Category: Nevin Manimala

JAMA Netw Open. 2025 Mar 3;8(3):e250392. doi: 10.1001/jamanetworkopen.2025.0392.

ABSTRACT

IMPORTANCE: Addressing health disparities in lesbian, gay, bisexual, transgender, and queer (LGBTQ+) communities has been a significant policy focus for more than a decade. Ensuring access to safe, respectful primary health care from knowledgeable clinicians is crucial for reducing health inequalities.

OBJECTIVE: To assess the engagement of primary care practices in LGBTQ+ affirming care activities and identify practice characteristics associated with increased engagement.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from the National Survey of Healthcare Organizations and Systems II, which focused on primary care practices in the US and was administered between June 2022 through February 2023. Participants were primary care physicians and practice managers. Percentages were weighted for national representation. Data were analyzed from November 2023 to December 2024.

EXPOSURE: Practice characteristics including practice size, ownership, federally qualified health center (FQHC) designation; percentage of patients enrolled in Medicare; percentage of patients enrolled in Medicaid; having accountable care organization (ACO) contracts for Medicare, Medicaid, or commercial insurance; rurality; census region; and LGBTQ+ Equality Score by state policy.

MAIN OUTCOMES AND MEASURES: Sexual orientation- and gender identity- (SOGI) affirming activities, a composite variable reflecting activity specific to SOGI patients.

RESULTS: Among 1245 practices in the sample (38.4% response rate), 923 (77.40%) collected data on gender identity, 921 (75.62%) on sexual orientation, and 742 (65.83%) on patients’ pronouns. Only 412 practices (34.42%) provided LGBTQ+ training for clinicians and 480 practices (39.20%) provided training for staff. Practices designated as FQHCs had 3.16 (95% CI, 4.60 to 19.73) percentage points higher probability of engaging in all SOGI-affirming activities) compared with non-FQHCs (P = .001). Practices with a Medicaid payer mix at least 50% had 3.28 (95% CI, 1.19 to 5.36) percentage points higher probability than practices with less than 50% Medicaid payer mix (P = .002), and participation in a Medicaid ACO was associated with 4.26 (95% CI, 0.78 to 7.73) percentage points increased probability compared with nonparticipants (P = .02). Each 1-unit increase in the state-level LGBTQ+ Equality Score was associated with 1.07 (95% CI, 0.28 to 1.85) percentage points higher probability of engaging in all SOGI-affirming activities (P = .02). High performance was negatively associated with practice rurality (average marginal effect, -16.00 [95% CI, -29.72 to -2.28]; P = .02), and rural practices were less likely to provide appropriate referrals (average marginal effect, -15.47 [95% CI, -29.22 to -1.72]; P = .03).

CONCLUSIONS AND RELEVANCE: These findings suggest there is a need for federal and state mandates to require LGBTQ+ health care and competency training for health professionals and standardized data collection on SOGI, and these may be particularly important in rural regions. These measures are essential to evaluate practice performance and address health disparities effectively.

PMID:40063021 | DOI:10.1001/jamanetworkopen.2025.0392

JAMA Pediatr. 2025 Mar 10. doi: 10.1001/jamapediatrics.2024.7057. Online ahead of print.

ABSTRACT

IMPORTANCE: Recent studies have associated the COVID-19 pandemic with negative developmental outcomes in children. However, research focused on young children remains limited, with few studies including multiple years of pre- and postpandemic onset data.

OBJECTIVE: To examine the impact of the COVID-19 pandemic on US kindergarteners’ developmental health.

DESIGN, SETTING, AND PARTICIPANTS: This repeated cross-sectional panel study examined developmental health trends, as measured by the Early Development Instrument (EDI), among a convenience sample US kindergarteners from 2010 to 2023. EDI data were obtained from 390 school districts across 19 states. Data were analyzed from June December 2024.

