Category: Nevin Manimala

CNS Neurosci Ther. 2026 Jul;32(7):e71005. doi: 10.1002/cns.71005.

ABSTRACT

AIMS: The optimal antiplatelet regimen for branch atheromatous disease (BAD)-related stroke remains uncertain. This study aimed to compare the clinical outcomes of dual antiplatelet therapy (DAPT) vs. single antiplatelet therapy (SAPT) in these patients.

METHODS: From the multicenter prospective BAD-study, we collected consecutive patients with BAD who received DAPT and SAPT. Propensity score matching (PSM) was used to balance baseline characteristics. The primary efficacy endpoint was an excellent outcome, defined as a modified Rankin Scale score of 0 to 1 at 90 days. The safety endpoint was bleeding events within 7 or 90 days.

RESULTS: A total of 449 patients were enrolled in the analysis, with a median age of 60 years and a median National Institutes of Health Stroke Scale score of 3 at admission. After PSM, there were 112 patients in the SAPT group and 171 patients in the DAPT group, with well-balanced baseline characteristics. Excellent outcome occurred in 69.6% of the SAPT group and 79.5% of the DAPT group (odds ratio, 0.590; 95% confidence interval, 0.341 to 1.022; p = 0.059). No significant differences were observed in other efficacy outcomes between the two groups. In exploratory subgroup analysis, no significant treatment-by-subgroup interactions were observed, and after correction for multiple comparisons, no within-subgroup differences remained statistically significant. No increased bleeding risk was observed in DAPT.

CONCLUSION: In acute BAD-related stroke, DAPT was safe but not statistically superior to SAPT for excellent functional outcome; however, its numerical trend toward benefit warrants further investigation.

PMID:42378031 | DOI:10.1002/cns.71005

Epilepsia Open. 2026 Jun 30. doi: 10.1002/epi4.70297. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to analyze differences in pre-implantation invasive electroencephalographic (IEEG) data between vagus nerve stimulation (VNS) responders (>50% seizure reduction) and VNS nonresponders (<50% seizure reduction).

METHODS: We retrospectively identified 19 patients with drug-resistant focal epilepsy who underwent IEEG followed by VNS implantation instead of resective brain surgery. Resting-state IEEG recordings (30 min) were selected for all patients. Three biomarkers were analyzed in the IEEG data: (1) the number of interictal epileptiform discharges (IEDs), (2) the number of high-frequency oscillations (HFOs; ripples: 80-250 Hz, fast ripples: 250-600 Hz), and (3) relative entropy (all frequency bands, 80-250 Hz, and 250-600 Hz). Analyses were performed in three regions of interest: (1) the all contact zones (ACZ), (2) the seizure-onset zones (SOZ), and (3) the non-seizure onset zones (NON SOZ). Differences between VNS responders and nonresponders were then evaluated. Finally, a statistical classifier was constructed to predict VNS efficacy based on all three biomarkers in the ACZ, SOZ, and non-SOZ.

RESULTS: The only biomarker that revealed significant differences between VNS responders and nonresponders was Relative Entropy (SOZ: ripples [U = 1, p = 0.18] and fast ripples [U = 8.0, p = 0.009]), but analysis of effect size using Cliff’s delta demonstrated large effects across all three zones in the raw signal, ripple, and fast ripple frequency bands. The best accuracy of 0.84 was obtained for the classifier based on the ACZ; the accuracy of the classifier for the SOZ and NON SOZ was 0.72 and 0.79, respectively.

SIGNIFICANCE: Invasive electroencephalographic recordings can be used to predict pre-implantation VNS efficacy. In this context, Relative Entropy appears to be a crucial biomarker for distinguishing between VNS responders and nonresponders.

PLAIN LANGUAGE SUMMARY: This study shows that brain recordings taken with internal electrodes can help doctors predict whether vagus nerve stimulation will successfully reduce a patient’s seizures. We found that a specific measure of brain activity patterns, called Relative Entropy, is a key indicator of whether the treatment will be effective. These findings suggest that analyzing these brain signals can help identify the patients most likely to benefit from vagus nerve stimulation before the device is implanted.

