Category: Nevin Manimala

JAMA Health Forum. 2025 Dec 5;6(12):e255597. doi: 10.1001/jamahealthforum.2025.5597.

ABSTRACT

IMPORTANCE: Food insecurity (FI) is associated with poor health and has risen in the US. The Supplemental Nutrition Assistance Program (SNAP) is the largest US food-purchasing assistance program. Policies related to eligibility assessment and administrative burden that impact SNAP participation vary between states. How such policies influence FI is not well known.

OBJECTIVES: To evaluate the association between changes in state SNAP policies and county FI rates.

DESIGN, SETTING, AND PARTICIPANTS: This repeated cross-sectional study used annual county-level FI estimates from the Feeding America Map the Meal Gap dataset, state-level SNAP policy data from the US Department of Agriculture from 2009 to 2019, and data on economic and demographic measures from the US Census Bureau for county residents. Data were analyzed from August 2024 to August 2025.

EXPOSURES: Changes in state SNAP policies from 2009 to 2019. Due to incomplete policy data, the analysis was not extended beyond 2019.

MAIN OUTCOMES AND MEASURES: County-level FI rates for individuals. An annual index of SNAP policy adoption was calculated, scaled from 0.1 to 10, with a higher level indicating a greater adoption of policies associated with SNAP participation. G-computation, a robust causal inference methodology, was used to evaluate the association between change in the SNAP index and state-level SNAP participation rates and county-level FI rates. The model accounted for demographic and clinical factors, state and year fixed effects, and baseline SNAP index levels.

RESULTS: Of a total of 3143 US counties, 3134 were included in the analysis. A 1-point increase in the SNAP policy index was associated with a 0.7-percentage point (pp; 95% CI, 0.3-1.2 pp; P = .002) higher state-level SNAP participation rate and a 0.1-pp (95% CI, 0.02-0.2 pp; P = .02) lower county-level FI rate from 2009 to 2019. In 2019, an estimated 6.5 million (95% CI, 3.8-9.1 million) fewer individuals would have experienced FI if all states had adopted policies equivalent to the most generous state in each year compared to if all states had adopted policies equivalent to the least generous state.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, adoption of state-level policies associated with higher SNAP participation was also associated with lower county-level FI rates. Policies that lower barriers to SNAP participation may help address rising FI rates observed in 2022 and 2023.

PMID:41385208 | DOI:10.1001/jamahealthforum.2025.5597

JAMA Health Forum. 2025 Dec 5;6(12):e255605. doi: 10.1001/jamahealthforum.2025.5605.

ABSTRACT

IMPORTANCE: The Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act expanded access to community-based health care for veterans enrolled in the Veterans Affairs (VA) Health Care System. At the same time, the COVID-19 pandemic created unprecedented demand for intensive care unit (ICU) care. The combined impact of these changes on critical care delivery, outcomes, and spending remains unclear.

OBJECTIVE: To describe patterns in ICU admissions, case complexity, 90-day mortality, and VA spending for VA-delivered vs VA-purchased community ICU care from 2019 to 2023.

DESIGN, SETTING, AND PARTICIPANTS: Repeated cross-sectional study of 1 151 915 ICU admissions among veterans treated at 99 VA medical centers (VAMCs) and 4288 community hospitals reimbursed through the VA Community Care Network from January 1, 2019, to December 31, 2023. Stratified time series analyses were used to illustrate trends across 4 periods: pre-MISSION, post-MISSION, COVID-19 emergency, and post-COVID-19 stabilization. Interrupted time series analyses were then applied using unified regression models with interaction terms to assess differences across these periods.

MAIN OUTCOMES AND MEASURES: Main outcomes were monthly ICU admission volume, Case Mix Index weight, Charlson Comorbidity Index, 90-day all-cause mortality, and VA expenditures on community ICU care. Models were adjusted for demographic, clinical, and temporal covariates.