EXPOSURE: Kindergarteners’ developmental health was compared between prepandemic (2018 to 2020) and postpandemic (2021 to 2023) onset cohorts.

MAIN OUTCOMES AND MEASURES: Outcomes were EDI scores across time in 5 domains: (1) physical health and well-being, (2) social competence, (3) emotional maturity, (4) language and cognitive development, and (5) communication and general knowledge. The mean (95% CI) EDI scores were assessed.

RESULTS: In this sample of of 475 740 US kindergarten students, 242 869 were male (51.1%), there were 53 841 African American or Black students (11.4%), 263 037 Hispanic or Latino/a students (55.5%), and 95 258 White students (20.1%), and the mean (SD) age was 6 (0.4) years (range, 4.0-8.0 years). Compared with the immediate prepandemic onset period, the rate of change in EDI scores was significantly lower following the pandemic onset in language and cognitive development (mean change, -0.45; 95% CI, -0.48 to -0.43), social competence (mean change, -0.03; 95% CI, -0.06 to -0.01), and communication and general knowledge (mean change, -0.18; 95% CI, -0.22 to -0.15). EDI scores were significantly higher in emotional maturity (mean change, 0.05; 95% CI, 0.03 to 0.07), and no significant changes were observed in the physical health and well-being domain (mean change, 0; 95% CI, -0.01 to 0.02).

CONCLUSIONS AND RELEVANCE: The COVID-19 pandemic was associated with varying developmental health outcomes in kindergarteners. Negative developmental trends existed immediately before the pandemic, with most persisting or slowing postpandemic onset. These results highlight troubling trends in kindergarteners’ development, both before and during the pandemic, and more information is needed to understand why developmental outcomes are worsening over time.

PMID:40063020 | DOI:10.1001/jamapediatrics.2024.7057

Eur J Psychotraumatol. 2025 Dec;16(1):2469978. doi: 10.1080/20008066.2025.2469978. Epub 2025 Mar 10.

ABSTRACT

Background: Evidence supporting the association between posttraumatic stress disorder (PTSD) and cognitive impairment is accumulating. However, less is known about which factors influence this association.Objective: The aims of this meta-analysis were to (1) elucidate the association between PTSD and a broad spectrum of cognitive impairment, including the risk of developing neurocognitive disorder (NCD) later in life, using a multilevel meta-analytic approach, and (2) identify potential moderating factors of this association by examining the effects of age (20-39, 40-59, 60+), study design (cross-sectional or longitudinal), study population (war-exposed populations/veterans or the general population), neurocognitive outcome assessed (i.e. a diagnosis of NCD or type of cognitive domain as classified according to A Compendium of Neuropsychological tests), gender (≥50% women or <50% women), study quality (high vs low), type of PTSD measure (self-report or clinical diagnosis), as well as the presence of comorbidities such as traumatic brain injury (TBI), depression, and substance use (all coded as either present or absent).Method: Peer-reviewed studies on this topic were extracted from PubMed and Web of Science with predetermined keywords and criteria. In total, 53 articles met the criteria. Hedge’s g effect sizes were calculated for each study and a three-level random effect meta-analysis conducted.Results: After accounting for publication bias, the results suggested a significant association between PTSD and cognitive impairment, g = 0.13 (95% CI: 0.10-0.17), indicating a small effect. This association was consistent across all examined moderators, including various neurocognitive outcomes, age, gender, study design, study population, study quality, type of PTSD measure, and comorbidities such as depression, substance use, and TBI.Conclusions: These findings collectively suggest that PTSD is associated with both cognitive impairment and NCD. This emphasizes the need for early intervention (including prevention strategies) of PTSD, alongside monitoring cognitive function in affected individuals.International Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD42021219189, date of registration: 02.01.2021.

PMID:40062977 | DOI:10.1080/20008066.2025.2469978

Clin Neuropharmacol. 2025 Mar 10. doi: 10.1097/WNF.0000000000000630. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to explore the changes in brain functional activity before and after acceptance and commitment therapy (ACT) treatment in patients with major depressive disorder (MDD) and the correlation between brain functional changes and clinical symptoms.

