Nevin Manimala

J Occup Health. 2026 Jul 31:uiag044. doi: 10.1093/joccuh/uiag044. Online ahead of print.

ABSTRACT

OBJECTIVES: Unpredictable work schedule changes have emerged as a distinct occupational health concern, yet their association with chronic sleep disorders remains understudied. Given the contrasting institutional contexts of Korea and Europe, we hypothesized that the association would differ in magnitude between the two regions and examined this using a dose-response framework based on advance notice timing.

METHODS: This cross-sectional study analyzed data from the 2017 Korean Working Conditions Survey and the 2015 European Working Conditions Survey. Habitual work schedule unpredictability, reflecting structural instability in working time arrangements, was assessed by advance notice timing. Sleep disorders were assessed using the validated Minimal Insomnia Symptom Scale. Stratified and sensitivity analyses were performed.

RESULTS: Unpredictable schedule changes were associated with higher odds of sleep disorders in Korea (adjusted OR = 2.544, 95% CI: 2.195-2.948) and Europe (adjusted OR = 1.787, 95% CI: 1.543-2.070), with a formally confirmed regional difference (p for interaction < 0.0001). Risk increased progressively as advance notice shortened, demonstrating a clear dose-response relationship. Among subgroups, a statistically significant interaction was identified for long working hours in Korea, with stronger associations observed among those without overtime.

CONCLUSION: Habitual work schedule unpredictability is a distinct occupational risk factor for sleep disorders. The observed dose-response pattern suggests that greater advance notice may be associated with lower risk, highlighting schedule predictability as a potential occupational health priority warranting regulatory and organizational attention.

PMID:42536410 | DOI:10.1093/joccuh/uiag044

JAMA Health Forum. 2026 Jul 2;7(7):e262492. doi: 10.1001/jamahealthforum.2026.2492.

ABSTRACT

IMPORTANCE: US nursing home closures, whether planned or unexpected, can disrupt continuity of care, place additional burdens on remaining facilities, and disproportionately affect vulnerable populations. It is important to understand the trends and factors associated with these closures, as such knowledge can inform policy decisions, guide resource allocation, and help develop strategies to mitigate negative effects on both residents and the broader health care system.

OBJECTIVE: To examine nursing home operational dynamics in the US and to identify how facilities transition through openings, closures, and changes of ownership (CHOW).

DESIGN, SETTING, AND PARTICIPANTS: A longitudinal cohort study used 40 years of data from the Centers for Medicare & Medicaid Services Provider of Services File, covering the period from 1985 through June 2025. Facility trajectories were examined using physical location identifiers rather than facility names or provider identifiers.

MAIN OUTCOMES AND MEASURES: Facility lifecycle status (active, closed, or reopened), CHOW events, net changes in certified bed capacity, facility size, availability of specialized beds for patients with dementia, Medicare and Medicaid participation, and staffing intensity were assessed. Descriptive statistics and multivariate logistic regression were used to analyze trends and differences between closed and active facilities.

RESULTS: A total of 39 449 records were analyzed, representing 33 110 unique physical locations and 80 257 event records. Nearly half of all entities followed an entry-exit trajectory without any CHOW, accounting for 46.29% (n = 15 328). A substantial proportion of entities remained active while experiencing at least 1 CHOW (20.48% [n = 6780]). CHOW events accounted for 13 053 occurrences (16.26%) of lifecycle activity, and capacity changes were increasingly concentrated in recent years in select states. Overall, organizational restructuring and within-facility capacity adjustment became more prominent over time than entry or exit.

CONCLUSIONS AND RELEVANCE: This study found that nursing home markets were characterized by continuous organizational change, with ownership transitions and capacity reconfiguration increasingly substituting for entry and exit. Examining the location-based life cycle of the facility shows that closure often reflects restructuring within evolving ownership structures rather than a single terminal event. These findings suggest that nursing home policy and oversight should attend to ownership transitions and capacity reconfiguration, alongside measures of facility entry and exit.