RESULTS: Of 1 151 915 ICU admissions among VA-enrolled veterans, including 270 237 at 99 VAMCs and 881 678 at 4288 community hospitals reimbursed through the VA community care network, 881 678 occurred in community hospitals. From 2019 to 2023, ICU admissions decreased by 21.3% in VAMCs and increased by 46.8% in community hospitals. Interrupted time series models showed increased mortality during the COVID-19 period in both settings and decreased mortality in VAMCs following the pandemic. Stratified time series models showed a postpandemic adjusted mortality rate of 18.4% (95% CI, 18.2%-18.7%) at VAMCs compared with 20.0% (95% CI, 19.8%-20.2%) in the community. Community hospitals had higher median Case Mix Indices, and total inflation-adjusted VA spending on community ICU care increased by 50% from $2.70 billion in 2019 to $4.04 billion in 2023, driven by increased admission volume.

CONCLUSIONS AND RELEVANCE: This study found that VA-purchased community ICU care expanded markedly while incurring higher costs and slightly worse outcomes. These shifts underscore growing reliance on external critical care infrastructure and raise policy concerns around VA capacity planning, care integration, and quality oversight for veterans with high-acuity needs.

PMID:41385207 | DOI:10.1001/jamahealthforum.2025.5605

Przegl Epidemiol. 2025 Dec 12;79(3):462-472. doi: 10.32394/pe/213582. Epub 2025 Oct 28.

ABSTRACT

BACKGROUND: Measles remains one of the most contagious viral diseases, spreading rapidly in populations with insufficient vaccination coverage. Despite the availability of an effective vaccine, cases continue to occur worldwide. The World Health Organization (WHO) has set goals of regional elimination and, ultimately, global eradication. Essential elements include ≥95% vaccination coverage, sensitive epidemiological surveillance, and laboratory confirmation. In Poland, these functions are coordinated by the National Institute of Public Health NIH – National Research Institute (NIPH NIH – NRI).

OBJECTIVE: To assess the epidemiological situation of measles in Poland in 2022-2023, with particular focus on vaccination coverage, progress in implementing the WHO elimination programme, and the impact of the COVID-19 pandemic.

MATERIAL AND METHODS: The analysis was based on case reports submitted to NIPH-NIH by Provincial Sanitary and Epidemiological Stations, data from the national bulletins Infectious diseases and poisoning in Poland (2022-2023) and Vaccinations in Poland (2022-2023), and individual epidemiological interviews registered in the EpiBaza system.

RESULTS: In 2022, 27 cases of measles were reported (incidence 0.07/100,000), and in 2023 – 35 cases (0.09/100,000). Compared to 2021 (13 cases, 0.03/100,000), this represented a 107.7% increase, although the incidence remained 97.7% lower than in 2019 (1,502 cases, 3.31/100,000). The highest rates were recorded among children: in 2022 in the 0-4 age group (0.61/100,000) and in 2023 in the 5-9 group (0.61/100,000). Hospitalisations increased from 7 patients in 2022 (25.9%) to 11 in 2023 (31.4%). No deaths were reported.

CONCLUSIONS: In 2022-2023, Poland saw a rise in measles cases compared to 2021, but incidence remained much lower than in the pre-pandemic period. The predominance of cases among children and suboptimal vaccination coverage (<95%) highlight the ongoing risk of outbreaks. Strengthening epidemiological surveillance, systematic monitoring of vaccination rates, and public education are key to meeting WHO elimination targets.

PMID:41385201 | DOI:10.32394/pe/213582

Przegl Epidemiol. 2025 Dec 12;79(3):451-461. doi: 10.32394/pe/213328. Epub 2025 Oct 22.

ABSTRACT

BACKGROUND: Mumps is a viral disease primarily transmitted by infected individuals. A milestone in controlling mumps in Poland was the introduction of mandatory MMR vaccination in 2003, protecting against measles, mumps, and rubella. Since then, the incidence has decreased substantially, and complications have become rare.

OBJECTIVE: The aim of the study was to conduct an epidemiological assessment of the incidence of mumps in Poland in 2023 compared to previous years, taking into account the impact of the COVID-19 pandemic.

