systems can help protect patients from the increasing threat of extreme heat-driven morbidity and mortality. Electronic health records (EHRs) provide insight into trends and local variation in thresholds above which extreme heat is associated with emergency department (ED) use among at-risk patient populations.

OBJECTIVE: To examine associations between extreme heat exposure and all-cause ED visits among patients aged 65 years and older.

DESIGN, SETTING, AND PARTICIPANTS: This matched case-control study of patients seeking emergency care at an urban health care system during the summer (May 1 to September 30) from 2022 to 2024. Two New York City (NYC) EDs were included: (1) ED-1, predominantly serving Medicaid-enrolled patients from minoritized racial and ethnic groups, and (2) ED-2, predominantly serving White, privately insured patients. Included patients were aged 65 years or older and presented to ED-1 and ED-2 during the study period. Data were analyzed from April to August 2025.

EXPOSURES: Daily maximum heat index (HImax) values during the summer were calculated from the National Centers for Environmental Information monitor-derived recordings.

MAIN OUTCOMES AND MEASURES: Daily all-cause ED use counts were derived from EHRs, and extreme heat exposure-outcome curves were calculated. Daily HImax anomalies were calculated based on a 30-year baseline average. The cumulative odds ratio (OR) and 95% CIs were calculated.

RESULTS: This study included 55 200 ED encounters and represented 15 092 unique patients at ED-1 and 19 559 at ED-2 with a mean (SD) age of 74.9 (8.92) years at ED-1 and 74.9 (8.72) years at ED-2. Compared with ED-2, more ED-1 patients were female (8589 [56.9%] vs 10 767 [55.0%]), Hispanic (3544 [23.5%] vs 2576 [13.2%]), and Medicaid-enrolled (1321 [8.8%] vs 824 [4.2%]). At ED-1, daily HImax associations increased after 66 °F (OR, 1.10 [95% CI, 1.01-1.21]), peaking at 101 °F (OR, 1.24 [95% CI, 1.11-1.39]), and were higher on days with HImax anomalies between 15 °F (OR, 1.07 [95% CI, 1.01-1.13]) and 18 °F (OR, 1.10 [95% CI, 1.01-1.20]) warmer than average. At ED-2, daily HImax ED use associations were not significant and were significantly negative for days with HImax anomalies above 16 °F, nadiring at 21 °F (0.84, 95% CI [0.73, 0.95]) warmer than average.

CONCLUSIONS AND RELEVANCE: In this case-control study of the association between heat exposure and ED use in adults aged 65 years and older, positive associations were only observed at ED-1, which served a predominantly lower-income population from minoritized racial and ethnic groups. These association thresholds were not fully captured by NYC heat advisories, which were triggered by 2 days above HImax 95 °F or any time above 100 °F, highlighting an opportunity for future research to develop targeted, risk-informed health care system-based heat warning strategies.

PMID:41860548 | DOI:10.1001/jamanetworkopen.2026.2645

JAMA Health Forum. 2026 Mar 6;7(3):e260034. doi: 10.1001/jamahealthforum.2026.0034.

NO ABSTRACT

PMID:41860540 | DOI:10.1001/jamahealthforum.2026.0034

JAMA Health Forum. 2026 Mar 6;7(3):e260041. doi: 10.1001/jamahealthforum.2026.0041.

ABSTRACT

IMPORTANCE: The US has faced a nationwide shortage of attention-deficit/hyperactivity disorder (ADHD) medications since 2022, yet the underlying causes remain unclear. Public debate has largely centered on prescribing trends and Drug Enforcement Administration (DEA) quotas, although evidence suggests that quotas were not binding. A sound policy response requires a clear understanding of the drivers behind the shortage.

OBJECTIVE: To examine descriptive evidence on the potential causes of the shortage.

SETTING AND DESIGN: In this economic evaluation, we use time series data (2015-2025) from multiple sources, such as Symphony Health and the DEA’s Automation of Reports and Consolidated Orders System (ARCOS) summary reports, to characterize US production, consumption, and trade of amphetamine-based and other stimulants, including manufacturer-level production volumes, before and during the shortage period.

FINDINGS: The sharp, simultaneous production cutbacks across several medium-sized and smaller manufacturers in late 2022 and early 2023 coincided with a steep contraction in US imports of raw amphetamines and more modest declines in phenylacetone, a key precursor.

CONCLUSIONS AND RELEVANCE: These patterns align with manufacturers’ reports to the US Food and Drug Administration citing a shortage of the active ingredient as the cause of backorders. More broadly, this economic evaluation reframes the discussion of ADHD medication shortages beyond DEA quotas, highlighting the vulnerability of US pharmaceutical manufacturing to international supply chain disruptions and underscoring the need for policies that strengthen supply chain resilience.

PMID:41860539 | DOI:10.1001/jamahealthforum.2026.0041

JAMA Health Forum. 2026 Mar 6;7(3):e260123. doi: 10.1001/jamahealthforum.2026.0123.