PMID:42536385 | DOI:10.1001/jamahealthforum.2026.2492

J Vis. 2026 Jul 1;26(7):18. doi: 10.1167/jov.26.7.18.

ABSTRACT

The spatial suppression of a high-probability distractor location (HPDL) acquired through statistical learning critically reduces its attentional priority. The present study conducted four experiments to systematically investigate the mechanisms underlying how this learned suppression generalizes to novel tasks. Specifically, we focused on how generalization is influenced by the priority-enhancing attentional capture of a salient target and the competing demands of a newly introduced suppression process. Following training, Experiments 1 and 2 employed a salient color singleton target to test attentional capture. Experiment 1 reused training stimuli, whereas Experiment 2 introduced novel shapes to determine if the capture effect of novel stimuli would completely override the learned suppression. Experiment 3 introduced a new suppression process to evaluate the impact of competing suppression demands. Finally, Experiment 4 utilized a feature search paradigm as a test task devoid of color singletons to eliminate these interfering factors. The results revealed that the intense capture effect of novel stimuli in Experiment 2 completely masked the generalization. Furthermore, sliding window analyses in Experiments 1 and 3 uncovered a dynamic process where generalization only manifested during the middle of the test phase, indicating a competition between these newly introduced factors and the previously acquired suppression. Conversely, eliminating all interference in Experiment 4 yielded a highly stable and persistent generalization of the HPDL suppression. These findings demonstrate that novel interfering factors drive a dynamic adjustment of the HPDL weight within the priority map, revealing the highly flexible and adaptive nature of human attentional control.

PMID:42536381 | DOI:10.1167/jov.26.7.18

JAMA Netw Open. 2026 Jul 1;9(7):e2625985. doi: 10.1001/jamanetworkopen.2026.25985.

ABSTRACT

IMPORTANCE: Prior research found differences in the perceived safety benefits from firearm exposure among diverse gun owners. More women have bought firearms in recent years, resulting in a growing proportion of women who own guns.

OBJECTIVE: To examine differences in perceptions of safety among US women, including women who personally own firearms.

DESIGN, SETTING, AND PARTICIPANTS: This descriptive survey study used data from the nationally representative National Survey of Gun Policy, fielded January 6 to 24, 2025. Participants included members of the AmeriSpeak panel who were invited to, and completed, the survey (survey completion rate, 69.8%; N = 2977) online or by telephone in English or Spanish. This study focused specifically on women respondents.

EXPOSURES: Women respondents were stratified by whether they personally owned a gun, lived in a home with a gun that did not belong to them, or had no guns in the home.

MAIN OUTCOMES AND MEASURES: The main outcome was differences in respondents affirming whether “personally owning a gun will make me safer” and “I would feel safer if more people were allowed to legally carry guns.” These perceptions were also examined across racial and ethnic subgroups of gun-owning women and by whether protection in or out of the home were important reasons for ownership. Differences were assessed using survey-weighted logistic regression models.

RESULTS: A total of 1411 women completed the survey. The mean (SE) age of women respondents was 48.4 (0.6) years; 12.8% self-identified as non-Hispanic Black, 17.4% as Hispanic, 60.3% as non-Hispanic White, and 9.5% as non-Hispanic other race. Overall, 41.1% (95% CI, 37.7%-44.4%) of women affirmed that personally owning a gun would make them safer, and 21.3% (95% CI, 18.5%-24.0%) agreed they would feel safer if more people were allowed to legally carry guns. Affirmations were significantly higher among gun-owning women (69.7% [95% CI, 63.0%-76.3%] and 35.3% [95% CI, 28.6%-42.0%], respectively), compared with those living in homes with guns (48.9% [95% CI, 40.6%-57.1%] and 22.2% [95% CI, 15.1%-29.3%]) and gun-free homes (26.0% [95% CI, 22.5%-29.6%] and 14.8% [95% CI, 11.9%-17.8%]). Among gun owners, agreement with perceived safety gains from ownership ranged from 63.2% (95% CI, 36.7%-89.8%) among non-Hispanic other to 72.6% (95% CI, 56.1%-89.1%) among Hispanic respondents, and perceived safety from others carrying from 20.1% (95% CI, 9.4%-30.9%) among Black to 40.5% (95% CI, 13.4%-67.6%) among non-Hispanic other respondents, with no significant differences by racial and ethnic groups. There were no significant differences when comparing those who did vs did not report that protection in the home or out of the home were important reasons for ownership.

