Category: Nevin Manimala

Health Aff (Millwood). 2025 Feb;44(2):224-233. doi: 10.1377/hlthaff.2024.00145.

ABSTRACT

The Hyde Amendment prohibits US federal spending on abortion, including federal Medicaid dollars. Seventeen states cover abortion care in their Medicaid programs, using state funds, but causal evidence on how Medicaid coverage for abortion affects pregnancy outcomes is limited. Using a difference-in-differences design and 2014-21 birth and abortion data from the Centers for Disease Control and Prevention that predate the US Supreme Court’s Dobbs decision in 2022, we evaluated a 2018 policy introducing Medicaid coverage for abortion in Illinois. This change increased the number of abortions in the state by 2.43 per 1,000 reproductive-age females, an 18.2 percent increase, and reduced births by 1.66 per 1,000 reproductive-age females, a 2.8 percent decrease, relative to twenty-nine comparison states that did not cover abortion during the study period. Subgroup analyses of birth rates suggested that decreases in birth rates were more pronounced among Black and Hispanic residents, residents in counties with higher poverty rates, and residents closer to an abortion facility. Our finding suggests that Medicaid can play an important role in abortion access.

PMID:39899778 | DOI:10.1377/hlthaff.2024.00145

Health Aff (Millwood). 2025 Feb;44(2):187-195. doi: 10.1377/hlthaff.2024.00978.

ABSTRACT

The evolving composition and experiences of the family caregiver workforce have profound ramifications for public policy but are not well understood. Drawing on the linked National Health and Aging Trends Study and National Study of Caregiving, we found that the numbers of family caregivers providing help to older adults increased by nearly six million between 2011 and 2022, rising from 18.2 million to 24.1 million. Among older adults receiving care, network size was stable, at about two caregivers per older adult at both points in time. However, in 2022, family caregivers were assisting older adults who were younger, more likely to be male and better educated, and less likely to have dementia. We found few changes in competing work and child care responsibilities, weekly care hours, and caregiving-related difficulty. A smaller number of family caregivers were assisting fewer older adults with dementia, but in this group, co-residence increased by 25 percent, average care hours increased by 50 percent, and employment decreased. For family caregivers as a whole, challenges persist, and for those assisting people with dementia, tailored surveillance and effective support programs are needed.

PMID:39899774 | DOI:10.1377/hlthaff.2024.00978

Health Aff (Millwood). 2025 Feb;44(2):206-214. doi: 10.1377/hlthaff.2024.00687.

ABSTRACT

Private equity (PE) acquisitions of health care providers are often framed as a monolithic intervention, but firms’ strategies for generating returns for investors may vary. In a difference-in-differences analysis using data from the 2005-19 Medicare hospital cost reports, we compared 242 US hospitals acquired by PE firms with 870 matched control hospitals not acquired by such firms. By firm, we examined changes in salary expenditures (reflecting staffing costs of delivering care) and cumulative charges (reflecting service utilization) associated with acquisition. On average, hospitals acquired by PE firms reduced salary expenditures, whereas control hospitals increased salary expenditures. At the firm level, salary expenditures declined between 12.9 percent and 27.3 percent of preacquisition levels. These reductions occurred across most clinical departments, although the specific departments and sizes of salary cuts varied across firms. Consistent with reduced staffing and capacity, most hospitals demonstrated a simultaneous decline in cumulative charges after acquisition-despite often raising their chargemaster rates (charges per service)-implying a reduced volume of services delivered. Some hospitals exhibited an alternative strategy of increasing cumulative charges without cutting salary expenditures. PE firms varied in management strategies, with most demonstrating cost cutting through salary expenditures.

PMID:39899773 | DOI:10.1377/hlthaff.2024.00687

J Am Acad Orthop Surg Glob Res Rev. 2025 Feb 3;9(2). doi: 10.5435/JAAOSGlobal-D-24-00152. eCollection 2025 Feb 1.

ABSTRACT

INTRODUCTION: Healthcare institutions have sought to standardize opioid prescribing after elective total joint arthroplasty. The purpose of this study was (1) to compare opioid prescriptions at discharge with perceived opioid prescribing patterns and (2) to determine the relationship between preoperative adjunctive treatments and opioids prescribed at discharge.

METHODS: All surgeons who performed total joint arthroplasty of the shoulder, hip, or knee from January 1, 2021, to October 4, 2023, at a single academic institution were included. Surgeons completed a survey assessing perceived opioid prescriptions at discharge and perioperative pain protocols. Actual prescriptions were captured using our institutional opioid database. All opioid prescriptions were converted to morphine milligram equivalents (MMEs).

RESULTS: Orthopaedic surgeons prescribed on average 594.2 MMEs more than they perceived as their postoperative protocol. They prescribed an additional 60.9 MMEs for every 10 MMEs that they perceived they were prescribing. Patients receiving liposomal bupivacaine were prescribed on average 597 fewer MMEs and had fewer opioid prescriptions (P < 0.001). Genicular nerve blocks and cryoneurolysis were associated with fewer prescribed MMEs (P < 0.001).