ABSTRACT

IMPORTANCE: Rates of congenital syphilis in the US have surged over the past decade, despite most states having long-standing mandates requiring clinicians to offer syphilis screening early in pregnancy. Gaps in screening coverage remain, and first-trimester screening alone may miss cases. Several professional bodies now recommend repeat screening in the third trimester and at delivery. Evidence on the impact of expanded prenatal syphilis screening mandates on case detection is limited.

OBJECTIVE: To evaluate the effectiveness of expanding prenatal syphilis screening mandates on syphilis case detection during pregnancy.

DESIGN, SETTING, AND PARTICIPANTS: Birth certificate data from 33 US states between 2012 and 2022 were analyzed using a staggered difference-in-differences design. Maternal syphilis case detection in 4 states that enacted mandates for third-trimester and delivery screening (Arizona, Georgia, Louisiana, and Michigan) were compared with 29 control states without such mandates during this period. The new mandates required all pregnant people be offered third-trimester screening. Three of the states further required that individuals at high risk of syphilis infection be offered screening again at delivery, and 1 state required universal delivery screening. To ascertain whether expanded mandates were associated with changes in screening coverage, inpatient discharge records from 1 mandate expansion state (Georgia) were analyzed. Data were analyzed from December 2024 to September 2025.

EXPOSURES: Passage of a universal syphilis screening mandate in the third trimester and a high-risk or universal mandate at delivery between 2012 and 2022.

MAIN OUTCOMES AND MEASURES: Maternal syphilis case detection (cases per 100 000 live births) and the share of deliveries receiving syphilis screening.

RESULTS: The study sample included 16.3 million live births and 20 961 reported syphilis cases between 2012 and 2022 in 4 mandate expansion states and 29 control states. Expanded screening mandates were associated with a 26% (95% CI, 3-53) increase in maternal syphilis case detection in the first quarter after enactment. The increase in case detection attenuated thereafter and was no longer significant within 1 year (11%; 95% CI, -17 to 48; P = .48).

CONCLUSIONS AND RELEVANCE: In this study, expanded prenatal syphilis screening mandates may improve syphilis case detection in the near-term but are unlikely to have sustained impact without complementary efforts, such as those that facilitate clinician adherence and ensure patient access to and completion of treatment.

PMID:41860538 | DOI:10.1001/jamahealthforum.2026.0123

JAMA Health Forum. 2026 Mar 6;7(3):e260136. doi: 10.1001/jamahealthforum.2026.0136.

ABSTRACT

IMPORTANCE: Income is a key social determinant of health, yet its influence on health system performance may differ across settings. Cross-national comparisons can help identify where income-related disparities are most pronounced and inform targeted policy responses; the US and South Korea are 2 members of the Organisation for Economic Co-operation and Development with high poverty rates but different health systems.

OBJECTIVE: To compare health system performance and income-related inequalities in health system performance between the US and South Korea.

DESIGN, SETTING, AND PARTICIPANTS: This repeated cross-sectional study including nationally representative samples of noninstitutionalized adults from the US and South Korea used data from the Medical Expenditure Panel Survey (MEPS; 2010-2019), National Health and Nutrition Examination Survey (NHANES; 2009-2018), Korean Health Panel Study (KHPS; 2010-2019), and Korean National Health and Nutrition Examination Survey (KNHANES; 2010-2019). Data were analyzed from March 2024 to March 2025.

EXPOSURES: Annual household income, categorized into country-specific deciles.

MAIN OUTCOMES AND MEASURES: The main outcomes were 30 indicators across 6 domains: health care spending, health care utilization, access to care, health status, behavioral risk factors, and clinical outcomes. To evaluate income-related inequalities in outcomes, adjusted mean values across income deciles were estimated using regression models.

RESULTS: The sample included 224 168 US adults (female: 51.1% in MEPS, 51.7% in NHANES) and 179 452 South Korean adults (female: 52.4% in KHPS, 56.1% in KNHANES). Mean (SD) age was 46.6 (18.0) years in MEPS, 46.5 (17.4) years in NHANES, 47.7 (16.2) years in KHPS, and 50.5 (17.1) years in KNHANES. US adults had higher mean total health care spending (lowest income decile: $7852 [95% CI, $7456-$8247]; highest decile: $6510 [95% CI, $6218-$6802]) than South Korean adults (lowest decile: $1184 [95% CI, $1105-$1263]; highest decile: $1025 [95% CI, $950-$1100]) despite similar levels of self-reported good health. A 1-decile increase in income was associated with a difference of -$142 (95% CI, -$179 to -$104) in total health care spending in the US compared with -$33 (95% CI, -$41 to -$25) in South Korea. A 1-decile increase in income was associated with an increase of 2.4 (95% CI, 2.3-2.5) percentage points (pp) in self-reported good health in the US compared with 1.5 (95% CI, 1.4-1.6) pp in South Korea. Income-related disparities in preventive service use were also larger in the US, ranging from 0.2 (95% CI, 0.2-0.2) pp for cervical cancer screening to 4.0 (95% CI, 3.9-4.1) pp for dental checkups. In South Korea, disparities ranged from 0.6 (95% CI, 0.4-0.8) pp for dental checkups to 2.0 (1.8-2.2) pp for routine checkups. Similar income gradients were observed in access to care and behavioral risk factors. Differences in clinical outcomes were modest in both countries.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, income was associated with disparities in health system performance in both the US and South Korea, with larger differences by income in the US. The findings suggest that structural and systemic policy efforts are needed to address income-based health inequalities, particularly in the US.