CONCLUSIONS AND RELEVANCE: In this survey study of US women, more than half of overall respondents perceived they would not feel safer with greater exposure to firearms, although results varied by personal gun ownership. As gun ownership diversifies, these findings highlight the importance of attending to perceptions of safety in discussions of interventions to reduce gun violence.

PMID:42536373 | DOI:10.1001/jamanetworkopen.2026.25985

JAMA Netw Open. 2026 Jul 1;9(7):e2626522. doi: 10.1001/jamanetworkopen.2026.26522.

ABSTRACT

IMPORTANCE: Remote patient monitoring (RPM), including self-measured blood pressure monitoring with clinician review and telehealth-supported feedback, can support hypertension management. However, RPM use and related care continuity after switching from Medicare fee-for-service (FFS) to Medicare Advantage (MA) remain unclear.

OBJECTIVE: To compare RPM adoption, clinician continuity, and hypertension-related acute care utilization among beneficiaries who remained in Medicare FFS vs switched to MA plans, categorized as value-based contract (VBC) proxy or non-VBC.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study with an observational difference-in-differences design with propensity score matching used data from 2016 to 2022 Medicare enrollment, FFS claims, and MA encounter data. Beneficiaries were aged 65 years or older with prevalent diagnosed hypertension in 2018 and continuous enrollment in Parts A and B in 2018. Treated groups switched from FFS to MA in January 2019 and remained enrolled through 2022; comparators remained in FFS. Follow-up extended from January 1, 2019, through December 31, 2022. Data analysis was conducted from April to July 2025.

EXPOSURE: Switching from Medicare FFS to MA-VBC proxy or MA non-VBC in 2019.

MAIN OUTCOMES AND MEASURES: The primary outcome was annual RPM adoption during hypertension-related visits; secondary outcomes included clinician loss without replacement, clinician switching or substitution, and hypertension-related emergency department (ED) visits and hospitalizations.

RESULTS: Matched samples included 281 620 beneficiaries, with 46 833 MA-VBC proxy plan switchers and 46 833 FFS comparators (27 920 [59.6%] aged 71 years or older and 27 685 female [59.1%] in each group) and 93 977 MA non-VBC switchers and 93 977 FFS comparators (67 188 [71.5%] aged 71 years or older; 53 122 female [56.5%] in each group). Common comorbidities included diabetes, chronic kidney disease, and heart failure. Switching to MA was associated with lower RPM adoption in 2022 (MA-VBC proxy: odds ratio [OR], 0.55; 95% CI, 0.42-0.72; -0.63 percentage points; non-VBC: OR, 0.73; 95% CI, 0.54-0.99; -0.52 percentage points), greater clinician loss without replacement (MA-VBC proxy: OR, 1.27; 95% CI, 1.23-1.32; 3.41 percentage points; MA non-VBC: OR, 1.09; 95% CI, 1.06-1.12; 0.83 percentage points), and higher hypertension-related hospitalizations (MA-VBC proxy: OR, 1.75; 95% CI, 1.48-2.06; MA non-VBC: OR, 1.94; 95% CI 1.71-2.19; 1.56 percentage points in both comparisons). Event-study analyses showed postswitch divergence through 2022.

CONCLUSIONS AND RELEVANCE: In this cohort study of older Medicare beneficiaries with hypertension, switching from FFS to MA was associated with lower RPM adoption, greater clinician discontinuity, and higher hypertension-related acute care use. These findings suggest that continuity safeguards and clearer payment or quality incentives during MA transitions may support remote monitoring and clinician follow-up for hypertension.