METHODS: We recruited 12 patients who met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria for MDD. Patients underwent clinical assessments and resting-state functional magnetic resonance imaging (rs-fMRI) scans before and after ACT intervention. The amplitude of low-frequency fluctuations (ALFF) and fractional ALFF (fALFF) maps were obtained after data preprocessing, and the ALFF/fALFF values of patients were extracted and compared. Pearson correlation analysis was used to analyze the correlation between fALFF/ALFF values and clinical symptoms.

RESULTS: A total of nine MDD patients completed the study. The results showed that, following treatment, there was an improvement in psychological flexibility, along with a reduction in depressive symptoms. Additionally, MDD patients exhibited increased ALFF in the left inferior frontal gyrus and triangle, as well as increased fALFF in the left medial superior frontal gyrus following symptom remission. Pearson correlation analysis showed that fALFF of the left medial superior frontal gyrus at baseline was negatively correlated with the rate of Acceptance and Action Questionnaire, Second Edition (AAQ-II), change (r = -0.76, P < 0.05).

CONCLUSIONS: We observed alterations in spontaneous activity in regions of the prefrontal cortex in MDD patients following ACT, providing preliminary relevant insights into understanding the neural mechanisms underlying the treatment of MDD by ACT.

PMID:40062938 | DOI:10.1097/WNF.0000000000000630

J Craniofac Surg. 2025 Mar 7. doi: 10.1097/SCS.0000000000011200. Online ahead of print.

ABSTRACT

Iatrogenic internal nasal valve (INV) dysfunction is a significant complication after nasal surgery, often necessitating revision surgeries involving cartilage grafting, which carries high risks of complications such as mucosal synechiae, septal perforations, and chronic inflammation. This study evaluates the efficacy of a modified dermal-fat flap suspension technique as an alternative to conventional cartilage grafting for INV reconstruction. A retrospective review was conducted of 30 patients treated between March 2019 and March 2023, including 8 patients who underwent the modified dermal suspension technique and 22 who received spreader grafts. Preoperative and postoperative nasal obstruction symptom evaluation scores were statistically analyzed using the Mann-Whitney U test. While both groups demonstrated significant postoperative improvements, no statistically significant differences were found between the groups. The modified technique, performed under local anesthesia, was associated with fewer complications and avoided extensive cartilage grafting or mucosal dissection, making it particularly suitable for patients with advanced age, high ASA scores, or complex surgical histories. Common complications included transient orbital edema and rare cases of skin discoloration, which resolved over time. Despite a small sample size and reliance on subjective nasal obstruction symptom evaluation scores, this study highlights the potential of the modified dermal-fat flap suspension technique as a less invasive, effective alternative for managing INV dysfunction, especially in high-risk patients. Further studies with larger cohorts and objective measures are needed to validate these findings.

PMID:40062937 | DOI:10.1097/SCS.0000000000011200

Artif Organs. 2025 Mar 10. doi: 10.1111/aor.14986. Online ahead of print.

ABSTRACT

BACKGROUND: Prior studies of anticoagulation bridging during periods of low International Normalized Ratio (INR) in outpatients with a durable, continuous flow left ventricular assist device (CF-LVAD) have shown a variable impact on thrombotic and bleeding events. These studies include predominantly older devices such as the HeartMate 2 (HM2) and HeartWare HVAD, which are known to experience more overall thrombotic events than the HeartMate 3 (HM3) device. The majority of these patients also received concomitant aspirin.

METHODS: The primary objective of this study was to compare hemocompatibility-related adverse events (HRAEs) occurring while bridging subtherapeutic (≤ 1.7) INRs with therapeutic low-molecular weight heparin (LMWH) versus not bridging in outpatients with an HM3 CF-LVAD, many of whom were not receiving concomitant aspirin.