CONCLUSION: Orthopaedic surgeons prescribe substantially more opioids than intended. This study underscores the need for standardized opioid prescribing practices and the potential of adjunctive treatments in reducing opioid prescribing.

PMID:39899747 | DOI:10.5435/JAAOSGlobal-D-24-00152

J Chem Inf Model. 2025 Feb 3. doi: 10.1021/acs.jcim.4c02013. Online ahead of print.

ABSTRACT

Quantitative structure-property relationship (QSPR) analysis plays a crucial role in predicting physicochemical properties and biological activities of pharmaceutical compounds, aiding in drug design and optimization. This study focuses on leveraging QSPR within the framework of vertex and edge-weighted (VEW) molecular graphs, exploring their significance in drug research. By examining 48 drugs used in the treatment of various cancers and their physicochemical properties, previous studies serve as a foundation for our research. Introducing a novel methodology for computing vertex and edge weights, we highlight the importance of considering atomic properties and interbond dynamics. Statistical analysis, employing linear regression models, reveals enhanced correlations between topological indices and the physicochemical properties of drugs. Comparison with previous studies on unweighted molecular graphs highlights the enhancements achieved with our approach.

PMID:39899740 | DOI:10.1021/acs.jcim.4c02013

J Am Acad Orthop Surg Glob Res Rev. 2025 Jan 29;9(2). doi: 10.5435/JAAOSGlobal-D-24-00151. eCollection 2025 Feb 1.

ABSTRACT

BACKGROUND: Preoperative optimization of modifiable risk factors (MRFs) for arthroplasty patients is a critical aspect of predicting and improving postoperative outcomes. This study evaluates the correlation between seven MRFs and postoperative adverse outcomes after total hip arthroplasty (THA) and total knee arthroplasty (TKA).

METHODS: A retrospective review of primary TKA and THA were identified from a large medical claims database. Patients were categorized based on the number of MRF diagnoses present before surgery (anemia, malnutrition, obesity, opioid abuse/dependence, mental illness, type 2 diabetes mellitus, and tobacco use), from zero to seven. Adverse outcomes evaluated were surgical site infections (SSIs), venous thromboembolic events (VTEs), and readmissions.

RESULTS: Of the patient records queried (THA = 303,857; TKA = 692,157), two or more MRFs were identified in 41% of THA patients and 47% of TKA patients. Patients with two or more MRFs were at an increased odds of developing an SSI, and patients with three or more MRFs had increase odds of having a 30-day hospital readmission.

CONCLUSIONS: This study adds to the compendium of literature, which promotes preoperative optimization of MRFs in arthroplasty patients to decrease the risks of 90-day postoperative complications.

PMID:39899738 | DOI:10.5435/JAAOSGlobal-D-24-00151

Proc Natl Acad Sci U S A. 2025 Feb 11;122(6):e2417812122. doi: 10.1073/pnas.2417812122. Epub 2025 Feb 3.

ABSTRACT

Researchers in the social sciences are interested in the consequences of institutions, increasingly on a global scale. Institutions that may be negotiated between states can have consequences at a microlevel, as local populations adjust their expectations and ultimately even their behavior to take institutional rules into account. However, large-scale fine-grained analyses that test for the complex evidence of such institutions locally are rare. This article focuses on a key institution: International borders. Using computer vision techniques, we show that it is possible to produce a geographically specific, validated, and replicable way to characterize border legibility, by which we mean the ability to visually detect the presence of an international border in physical space. We develop and compare computer vision techniques to automatically estimate legibility scores for 627,656 imagery tiles from virtually every border in the world. We evaluate statistical and data-driven computer vision methods, finding that fine-tuning pretrained visual recognition models on a small set of human judgments allows us to produce local legibility scores globally that align well with human notions of legibility. Finally, we interpret these scores as useful approximations of states’ border orientations, a concept that prior literature has used to capture the visible investments states make in border areas to maintain jurisdictional authority territorially. We validate our measurement strategy using both human judgments and five nomological validation indicators.

PMID:39899723 | DOI:10.1073/pnas.2417812122

Ann Work Expo Health. 2025 Feb 3:wxaf002. doi: 10.1093/annweh/wxaf002. Online ahead of print.

ABSTRACT

OBJECTIVES: With continued global warming, the effects of elevated temperatures on the health of agricultural workers are a particular concern. This study characterized the levels of heat stress in Thai sugarcane workers and investigated whether season and harvesting method were associated with it.

METHODS: Three hundred sugarcane workers in Nakhon Sawan Province, Thailand, were recruited, and information on demographics, working conditions, and clothing characteristics was collected from participants during the cooler months (n = 152 participants, mid-January to mid-February) and hotter month (n = 148, March). Heat stress was measured using the Wet Bulb Globe Temperature (WBGT) index, and the WBGT instruments were operated for a full work shift in the sugarcane fields where the participants worked. One-hour time weighted average (TWA) effective WBGT (WBGTeff-1hrTWA) estimates were determined for different times of the day based on the measured WBGT and clothing adjustment factor.