PMID:42536372 | DOI:10.1001/jamanetworkopen.2026.26522

JAMA Netw Open. 2026 Jul 1;9(7):e2626538. doi: 10.1001/jamanetworkopen.2026.26538.

ABSTRACT

IMPORTANCE: Perspectives of families from historically marginalized groups regarding pediatric oncology clinical trial participation are not well-represented in the literature.

OBJECTIVE: To describe clinician- and parent-perceived facilitators and barriers to clinical trial participation.

DESIGN, SETTING, AND PARTICIPANTS: This single-center cross-sectional study with an explanatory sequential mixed-methods design enrolled parents of Black and Hispanic children with cancer as well as pediatric oncology clinicians from a large pediatric cancer center in Boston, Massachusetts. Parent participants completed single-time point surveys, and a subset, purposively sampled based on self-identified race and ethnicity, language, and household material hardship (HMH; ie, food, housing, transportation, or utility insecurity), completed semistructured interviews from September to December 2021. Clinicians completed semistructured interviews from February to March 2022. Data were analyzed from April 2022 to October 2025.

MAIN OUTCOMES AND MEASURES: Key factors influencing clinical trial participation in pediatric oncology among parents from historically marginalized groups. Quantitative data were summarized descriptively. Interview transcripts were analyzed using thematic analysis and integrated along key domains.

RESULTS: A total of 60 parents completed the questionnaire; self-identified race and ethnicity included 5 Hispanic Black (8%), 10 Hispanic White (17%), 21 Hispanic other (35%), 21 non-Hispanic Black (35%), and 3 non-Hispanic White (5%) parents; most were mothers (51 [85%]). Twenty parents participated in interviews. Fifteen clinicians (10 [67%] female participants; 10 [67%] with ≥10 years caring for children with cancer) were interviewed, including 12 (80%) attendings and 3 (20%) advanced practice practitioners; most identified as non-Hispanic White (14 [93%]). Most families experienced HMH (44 [73%]) and reported high trust in their oncology team (mean [SD] score, 4.63 [0.65] of 5.00). Qualitatively, parents and clinicians aligned in identifying altruism and trustworthiness as facilitators to trial participation, while the informed consent discussion, non-English language preference, trial materials, and study requirements were participation barriers. Unlike clinicians, parents did not identify HMH or the experimental nature of trials as significant barriers to participation. Parents identified the desire for representation as a facilitator to participation, and clinicians identified gatekeeping as a barrier.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of pediatric oncology families from historically marginalized groups and clinicians, clinician- and parent-perceived barriers identified opportunities to increase equitable trial participation. Next steps include standardization of trial eligibility screening and systematic HMH screening and support to reduce gatekeeping.

PMID:42536371 | DOI:10.1001/jamanetworkopen.2026.26538

JAMA Netw Open. 2026 Jul 1;9(7):e2626547. doi: 10.1001/jamanetworkopen.2026.26547.

ABSTRACT

IMPORTANCE: Endotracheal aspirate culture (EAC) practices for evaluation of ventilator-associated infections (VAI) vary widely across pediatric hospitals, and overuse can contribute to overdiagnosis and overtreatment for VAI. Diagnostic stewardship strategies to optimize EAC testing practices may reduce overtesting and unnecessary antibiotic treatment.

OBJECTIVE: To evaluate the association of diagnostic stewardship of EACs using clinical decision support with culture rates, antibiotic use, and patient outcomes across a multicenter collaborative of pediatric intensive care units (PICUs).

DESIGN, SETTING, AND PARTICIPANTS: This was a multicenter cohort study with a pre-post study design among the BrighT STAR (Testing Stewardship for Antibiotic Reduction) Quality Improvement (QI) Collaborative involving PICUs across the US between 2019 and 2023. Data were collected from the participating sites and from the Children’s Hospital Association Pediatric Health Information System and were analyzed from August to December 2025.

EXPOSURE: Participating PICUs conducted local QI programs focused on optimizing EAC practices, facilitated by the BrighT STAR collaborative.