PMID:42378010 | DOI:10.1002/epi4.70297

OTJR (Thorofare N J). 2026 Jun 30:15394492261464102. doi: 10.1177/15394492261464102. Online ahead of print.

ABSTRACT

The World Federation of Occupational Therapists emphasizes sustainability as a core component of occupational therapy education and practice. This study examined how Israeli occupational therapists perceive and apply sustainability, formally recognized but inconsistently embedded in health and social care systems. Using a cross-sectional, exploratory design, an online survey with open- and closed-ended questions was distributed via email and social media. One hundred eleven occupational therapists from diverse practice areas participated. Data were analyzed using descriptive statistics and directed content analysis. Social equity was rated as the most important sustainability principle (78.4%), followed by economic prosperity (41.4%) and environmental integrity (31.5%). Reported barriers included lack of knowledge (21%), time constraints (15%), limited organizational support (14%), limited influence (11%), and lack of incentives (11%). Findings indicate that while Israeli occupational therapists value sustainability, additional education, resources, and institutional support are needed to facilitate its integration into practice, consistent with international patterns.

PMID:42378008 | DOI:10.1177/15394492261464102

JAMA Netw Open. 2026 Jun 1;9(6):e2620264. doi: 10.1001/jamanetworkopen.2026.20264.

ABSTRACT

IMPORTANCE: Nutrition security is increasingly recognized as a critical but underexamined driver of health. Identifying barriers to nutrition security is essential for developing effective interventions.

OBJECTIVE: To examine associations among barriers to healthy eating, their prevalence by sociodemographics, and their associations with health conditions.

DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, a population-based survey was conducted between February and April 2023 among English-speaking US adults aged 18 years or older recruited and surveyed through the Qualtrics panel service, with oversampling among people with annual household incomes less than $50 000. Data were analyzed from March 18 to November 9, 2025.

EXPOSURES: Nutrition security status and barriers to nutrition security, assessed through the Nutrition Security Screener.

MAIN OUTCOMES AND MEASURES: Primary outcomes were health conditions: type 2 diabetes, obesity, heart disease, high blood pressure, high cholesterol, stroke, and cancer. Independent variables were nutrition security barriers. Covariates included age, gender, race, ethnicity, educational attainment, annual household income, and food security status. Multivariable regressions with health condition outcomes were stratified by nutrition security status.

RESULTS: Of 3009 survey respondents, 3000 provided information on barriers to nutrition security and were included in analyses (1518 [50.6%] were female; 1983 [66.1%] were between ages 18 and 49 years). A mean (SD) of 7.8 (3.0) barriers were reported among participants with nutrition insecurity compared with 4.4 (3.2) among those who had nutrition security. Most barriers were only modestly intercorrelated (mean [SD] r = 0.45 [0.13]), with the highest correlation (r = 0.86) between insufficient time to shop and to cook. Barriers clustered into 2 factors that explained 61.4% of the variance. Black adults had higher odds of transportation barriers (adjusted odds ratio [AOR], 1.56 [95% CI, 1.17-2.08]) than White adults, whereas Hispanic/Latinx adults had higher odds of nutrition assistance barriers (AOR, 1.65 [95% CI, 1.26-2.17]) than those who were non-Hispanic/Latinx. A higher number of barriers (per unit increase [range, 0-13]) was associated with higher prevalence of diabetes (AOR, 1.10 [95% CI, 1.04-1.16]), heart disease (AOR, 1.16 [95% CI, 1.07-1.24]), and obesity (AOR, 1.09 [95% CI, 1.04-1.14]) among adults with nutrition security and of heart disease (AOR, 1.12 [95% CI, 1.03-1.22]) and stroke (AOR, 1.12 [95% CI, 1.02-1.25]) among those with nutrition insecurity.

CONCLUSIONS AND RELEVANCE: In this study among US adults, barriers to nutrition security were interrelated, varied across demographics, and were associated with disease conditions. These findings provide new insights into how barriers to healthy eating can be assessed, informing more targeted clinical, public health, and policy initiatives.

PMID:42377959 | DOI:10.1001/jamanetworkopen.2026.20264

JAMA Netw Open. 2026 Jun 1;9(6):e2620504. doi: 10.1001/jamanetworkopen.2026.20504.