RESULTS: The average WBGTeff-1hrTWA in the cooler months ranged from 22.5 °C during the early morning to 31.3 °C during the hottest time of the day, and for the hotter month, it ranged from 25.4 °C to 33.9 °C, respectively. The measured WBGT, natural wet-bulb temperature (Tnwb), dry-bulb temperature (Tdb), globe temperature (Tg), air velocity (Av), and absolute water vapor pressure (ea) were all statistically significantly higher in the hotter month than in the cooler months. Harvesting during the hotter month and harvesting burnt sugarcane were significantly associated with increased effective WBGT. The harvesters’ heat stress in both seasons exceeded the American Conference of Governmental Industrial Hygienists – Threshold limit value for 72.7% of the working time in the cooler months and 90.9% in the hotter month.

CONCLUSIONS: The heat stress in Thai sugarcane workers was high in both seasons, particularly in the hotter month and when harvesting burnt sugarcane. This results in a very high risk of developing heat-related health effects, and measures are needed to reduce heat stress. Heat stress in agricultural and other outdoor work in tropical climates is an immediate and growing problem.

PMID:39899707 | DOI:10.1093/annweh/wxaf002

J Addict Med. 2025 Jan-Feb 01;19(1):102-104. doi: 10.1097/ADM.0000000000001355.

ABSTRACT

OBJECTIVES: Nearly 70% of people who use tobacco want to quit. Combination nicotine replacement therapy (cNRT), a long-acting controller plus short-acting reliever, is the most effective way to prescribe nicotine but is infrequently prescribed by primary care physicians (PCPs). We tested the feasibility and effectiveness of a brief, educational intervention to increase cNRT prescribing by PCPs in a large integrated health system.

METHODS: We conducted a pre-post study from 2022-2023 at a large integrated health system in California where specific NRT products are covered with a prescription. PCPs were offered a 30-minute virtual training about cNRT during a required monthly meeting (n = 267; 202 attended). The training was interactive, included simple “asks” and a 6-week follow-up communication. Chi-square analysis was used to test for changes in cNRT prescribing behaviors in the 6 months before and after training.

RESULTS: Among physicians who completed a posttraining questionnaire (180/202), 93% reported increased confidence, 91% reported favorable attitudes, and 88% reported intention to prescribe cNRT. According to data obtained from the integrated pharmacy database, the total number of patients who received a cNRT prescription increased from the 6-month pre- to 6-month postintervention from 135 (9%) to 380 (23%), P < 0.001. The total number of physicians who prescribed cNRT increased pre- to posttraining from 78 (23%) to 124 (37%), P < 0.001.

CONCLUSION: cNRT is an underutilized form of tobacco cessation therapy by PCPs. This may reflect a gap in prescriber knowledge. A brief, virtual training delivered to PCPs was associated with increased cNRT prescribing.

PMID:39899675 | DOI:10.1097/ADM.0000000000001355

Clin Implant Dent Relat Res. 2025 Feb;27(1):e13441. doi: 10.1111/cid.13441.

ABSTRACT

INTRODUCTION: This retrospective study aimed to evaluate peri-implant marginal bone loss (MBL) and prosthetic complications between two types of locator attachments in two implant-supported mandibular overdentures.

MATERIAL AND METHOD: From the archived records, information about patients who had two implants inserted utilizing two different types of locator attachments into the interforaminal region between November 2019 and December 2023 was obtained. Overall, 60 patients (Total = 120 implants) from the archive records of the Prosthodontics Department, Faculty of Dentistry, Mansoura University, with ages ranging from 40 to 60 (mean age 50), were included in the study. Group I (control): Overall, 30 patients who would be delivered mandibular implant overdenture using conventional locator attachments. Group II (study): Overall, 30 patients who would be delivered mandibular implant overdenture using RTx locator attachments. After the placement of the mandibular overdenture (T0), 6 months (T6), 12 months (T12), and 3 years (T3) later, the marginal bone loss (MBL) was assessed. Prosthetic complications were evaluated for both groups 3 years after prosthetic delivery.

RESULT: A statistically significant increase (p = 0.000) was found in MBL scores at all observation times between both groups. Group II showed a statistical increase in MBL than Group I. For prosthetic complications, no significant difference was found between both groups. Group II showed more matrix wear than Group I however, it was not statistically significant (p = 0.60).

CONCLUSION: Within the limitation of this study, we can conclude the following: Both types of locator attachment (conventional and RTx locator) can be used clinically with no preference concerning the frequency of prosthetic complications. From the MBL perspective, conventional locators are more favorable than RTx locators.

PMID:39899315 | DOI:10.1111/cid.13441