MATERIAL AND METHODS: The analysis of the epidemiological situation of swine fever in Poland in 2023 was conducted based on the interpretation of data from the nationwide epidemiological surveillance system. The percentage of those vaccinated with the first dose was determined based on data for the 2021 cohort (children aged 3 years), and the percentage of those vaccinated with two doses was determined based on data for the 2017 cohort (children aged 6 years). Vaccination effectiveness was estimated using the screening method.

RESULTS: In 2023, 966 cases of swine fever were registered in Poland. This represented a 4.8% increase in the number of cases compared to 2022, when 922 cases were reported. The overall incidence rate was 2.6 per 100,000 inhabitants, which was 5.3% higher than in 2022. The highest incidence rate, 3.6 per 100,000 inhabitants, was recorded in the Śląskie voivodeship, and the lowest, as in previous years, of 1.2 per 100,000 inhabitants in Dolnośląskie voivodeship. The highest incidence(13.7/100,000) was recorded in children aged 0-4 and 5-9 (17.3/100,000). The incidence in men (3.0/100,000) was higher than in women (2.1/100,000). In 2023, the number of hospitalisations due to mumps in Poland was 12, a decrease of 40% compared to 2022, when 20 people were hospitalized.

CONCLUSIONS: In 2023, there was an increase in the number of registered cases of mumps, indicating a general upward trend. The decline in cases in2020-2021was the result of the COVID-19 pandemic, which was accompanied by restrictions significantly limiting the transmission of diseases spread by droplets, including mumps. Despite the increase in the number of cases in 2023, the level remains below that observed in the period before the COVID-19 pandemic.

PMID:41385200 | DOI:10.32394/pe/213328

Przegl Epidemiol. 2025 Dec 12;79(3):444-450. doi: 10.32394/pe/212512. Epub 2025 Oct 13.

ABSTRACT

BACKGROUND: The epidemiological situation of chickenpox in Poland has been stable in recent years, with no significant increase in the number of cases observed. Between 2016 and 2023, the incidence rate ranged from 389.4 to 506.2 cases per 100,000 population, except for 2020 and 2021, when the incidence rate decreased to 186.6 per 100,000 in 2020 and 151.1 per 100,000 in 2021, due to the COVID-19 pandemic. In 2022, an increase in the incidence rate was recorded, reaching 453.9 per 100,000.

OBJECTIVE: The aim of this study was to assess the epidemiological situation of chickenpox in Poland in 2023 compared to previous years.

MATERIAL AND METHODS: To assess the epidemiological situation of chickenpox in Poland, data submitted to the National Institute of Public Health NIH – National Research Institute by District Sanitary and Epidemiological Stations and published in the annual bulletin “Infectious diseases and poisonings in Poland in 2023” and data published in the annual bulletin “Vaccinations in Poland in 2023” were used.

RESULTS: A total of 190,825 cases of chickenpox were registered in 2023, which was 11.13% more than in 2022, and 27.59% more than the median number of cases for the years 2017-2021. The overall incidence was 506.2/100,000 population. In terms of age, the highest incidence was among children in the age groups 0-4 years (4,741.4/100,000) and 5-9 years (4,155.1/100,000), while in adults, the incidence did not exceed 100 cases per 100,000. In 2023, a total of 123,743 people were vaccinated against chickenpox, of whom 95.49% were children under 11 years of age (118,163 people).

CONCLUSIONS: The slowdown in the increase in incidence in 2023 (compared to 2022) may indicate a stabilization of the chickenpox situation, but the increase in the overall incidence rate above 500 per 100,000 is concerning and requires monitoring in next years.

PMID:41385199 | DOI:10.32394/pe/212512

Przegl Epidemiol. 2025 Dec 12;79(3):415-427. doi: 10.32394/pe/213329. Epub 2025 Oct 22.

ABSTRACT

BACKGROUND: Advances in dental technology have improved treatment quality but increased costs. In Poland, where the scope of services reimbursed by the National Health Fund (NFZ) is limited, the cost of dental treatment can be a financial barrier – especially for lower-income patients, particularly for older adults.

OBJECTIVE: The aim of this study was to analyze how income levels affect patients’ awareness of dental treatment costs and their decisions regarding available treatment options.