PMID:41860537 | DOI:10.1001/jamahealthforum.2026.0136

Hum Vaccin Immunother. 2026 Dec;22(1):2640760. doi: 10.1080/21645515.2026.2640760. Epub 2026 Mar 20.

ABSTRACT

Human papillomavirus (HPV)-associated cancers represent a substantial public health burden. This study analyzed the national burden of hospitalization and mortality from HPV-associated cancers in Brazil between 2011 and 2019. Outcomes included average annual numbers, crude and age-standardized rates per 100,000 population, and trends estimated via joinpoint regression for cervical, vulvar, vaginal, penile, anal, and head and neck cancers (oropharynx, larynx, and oral cavity). Between 2011 and 2019, HPV-attributable cancers accounted for an average of 29,155 hospitalizations (14.3 per 100,000) and 7526 deaths (3.7 per 100,000) annually across both sexes. Among females, there were an average of 24,921 hospitalizations (24.0 per 100,000) and 6430 deaths annually, largely driven by cervical cancer. Among males, there were an estimated 4234 HPV-attributable hospitalizations and 1096 deaths per year (4.1 and 1.1 per 100,000, respectively), with penile, anal, and oropharyngeal cancers being the largest contributors. Cervical cancer accounted for 74.3% of HPV-attributable hospitalizations, followed by anal (10.4%), head and neck (9.2%), and penile cancers (3.4%). Most HPV-associated cancers showed stable hospitalization and mortality trends over time. For cervical cancer, hospitalizations rose by 3.9% annually between 2016 and 2019, while mortality rose by 0.7% annually over the entire period. Anal cancer showed significant increases in both hospitalizations (AAPC = 3.1%) and mortality (AAPC = 10.9%). These findings underscore the need for continued efforts to prevent and reduce the burden of HPV-associated cancers in Brazil, including expanded cohort vaccination, consideration of higher-valency vaccines, and improved access to early detection and timely treatment for both sexes.

PMID:41860526 | DOI:10.1080/21645515.2026.2640760

J Am Dent Assoc. 2026 Mar 20:S0002-8177(26)00101-7. doi: 10.1016/j.adaj.2026.02.001. Online ahead of print.

ABSTRACT

BACKGROUND: Intraoral radiograph machines have evolved over the past century, but their design, especially the collimator, has changed little. Although circular collimation is easier to use, it exposes the patient to more radiation. Rectangular collimation reduces this dose by 50% through 60% but increases the risk of experiencing positioning errors. The authors aimed to determine whether the radioprotection benefits outweigh the technical disadvantages.

METHODS: This retrospective study included intraoral radiographs obtained by dental students with both standard circular collimation and rectangular collimation. Two independent blinded evaluators analyzed the radiographs to identify all types of errors and retakes.

RESULTS: The rates of cone cuts and cone cuts requiring retakes were 20.9% and 5.7%, respectively, with rectangular collimation. These rates were substantially higher than with circular collimation (1.8% and 0.7%, respectively). The differences in the proportion of retakes due to cone cuts between rectangular collimation (27.2%) and circular collimation (36.0%) were not statistically significant. Moreover, the overall retake rate was not significantly different between rectangular collimation (16.9%) and circular collimation (16.7%) (P = .922).

CONCLUSIONS: The number of retakes was not significantly higher with rectangular collimation, despite a significant increase in cone cuts. It should be recommended that clinicians with proper training use this type of collimation in conjunction with a positioning device due to the considerable reduction in radiation exposure.

PRACTICAL IMPLICATIONS: Special attention must be paid to cone positioning and clinical training to fully benefit from the radioprotective advantages of rectangular collimation.

PMID:41860525 | DOI:10.1016/j.adaj.2026.02.001

J Allergy Clin Immunol. 2026 Mar 20:S0091-6749(26)00173-9. doi: 10.1016/j.jaci.2026.02.035. Online ahead of print.

NO ABSTRACT

PMID:41860512 | DOI:10.1016/j.jaci.2026.02.035

JACC Heart Fail. 2026 Mar 19:103013. doi: 10.1016/j.jchf.2026.103013. Online ahead of print.

NO ABSTRACT

PMID:41860507 | DOI:10.1016/j.jchf.2026.103013