ABSTRACT

IMPORTANCE: Area-based social risk indices allow researchers to analyze social exposures when individual measures are not available. However, small area location data are absent from many research datasets, which motivates researchers to use higher-level geographies and clinic addresses for social risk measurement.

OBJECTIVE: To assess the suitability of using social risk indices calculated with higher-level geographies and clinic addresses.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used primary care patient records from those seen at clinics included in the American Family Cohort from 2019 through 2021. Records were linked to area-based social risk indices using either patient’s residential address or their primary care clinic’s address in a cross-sectional cohort design that included geographic levels ranging from Census block group to 3-digit zip code tabulation area (ZCTA). Data were analyzed from December 2025 to February 2026.

EXPOSURES: Three area-based social risk indices: Reproducible Area Deprivation Index (ReADI), Social Deprivation Index (SDI), and Social Vulnerability Index (SVI).

MAIN OUTCOMES AND MEASURES: Using indices calculated with patient block group as the reference, correlation of indices across geographic levels and address types (residence vs clinic) were compared, as were the indices’ associations with chronic kidney disease, hypertension, and diabetes.

RESULTS: We included 2 995 479 patients (1 667 673 [55.7%] female, 952 227 [34.0%] rural) seen at 809 clinics. Correlation of indices at the reference level (ie, block group) with the same index at the 3-digit ZCTA ranged from 0.34 to 0.48. ReADI had the highest correlation with all other geographic levels. Indices at clinic addresses were uncorrelated with patient reference values. Adjusted odds ratios (ORs) for reference indices and diabetes were between 1.21 (95% CI, 1.19-1.23) and 1.37 (95% CI, 1.34-1.40). ORs for other diseases were similar. These associations were primarily lower when higher-level geographies and clinic addresses were used.

CONCLUSIONS AND RELEVANCE: In this cohort study of the association between patient outcomes and area-based social risk indices at different geographic levels and using clinic location as a proxy for home address, indices calculated using county and 3-digit ZCTA data available in popular claims databases generally misrepresented patient risk at more granular area levels of Census block group and tract. Clinic addresses were not useful for measuring patients’ social risks.

PMID:42377958 | DOI:10.1001/jamanetworkopen.2026.20504

JAMA Netw Open. 2026 Jun 1;9(6):e2620512. doi: 10.1001/jamanetworkopen.2026.20512.

ABSTRACT

IMPORTANCE: Human papillomavirus (HPV)-related cancers cause substantial morbidity and mortality. People with HIV (PWH) and solid organ transplant recipients (SOTRs) are at heightened risk due to impaired immune function, but direct comparisons of these groups within the same population are limited; understanding the relative risk and contributing factors is essential for targeted prevention and screening.

OBJECTIVE: To compare the odds of HPV-related cancers in PWH and SOTRs with control participants and assess how clinical and sociodemographic factors modify these associations.

DESIGN, SETTING, AND PARTICIPANTS: This nested case-control study used incidence density sampling within the Swedish population. Individuals born between 1940 and 2000 and who were a resident of Sweden from 1983 to 2024 were included. HPV-related cancer cases were matched 1:10 with controls based on sex, year of birth, and region of birth.

EXPOSURE: HIV infection or history of organ transplant.

MAIN OUTCOME AND MEASURES: The primary outcome was HPV-related cancers, identified via diagnostic codes from the Swedish Cancer Registry. Odds ratios (ORs) with 95% CIs of HPV-related cancers by immunosuppression were estimated using conditional logistic regression. In secondary analyses, comparisons were stratified by sex, age at cancer diagnosis, calendar period of diagnosis, HPV-related cancer site, region of birth, education, income, income type, and civil status.