MAIN OUTCOMES AND MEASURES: The primary outcome was the monthly rate of EACs per 100 ventilator-days. Secondary outcomes included rates of antibiotic initiations and antibiotic days of therapy, bronchoalveolar lavage cultures, readmissions, length of stay, ventilation duration, ventilation-free days, sepsis, and septic shock. Analysis included adjustment for seasonality.

RESULTS: Across 15 sites (median [IQR] unit size, 30 [25-38] beds), the study captured 106 967 ventilator-days preimplementation and 92 167 ventilator-days postimplementation. Comparing 24 months in the preimplementation period with the 18 months in the postimplementation period, the mean monthly EAC rate declined by 16% from a preimplementation to postimplementation rate of 7.80 to 6.55 cultures per 100 ventilator-days (relative rate [RR], 0.84; 95% CI, 0.78-0.90). The rate of antibiotic initiations remained stable (RR, 0.98; 95% CI, 0.89-1.08), as well as the antibiotic days of therapy rate (RR, 1.03; 95% CI, 0.95-1.11). There were no significant changes in the rates of bronchoalveolar lavage cultures, PICU length of stay, PICU or hospital readmissions, sepsis, septic shock, ventilation duration, or ventilator-free days.

CONCLUSIONS AND RELEVANCE: In this multicenter cohort study, diagnostic stewardship of EACs using clinical decision support led by multidisciplinary teams was associated with reduced EAC use in the PICU without safety concerns. Future work will determine optimal implementation strategies, assess sustainability and the cost impact of EAC stewardship.

PMID:42536370 | DOI:10.1001/jamanetworkopen.2026.26547

JAMA Netw Open. 2026 Jul 1;9(7):e2626634. doi: 10.1001/jamanetworkopen.2026.26634.

ABSTRACT

IMPORTANCE: Previous research has shown neighborhood environmental interventions can improve health and safety for residents. It is unknown whether these interventions impact opioid overdose outcomes.

OBJECTIVE: To evaluate the association of neighborhood environmental interventions with opioid overdose rates.

DESIGN, SETTING, AND PARTICIPANTS: This quasi-experimental nonrandomized trial used a continuous treatment difference-in-differences design and was conducted in a single neighborhood of Philadelphia, Pennsylvania, between January 1, 2019, and December 31, 2021. The quasi-experimental design used nonrandomized comparator groups to evaluate the associations of neighborhood environmental interventions with opioid overdose rates since randomization was not possible. Data analysis took place between May 2022 and February 2025.

INTERVENTIONS: Community trash pickups, vacant lot cleanups, and abandoned house remediation.

MAIN OUTCOMES AND MEASURES: Outcomes of interest were nonfatal and fatal opioid overdoses.

RESULTS: Of 1667 individual blocks (median household income, $37 821) included in the study geography, 622 blocks (37.3%) received at least 1 intervention during the study period. Among 59 590 residents in the study area, there were 1179 Asian residents (2.0%), 9951 Black residents (16.7%), 23 261 White residents (39.0%), 5016 residents (8.4%) who identified as 2 or more races, and 19 903 residents (33.4%) who identified as another race; 30 286 residents (50.8%) were Hispanic or Latinx. A total of 763 community trash pickups, 483 abandoned house remediations, and 855 vacant lot cleanups were included in analysis. In aggregate, the interventions were associated with a significant reduction in fatal opioid overdoses (change, -6.6%; 95% CI, -10.5% to -2.4%), with no measurable association for nonfatal opioid overdoses (change, -0.0%; 95% CI, -3.4% to 3.5%). Abandoned house remediation was associated with a significant reduction in both fatal (change, -17.6%; 95% CI, -26.2% to -7.9%) and nonfatal (change, -11.5%; 95% CI, -19.0% to -3.3%) opioid overdoses. Community trash pickup was not associated with rates of fatal or nonfatal overdoses. Vacant lot cleanup was not associated with rates of fatal overdoses but was associated with a significant increase in nonfatal overdoses (change, 11.7%; 95% CI, 4.0% to 20.0%). No significant displacement associations were found in other locations.