MATERIAL AND METHODS: A cross-sectional survey of 282 participants (dental patients, medical students, healthcare and education professionals, and their families) was conducted from late 2023 to early 2024. Data from a self administered questionnaire were analyzed in Python using chi-square tests, Cramér’s V, and phi coefficients (p < 0.05). Income was dichotomized (<PLN 3,500 vs. >PLN 3,500) when necessary.

RESULTS: Lower-income patients (<PLN 3,500) were more likely to postpone check-ups due to cost (24.8% vs. 13.1%, p = 0.03) and preferred NHF-covered treatments, whereas higher-income individuals opted for private care. No significant associations were found regarding awareness of NHF benefits, installment usage, or treatment withdrawal rates.

CONCLUSIONS: Income significantly affects dental care utilization, influencing check-up postponement and treatment choices. However, weak correlations suggest other factors – such as health awareness, service quality and appointment availability – also play key roles.

PMID:41385197 | DOI:10.32394/pe/213329

Przegl Epidemiol. 2025 Dec 12;79(3):404-414. doi: 10.32394/pe/211665. Epub 2025 Oct 16.

ABSTRACT

Adverse drug reactions (ADRs) remain a major, yet largely preventable, global public health challenge, causing significant morbidity, mortality, and healthcare costs. This review synthesises evidence on the global burden, pharmacovigilance systems, and prevention strategies for ADRs, integrating data from multiple regions, healthcare settings, and drug classes. Epidemiological findings reveal wide variability in incidence and mortality, with older adults, low-resource settings, and exposure to high-risk medicines-such as antibiotics, antiretrovirals, and cardiovascular agents-representing key vulnerabilities. Despite advances in surveillance, underreporting, data quality issues, and methodological biases persist, particularly in low- and middle-income countries. Comparative analyses of pharmacovigilance platforms, including World Health Organization’s (WHO’s) VigiBase, EudraVigilance, and EU-ADR, highlight complementary strengths and the value of integrating spontaneous reporting with electronic health record analytics. Emerging statistical methods, including machine learning and federated analytics, offer improved signal detection timeliness and precision. Prevention strategies span prescriber-level, system-level, and patient engagement interventions. These include clinical decision support systems, pharmacogenomic-guided therapy, deprescribing protocols, mobile reporting applications, and wearable biosensors. Evidence shows that active surveillance and automated alerts outperform voluntary reporting, while digital tools can enhance detection and risk communication. However, implementation remains uneven due to infrastructure, workforce, and policy gaps. Looking forward, achieving the World Health Organization’s goal of halving severe medication-related harm by 2030 will require embedding ADR surveillance and prevention into universal health coverage frameworks. Policy priorities include mandating interoperable safety systems, harmonising international safety indicators, investing in capacity building for resource-limited settings, and aligning incentives with safer prescribing. Coordinated global action can bridge surveillance gaps, strengthen prevention, and build resilient, equitable pharmacovigilance systems, advancing both patient safety and sustainable health systems worldwide.

PMID:41385196 | DOI:10.32394/pe/211665

Przegl Epidemiol. 2025 Dec 12;79(3):393-403. doi: 10.32394/pe/211093. Epub 2025 Oct 9.

ABSTRACT

BACKGROUND: Over the past 10 years the number of newly diagnosed HIV infections per year in Poland has been increasing. International data shows that in-school education about prevention of HIV leads to improved knowledge, increased condom use and safer sex attitudes. Data about HIV knowledge in polish schools is lacking.

OBJECTIVE: The aim of the study was to assess the knowledge of polish secondary school students regarding HIV/AIDS, and how it changes after one training in this topic.

MATERIAL AND METHODS: An online questionnaire with 30 questions about HIV/AIDS and sources of knowledge was given to students in two secondary schools in Warsaw, Poland. After completing the questionnaire an educational training was conducted. The same online questionnaire was distributed to the same classes after a year from the first survey and training. Numbers of correct answers were counted and the change of correct answers between first and second questionnaire was calculated.