RESULTS: The study included 32 093 cases (21 206 female [65.5%]; 12 534 aged <50 years [39.4%]) and 320 930 matched control encounters (308 507 unique individuals; 201 667 female [65.4%]; 122 055 aged <50 years). Both PWH and SOTRs had elevated odds of HPV-related cancers compared with controls (PWH: adjusted OR [aOR], 4.50; 95% CI, 3.46-5.84; SOTRs: aOR, 2.23; 95% CI, 1.85-2.68). Among PWH, the highest site-specific odds were observed for anal (aOR, 58.79; 95% CI, 22.63-152.79) and penile (aOR, 8.05; 95% CI, 3.38-19.16) cancer. Among SOTRs, the highest odds were for vulvar (aOR, 7.07; 95% CI, 4.31-11.60) and penile (aOR, 6.01; 95% CI, 3.47-10.52) cancers, with variation by organ sites and time since transplant (>10 years posttransplant). In PWH, lower nadir (aOR 5.90; 95% CI, 4.04-8.61) and current (aOR, 8.62; 95% CI, 3.70-20.04) CD4 counts, shorter duration of viral suppression (aOR, 7.04; 95% CI, 4.40-11.27), and higher peak plasma HIV RNA levels (aOR, 5.66; 95% CI, 2.96-10.84) were associated with increased odds. In secondary analyses, sociodemographic factors such as lower income and nonmarried status were associated with elevated odds in both groups.

CONCLUSIONS AND RELEVANCE: In this case-control study of immunosuppressed populations, HPV-related cancer odds were increased among both PWH and SOTRs, with larger magnitudes of association observed in PWH; variation was observed by immune status, transplant characteristics, and sociodemographic factors. These findings highlight the need for enhanced prevention, including HPV vaccination, screening, and optimized immunosuppressive regimens.

PMID:42377957 | DOI:10.1001/jamanetworkopen.2026.20512

JAMA Netw Open. 2026 Jun 1;9(6):e2620871. doi: 10.1001/jamanetworkopen.2026.20871.

ABSTRACT

IMPORTANCE: Clean intermittent catheterization (CIC) is the preferred management for urinary retention. Single-use catheters generate substantial environmental and financial burdens, whereas evidence on the safety of reusable catheters is limited.

OBJECTIVE: To examine whether reusable catheters are noninferior to single-use catheters for CIC with respect to urinary tract infection (UTI) incidence.

DESIGN, SETTING, AND PARTICIPANTS: This multicenter, noninferiority randomized clinical trial was conducted between February 21, 2020, and April 3, 2025, at 12 Dutch hospitals and included patients aged 16 years or older performing CIC at least twice daily, with 1-year follow-up.

INTERVENTIONS: Participants were randomly assigned to reusable or single-use catheters. Reusable catheters were disinfected daily in 2% sodium hypochlorite solution, rinsed before and after use, and replaced every 2 weeks; single-use catheters were permitted for 20% or less of weekly catheterizations in the reusable group.

MAIN OUTCOMES AND MEASURES: The primary outcome was UTI incidence per patient-month. Secondary outcomes included catheter-related complications, adverse events, and patient-reported outcomes. The noninferiority margin was set at an absolute difference of 0.07 UTIs per patient-month.

RESULTS: A total of 386 patients (mean [SD] age, 61.4 [15.9] years; 243 [63%] male; and 139 [36%] with neurogenic lower urinary tract dysfunction) were included. In the reusable catheter group, 72 of 185 participants (39.0%) discontinued study participation, mainly due to reduced ease of use and urethral irritation. In the modified intention-to-treat population (n = 326), mean (SD) follow-up was 12.0 (1.9) months in the single-use group and 11.4 (2.9) months in the reusable group. During this period, 1 or more UTIs occurred in 59 of 191 single-use catheter users (30.9%) and 40 of 134 reusable catheter users (29.9%). The incidence rate was 0.054 (95% CI, 0.040-0.069) vs 0.050 (95% CI, 0.035-0.067) UTIs per patient-month, with an absolute difference of -0.004 (95% CI, -0.025 to 0.019), meeting the predefined noninferiority margin. Catheter-related complications and serious adverse events were comparable between groups, whereas low-grade adverse events, mainly urethral irritation, were more frequent in the reusable group (37 [20.0%] vs 9 [4.7%]). Catheter-related quality of life was higher with reusable catheters, whereas catheterization satisfaction was higher with single-use catheters; overall health-related quality of life did not differ between groups.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial of patients with urinary retention, reusable catheters were noninferior to single-use catheters for UTIs, with variable tolerability and patient-reported outcomes highlighting the importance of individual preference and the need for design enhancements to improve usability and broaden implementation.