RESULTS: Of the 79 patients eligible for inclusion in this study, 64 were not bridged and 15 were bridged at least once during the study period. In the non-bridged group, there were a total of 12 HRAEs of 997 bridging opportunities (BOs) (1.20%) versus 0 of 39 BOs in the bridged group. Of the 12 HRAEs in the non-bridged group, 10 were bleeding events; the 2 thrombotic events were minor venous thromboembolisms.

CONCLUSION: Omission of LMWH bridging in HM3 CF-LVAD patients with a subtherapeutic INR and low rates of background aspirin use did not result in a statistically significant or clinically relevant increase in the rate of HRAEs.

PMID:40059801 | DOI:10.1111/aor.14986

Br J Nutr. 2025 Mar 10:1-47. doi: 10.1017/S0007114524002587. Online ahead of print.

ABSTRACT

There is a growing focus on understanding the complexity of dietary patterns and how they relate to health and other factors. Approaches that have not traditionally been applied to characterize dietary patterns, such as latent class analysis and machine learning algorithms, may offer opportunities to characterize dietary patterns in greater depth than previously considered. However, there has not been a formal examination of how this wide range of approaches has been applied to characterize dietary patterns. This scoping review synthesized literature from 2005-2022 applying methods not traditionally used to characterize dietary patterns, referred to as novel methods. MEDLINE, CINAHL, and Scopus were searched using keywords including latent class analysis, machine learning, and least absolute shrinkage and selection operator. Of 5274 records identified, 24 met the inclusion criteria. Twelve of 24 articles were published since 2020. Studies were conducted across 17 countries. Nine studies used approaches with applications in machine learning, such as classification models, neural networks, and probabilistic graphical models, to identify dietary patterns. The remaining studies applied methods such as latent class analysis, mutual information, and treelet transform. Fourteen studies assessed associations between dietary patterns characterized using novel methods and health outcomes, including cancer, cardiovascular disease, and asthma. There was wide variation in the methods applied to characterize dietary patterns and in how these methods were described. The extension of reporting guidelines and quality appraisal tools relevant to nutrition research to consider specific features of novel methods may facilitate consistent reporting and enable synthesis to inform policies and programs.

PMID:40059795 | DOI:10.1017/S0007114524002587

Ann Med. 2025 Dec;57(1):2476040. doi: 10.1080/07853890.2025.2476040. Epub 2025 Mar 10.

ABSTRACT

OBJECTIVE: This study aimed to construct a model based on machine learning to predict new HIV infections in HIV-negative men who have sex with men (MSM).

METHODS: This is a secondary analysis of a previous random clinical trial aiming to evaluate the preventive effects of PrEP on new HIV infection in MSM. During 2013-2015, 1455 HIV-negative MSM were enrolled. Participants were divided into treatment group and control group and regularly followed up until they seroconverted to HIV positive or until the 2-year endpoint reached. Five machine-learning approaches were applied to predict the risk of HIV infection. Model performance was evaluated using Harrel’s C-index and area under the receiver operator characteristic curve (AUC) and validated in an external validation cohort. To explain this model, shapley additive explanation (SHAP) values were calculated and visualized.

RESULTS: During the observation period, 102 MSM developed HIV infection. Thirteen parameters are selected to construct the model. The random survival forest model showed the best performance in the validation cohort, with a C-index of 0.7013, and could significantly categorize MSM into three groups. Our model indicated that MSM with younger age, receptive anal intercourse, and multiple male sexual partners had an increased risk of HIV infection, and those with higher AIDS knowledge scores had a lower risk.

CONCLUSION: We presented a machine learning-based model to predict their risk of developing HIV infection. This model could be applied to recognize MSM who are at a higher risk of developing HIV infection.