CONCLUSIONS AND RELEVANCE: In this study of the association of neighborhood environmental interventions with opioid overdose rates, interventions analyzed in aggregate were associated with reduced fatal opioid overdoses outcomes, with no association with nonfatal outcomes. Abandoned house remediation was significantly associated with reduced fatal and nonfatal opioid overdose rates and should be considered along with other essential interventions that provide treatment and harm reduction to individuals with substance use disorder.

PMID:42536369 | DOI:10.1001/jamanetworkopen.2026.26634

Biometrics. 2026 Jul 1;82(3):ujag122. doi: 10.1093/biomtc/ujag122.

ABSTRACT

In clinical trials, a treatment rarely benefits every patient, underscoring the need to identify subgroups that are more likely to respond. Traditional subgroup analysis approaches, including finite mixture and threshold models, often rely on stringent distributional assumptions and prespecified subgroup structures that may be unrealistic in practice. Moreover, the resulting subgroups can be difficult to interpret and may not generalize well to new patients. To address these challenges, we propose a new least-squares regression framework that accommodates flexible subgroup structure in heterogeneous data. Our model is distribution-free and allows subgroup membership to depend on covariates, while permitting both the number and the organization of coefficient groups to vary across covariates. Building on regularization, we develop a computationally efficient procedure to detect subgroup structure in linear regression coefficients and then use a support vector machine to recover the corresponding partitions, enabling subgroup membership prediction for future individuals. Relative to pairwise fused regularization, our approach substantially reduces computational complexity. We also establish theoretical guarantees for estimation of group-specific parameters and recovery of the underlying partitions. Simulation studies and a real-data application illustrate the practical effectiveness of the proposed method.

PMID:42536360 | DOI:10.1093/biomtc/ujag122

Cancer Epidemiol Biomarkers Prev. 2026 Jul 31. doi: 10.1158/1055-9965.EPI-26-0300. Online ahead of print.

ABSTRACT

BACKGROUND: It is believed that contact of the urothelial lining to carcinogens induces mutations that lead to cancer. Nocturia, waking up at night to urinate, may void carcinogens and reduce risk of bladder cancer.

METHODS: The Cancer Prevention Study-II Nutrition Cohort is a prospective study of cancer incidence that enrolled participants in 1992 with biennial follow-up beginning in 1997. Cases were ascertained through state cancer registry, medical record verification, or death certificate. Cox models were used to calculate hazard ratios(HR) and 95% confidence intervals(95%CI) for the association between nocturia and primary incident bladder cancer.

RESULTS: Among 49,767 males, 2,655 reported being current smokers in 1997 (30,559 former smokers). There were 1,207 bladder cancers over 210-million person-years of follow-up. Adjusting for demographic and health factors, nocturia once/night was associated with 46% decreased risk of bladder cancer among smokers(HR once/night 0.54, 95%CI 0.30, 0.95; HR 2+/night 0.90, 95%CI 0.52, 1.57). We observed no association among non-smokers(HR once/night 1.10, 95%CI 0.72, 1.69; HR 2+/night 1.17, 95%CI 0.75, 1.81) or former smokers(HR once/night 1.17, 95%CI 0.92, 1.49; HR 2+/night 1.12, 95%CI 0.87, 1.43). Our main findings were no longer statistically significant in 2-year(HR 0.58, 95%CI 0.31, 1.09) and 5-year lag models(HR 0.80, 95%CI 0.32, 1.99).

CONCLUSIONS: Only nocturia once per night was associated with lower risk of bladder cancer in current smokers; however, associations were attenuated in lag analyses, and no dose-response was observed.

IMPACT: Nocturia may reduce risk of bladder cancer among smokers. Further work is needed to confirm findings and understand mechanisms.

PMID:42536351 | DOI:10.1158/1055-9965.EPI-26-0300