RESULTS: In the first part of the study n=364 students filled in the questionnaire and in the second part n=257. The majority of students self-assessed their knowledge as not sufficient (84.3%). Questions answered incorrectly by most of the respondents concerned routes of transmission, pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). In 16/20 yes/no questions an improvement in knowledge was noted in the second survey.

CONCLUSIONS: This study showed some knowledge gaps about HIV/AIDS of surveyed students. More education about prevention of HIV/AIDS should be included in the school programme. A one-time educational training can be beneficial.

PMID:41385195 | DOI:10.32394/pe/211093

Przegl Epidemiol. 2025 Dec 12;79(3):379-392. doi: 10.32394/pe/209454. Epub 2025 Sep 22.

ABSTRACT

BACKGROUND: Both in Poland and worldwide, an increase in the number of smartphone users has been observed. It is estimated that two-thirds of the global population uses them. Smartphones significantly enhance many aspects of daily life. However, it is important to be aware that improper use of these devices can lead to negative health effects, both mental and physical. Adhering to digital hygiene principles can greatly reduce the risk of various ailments, which will undoubtedly improve users’ quality of life.

OBJECTIVE: The aim of the study was to assess behaviors related to smartphone use in the context of digital hygiene among medical students.

MATERIAL AND METHODS: The study was conducted with a diagnostic survey method. The technique used was a questionnaire, and the tool was a validated Digital Hygiene Self-Assessment Questionnaire developed by Bigaj and Woynarowska. The study group consisted of 71 individuals. Data analysis was conducted using Google Sheets, MS Excel, and SPSS software. Statistical analysis included Spearman’s rho correlation coefficient and the Mann-Whitney test.

RESULTS: Most respondents described their daily smartphone usage time as long. Just over 73% of those surveyed reported experiencing negative effects from using the device (n=52). The most common behaviors related to digital hygiene included limiting the number of notifications (n=28, 39.4%), deleting unused apps (n=25, 35.2%), and avoiding keeping the phone with them all the time (n=17, 23.9%).

CONCLUSIONS: Extensive daily smartphone usage may have negative health implications. Respondents are aware of the fact that they use smartphones too frequently, and their digital hygiene habits pose health risks. Systematic educational initiatives are necessary to not only raise awareness of the issue but also provide users with practical methods for implementing digital hygiene principles related to mobile device use.

PMID:41385194 | DOI:10.32394/pe/209454

Acta Neurol Belg. 2025 Dec 12. doi: 10.1007/s13760-025-02974-x. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: In stroke thrombi, neutrophil extracellular traps (NETs) have been hypothesized to promote thrombogenic processes that enhance stability and decrease amenability to thrombolysis and endovascular removal. Here, we examined the relationship between NET enrichment and clot structure and mechanical properties.

METHODS: Platelet-rich plasma and red blood cells (RBCs) were isolated from human blood and mixed with concentrated white blood cells to produce no-RBC and high-RBC clot analogs (0% and 40%, respectively). Lipopolysaccharide (LPS) was added at 3 different concentrations to enrich clots with varying amounts of NETs. Clots were analyzed mechanically using a uniaxial stretch tester. Clots were also imaged by microCT, and histology was used to investigate biologic structure and composition, as well as NET enrichment. Statistical analysis was completed to assess stiffness, radiomic, and histological features among clots of various NET enrichment. Clustering was performed on radiomic and histological image features to identify feature signatures unique to NET-enriched clots, and correlation was performed to identify radiomics and histomics related to NET enrichment.

RESULTS: LPS enriched clots with NETs in a dose-dependent manner, and NETs were associated with greater microstructural complexity. For fibrin-platelet rich clots (0% RBCs), NET enrichment produced a significant increase in mechanical stiffness as measured by Young’s Modulus, as well as in breaking strength. For each percent composition, radiomic and histomic profiling clustered clot analogs well by NET-enrichment, with NET-enriched clots demonstrating radiomic and histological texture feature correlations distinct from clots without NETs.

CONCLUSION: NET enrichment produces mechanically stiffer stroke clot analogs with distinct microstructure, radiomic, and histological profiles.

PMID:41385177 | DOI:10.1007/s13760-025-02974-x