PMID:40059791 | DOI:10.1080/07853890.2025.2476040

Otol Neurotol. 2025 Feb 24. doi: 10.1097/MAO.0000000000004469. Online ahead of print.

ABSTRACT

HYPOTHESIS: Simvastatin enhances radiation cytotoxicity of primary vestibular schwannoma (VS) and NF2-mutant human Schwann (HS01) cells.

BACKGROUND: Approximately 10% of VS progress after radiotherapy. Simvastatin is a lipid-lowering medication that promotes apoptosis, inhibits cell proliferation, and enhances radiation response in various cancers. In this study, we determine the effect of simvastatin on the viability of irradiated and nonirradiated primary VS and HS01 cells.

METHODS: Primary VS (N = 5) and HS01 cells were pretreated with simvastatin (0 or 1 μM) prior to irradiation (0 or 18 Gy). A cell-based assay was used to measure cell viability. Immunocytochemistry was performed for γH2AX (DNA damage marker) and RAD51 (DNA repair protein). Statistical analysis was conducted with parametric and nonparametric one-way analysis of variance tests.

RESULTS: Radiation initiated double-stranded breaks in DNA in both VS and HS01 cells. Two VS were radiation-resistant and the remaining three VS were radiation-sensitive. In response to radiation, radiation-resistant VS cells activated RAD51-mediated DNA repair. Simvastatin blocked RAD51 activation in radiation-resistant VS, increased levels of lethal DNA damage, and enhanced radiation-induced cell death. Simvastatin also enhanced radiation-induced cell death in radiation-sensitive VS cells through RAD51-independent mechanisms. However, simvastatin was not effective as a radiosensitizer in HS01 cells.

CONCLUSION: Simvastatin improved radiation response of radiation-resistant primary VS cells by inhibiting RAD51-related DNA repair. Although through RAD51-independent mechanisms, simvastatin also improved radiation response in radiation-sensitive VS cells. Additional preclinical investigations are warranted to evaluate the mechanisms of action and efficacy of statin drugs as radiosensitizers for VS patients.

PMID:40059781 | DOI:10.1097/MAO.0000000000004469

COPD. 2025 Dec;22(1):2468328. doi: 10.1080/15412555.2025.2468328. Epub 2025 Mar 10.

ABSTRACT

BACKGROUND: Clinical trials have shown beneficial results from lung volume reduction with endobronchial coils in patients with emphysema, but comprehensive safety data are not yet available for a new coil type, Coil #4. The objective of this study is to generate real-world data (RWD) on the safety and efficacy of endobronchial Coil #2 and Coil #4.

METHODS: This is a cohort study of prospectively collected data from the multicenter German Lung Emphysema Registry e.V. (LE-Registry) for patients with advanced lung emphysema undergoing lung volume reduction. All patients treated with Coil #2 or Coil #4 were evaluated at baseline and at 3 months for pulmonary function tests (FEV₁, FVC, RV, DLCO, pCO₂), exercise capacity, quality of life (mMRC, CAT, SGRQ), and adverse events. Descriptive statistics were used to analyze response rates and changes in clinical outcomes.

RESULTS: Data from 73 patients (37 Coil #2, 36 Coil #4) enrolled between 2017 and 2024 were evaluated. At 3 months, outcome data were available for 32 Coil #2 and 26 Coil #4 patients. In the Coil #2 cohort significant improvements in RV and SGRQ were observed. The Coil #4 cohort shows significant improvements in FVC, RV, SGRQ, and CAT. Complications occurred in 37% of Coil #2 and 37% of Coil #4 patients, with 26% of patients treated with Coil #4 experiencing pneumothorax.

CONCLUSIONS: The outcomes observed in this RWD study are consistent with other published coil studies. The higher pneumothorax rate with Coil #4 is surprising and should be minimized by adapting the technique.

TRIAL REGISTRATION: DRKS00021207 registered on 29/05/2020.

PMID:40059773 | DOI:10.1080/15412555.2025.2468328