TRIAL REGISTRATION: National Trial Register: NL8296.

PMID:42377956 | DOI:10.1001/jamanetworkopen.2026.20871

JAMA Netw Open. 2026 Jun 1;9(6):e2621242. doi: 10.1001/jamanetworkopen.2026.21242.

ABSTRACT

IMPORTANCE: Performing germline genetic testing of family members following the identification of an individual with a pathogenic variant in a cancer predisposition gene, a process known as cascade testing, is a critical step in maximizing the preventive benefit of genetic testing for hereditary cancer.

OBJECTIVE: To determine how often family members undergo cascade testing and to evaluate demographic, socioeconomic, and clinical factors associated with this process.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional study analyzed demographics, cancer history, genetic test results, and cascade testing data from probands who underwent multigene panel testing between December 2016 and August 2020 at a single diagnostic laboratory. The study cohort included probands found to have a pathogenic or likely pathogenic variant (P/LPV) in Lynch syndrome (MLH1, MSH2, MSH6, PMS2, or EPCAM) or hereditary breast and ovarian cancer (ATM, BRCA1, BRCA2, CHEK2, or PALB2) genes. Statistical analyses were conducted between June 2023 and March 2025.

EXPOSURE: Identification of a P/LPV in a cancer predisposition gene.

MAIN OUTCOMES AND MEASURES: Variables assessed included proband age, sex, race and ethnicity, socioeconomic status (SES), availability of free testing for family members, cancer history, type of test ordered, and clinician credentials. Differences in cascade testing rates were calculated via 2-sided χ2 test.

RESULTS: Of 22 932 probands (18 949 [81.38%] female; mean [SD] age at testing. 51.6 [14.5] years), 5559 (24.24%) had at least 1 family member who underwent cascade testing. Higher rates of cascade testing were seen in individuals aged 40 to 79 years compared with those aged 20 to 39 years (age 40-59 years: 2587 of 10 420 probands [24.83%]; P < .001; age 60-79 years: 1960 of 6869 probands [28.53%]; P < .001; age ≥80 years: 129 of 462 probands [27.92%]; P < .001), women (4740 of 18 948 female probands [25.02%] vs 817 of 3963 male probands [20.62%]; P < .001), non-Hispanic White individuals (3762 of 13 834 probands [27.19%]), those with a personal cancer history vs those without (4712 of 16 674 probands [39.43%] vs 847 of 6261 probands [15.64%]; P < .001), and those whose care involved genetic counselors vs those whose did not (3614 of 13 847 probands [26.10%] vs 1948 of 9088 probands [21.43%]; P < .001). People with BRCA1 or BRCA2 variants had higher cascade testing rates compared with those with ATM, CHEK2, or PALB2 variants (2614 of 9699 probands [26.95%] vs 2015 of 8973 probands [22.46%]; P < .001). Several disparities were identified, including lower rates of cascade testing among male probands and probands from racial or ethnic minority groups compared with non-Hispanic White probands (227 of 1406 African American or Black probands [16.15%]; P < .001; 175 of 875 Asian probands [20.00%]; P < .001; 319 of 1616 Hispanic probands [19.74%]; P < .001; 17 of 146 Middle Eastern probands [11.64%]; P < .001). SES had minimal associations with testing rates, and free family testing was not associated with boosting participation.

CONCLUSIONS AND RELEVANCE: In this retrospective cross-sectional study, cascade testing was underused, especially among specific demographic groups, with clinical and cultural factors appearing to play a larger role than financial barriers. These findings may guide efforts to address barriers preventing wider uptake of cascade testing and improve cancer prevention efforts, particularly among racial and ethnic minority groups.

PMID:42377955 | DOI:10.1001/jamanetworkopen.2026.21242

JAMA Netw Open. 2026 Jun 1;9(6):e2621250. doi: 10.1001/jamanetworkopen.2026.21250.

ABSTRACT

IMPORTANCE: Breast cancer incidence among Asian American, Native Hawaiian, and Pacific Islander females as an aggregated group have been increasing rapidly. The extent to which these trends apply across Asian American, Native Hawaiian, and Pacific Islander ethnic groups is unclear.

OBJECTIVE: To examine incidence trends of invasive breast cancer in 7 Asian American (Asian Indian or Pakistani, Chinese, Filipino, Japanese, Korean, Laotian or Kampuchean, and Vietnamese) and 2 Native Hawaiian or Pacific Islander (Guamanian, Chamorro, and Samoan and Native Hawaiian) ethnic groups overall and by age, stage, and subtype.

DESIGN, SETTING, AND PARTICIPANTS: This population-based, descriptive, cross-sectional study used National Cancer Institute Surveillance, Epidemiology, and End Results Program data contributed by 14 US states (3 in the Northeast, 2 in the Midwest, 4 in the South, and 5 in the West). Asian American, Native Hawaiian, and Pacific Islander females of any age diagnosed with invasive breast cancer between January 1, 2000, and December 31, 2022, were included. Data were analyzed between September 2025 and March 2026.

MAIN OUTCOMES AND MEASURES: Annual (or triannual) percentage change (APC) and 95% CIs of incidence rates were estimated using joinpoint regression, by age (<50 years, ≥50 years), stage (localized, regional, distant), and subtype (hormone receptor [HR] and ERBB2 [formerly HER2/neu] negativity and positivity).

RESULTS: A total of 148 608 Asian American, Native Hawaiian, and Pacific Islander females with breast cancer (44 234 aged <50 years [29.8%] and 104 374 aged ≥50 years [70.2%] at diagnosis; 138 808 of Asian American [93.4%] and 9800 of Native Hawaiian or Pacific Islander [6.6%] race and ethnicity) were included, among whom 63.9% were diagnosed at a localized stage and 66.6% with the HR-positive and ERBB2-negative subtype. Increased incidence rates of invasive breast cancer were observed among Asian American females (APC, 2.34%; 95% CI, 1.83%-3.68%) from 2012 to 2022, surpassing the trend in other racial and ethnic groups. A smaller steady increase was observed among Native Hawaiian or Pacific Islander females (APC, 0.84%; 95% CI, 0.48%-1.29%) from 2000 to 2022. Significant increases in overall and early-onset (ie, age <50 years) breast cancer were evident in all Asian American, Native Hawaiian, and Pacific Islander ethnic groups, with Chinese and Vietnamese females experiencing increased APCs of 4.57% (95% CI, 2.03%-8.36%) and 4.30% (95% CI, 1.98%-8.93%) since 2015 and 2016, respectively. Incidence increases were most pronounced for distant stage disease, with APCs of 4.02% (95% CI, 2.74%-5.72%) for Asian Indian and Pakistani females and 4.52% (95% CI, 2.55%-7.09%) for Chinese females. All Asian American groups, except Laotian and Kampuchean females, experienced increasing trends of HR-positive and ERBB2-negative cancer, with APCs ranging from 2.10% (95% CI, 0.74%-3.45%) for Japanese females to 6.00% (95% CI, 3.62%-8.78%) for Korean females since 2010, whereas Native Hawaiian and Pacific Islander groups saw stable trends. Nearly all Asian American groups experienced increases in triple-negative breast cancer, with an APC as high as 6.17% (95% CI, 3.30%-11.73%) among Chinese females for 2017 to 2022.

CONCLUSIONS AND RELEVANCE: This cross-sectional study found that breast cancer incidence rates increased rapidly across Asian American, Native Hawaiian, and Pacific Islander ethnic groups over a 20-year period. Research tailored to these distinct ethnic groups is needed to discern potentially novel risk factors for breast cancer. Culturally sensitive efforts are needed to promote awareness and increase breast cancer screening in distinct ethnic groups. The rapid recent increases in breast cancer incidence in Asian American, Native Hawaiian, and Pacific Islander women, especially early-onset disease, warrant urgent attention.

PMID:42377954 | DOI:10.1001/jamanetworkopen.2026.21250

JAMA Intern Med. 2026 Jun 30. doi: 10.1001/jamainternmed.2026.3411. Online ahead of print.

NO ABSTRACT

PMID:42377942 | DOI:10.1001/jamainternmed.2026.3411