Category: Nevin Manimala

JAMA Netw Open. 2025 Oct 1;8(10):e2535330. doi: 10.1001/jamanetworkopen.2025.35330.

ABSTRACT

IMPORTANCE: Mammography screening is essential for the early detection of breast cancer; however, delayed detection among screen-detected breast cancers (SDBCs) is rarely studied.

OBJECTIVES: To investigate whether women diagnosed with SDBC who missed the screening round immediately before the diagnostic round experience clinically significant delays in detection and whether tumor characteristics vary.

DESIGN, SETTING, AND PARTICIPANTS: This prospective register-based cohort study included all women diagnosed with SDBC in Stockholm, Sweden, between January 1, 1995, and February 28, 2020, with a follow-up until December 31, 2022. Data were analyzed from November 5, 2023, to May 27, 2024.

EXPOSURE: Nonparticipation in the screening immediately prior to the diagnostic round.

MAIN OUTCOMES AND MEASURES: Tumor characteristics and breast cancer-specific survival.

RESULTS: Among 8602 women with SDBC (median age at diagnosis, 61 [IQR, 55-66] years), 1482 (17.2%) did not attend the immediate past screening. Nonparticipants in the past screening were more likely to have larger tumors (adjusted odds ratio [AOR], 1.55 [95% CI, 1.37-1.76] for a tumor size ≥20 mm), lymph node involvement (AOR, 1.28 [95% CI, 1.12-1.45), and distant metastasis (AOR, 4.64 [95% CI, 2.10-10.29]) and less likely to have estrogen receptor-negative breast cancer (AOR, 0.74 [95% CI, 0.60-0.92]); however, there were no differences in progesterone receptor status (AOR, 0.96 [95% CI, 0.83-1.11]) or ERBB2 (formerly HER2 or HER2/neu) status (AOR, 1.00 [95% CI, 0.81-1.24]). In addition, these women experienced poorer breast cancer-specific survival, with an adjusted hazard ratio (AHR) of 1.33 (95% CI, 1.08-1.65). There was no association after adjusting for tumor characteristics (AHR, 1.11 [95% CI, 0.89-1.38]). Additionally, no association was found between nonparticipation in the second-to-last screening and tumor characteristics among those with screen-detected breast cancers (AHR, 0.98 [95% CI, 0.80-1.19] for stage II tumors or higher).

CONCLUSIONS AND RELEVANCE: The findings of this cohort study suggest that some women with SDBC experience delayed detection and have clinically relevant worse outcomes. Future research is needed to investigate whether advancing the next mammography screening invitation date could enhance early detection and improve breast cancer outcomes in this population.

PMID:41042510 | DOI:10.1001/jamanetworkopen.2025.35330

JAMA Netw Open. 2025 Oct 1;8(10):e2535408. doi: 10.1001/jamanetworkopen.2025.35408.

ABSTRACT

IMPORTANCE: Medicare enrollees with low income report challenges affording out-of-pocket costs for health care. Although the Medicare Savings Programs (MSPs) were established to provide financial support, recent patterns in program take-up are understudied.

OBJECTIVES: To provide national and state-level estimates of take-up of the MSPs from 2018 to 2020 and describe the profile of enrolled and unenrolled individuals eligible for the MSPs.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional analysis used data from the Medicare Current Beneficiary Survey (MCBS), a nationally representative survey of community-dwelling Medicare beneficiaries. Respondents from 2018 to 2020 who completed the income and assets questionnaire, which allowed assessment of MSP eligibility, were analyzed. Data were analyzed in July 2024.

EXPOSURES: Eligibility for the MSPs.

MAIN OUTCOMES AND MEASURES: The take-up rate of the MSPs, defined as the proportion of eligible beneficiaries enrolled in the program. The MCBS survey weights were applied to create a subsample that was nationally representative of the community-dwelling Medicare population.

RESULTS: The primary sample included 26 240 respondent-year observations, representing 179 221 355 beneficiary-years (14.0% [95% CI, 13.4%-14.5%] of respondents were <65 years, 55.1% [95% CI, 54.1%-56.0%] were female, and 37.7% [95% CI, 36.0%-39.4%] had a high school education or lower). A total of 20.9% (95% CI, 19.8%-22.0%) of the primary sample was eligible for the MSPs. Of those eligible, 56.7% (95% CI, 54.5%-59.0%) were enrolled. Take-up rates varied widely across states, ranging from 41.5% (95% CI, 25.7%-57.3%) in Ohio to 72.9% (95% CI, 67.6%-78.2%) in California. Take-up among Medicare Advantage beneficiaries was higher than among those in traditional Medicare (61.3% vs 52.9%; difference, 8.4 percentage points [pp] [95% CI, 3.5-13.2 pp]). Compared with eligible beneficiaries who were not enrolled, enrolled individuals had greater economic insecurity, including being 30.0 pp (95% CI, 25.4-34.6 pp) more likely to report income below 100% of the federal poverty level and 16.4 pp (95% CI, 13.2-19.6 pp) more likely to report assets less than $3000.

CONCLUSIONS AND RELEVANCE: This cross-sectional study of Medicare beneficiaries suggests that MSP take-up remains incomplete and varied across states despite policy efforts. A policy to encourage participation in the MSPs among eligible populations that target less socially and financially vulnerable-although still with low income and eligible for the MSPs-individuals may be more likely to be associated with gains in the MSP take-up.

PMID:41042507 | DOI:10.1001/jamanetworkopen.2025.35408

Ir J Med Sci. 2025 Oct 3. doi: 10.1007/s11845-025-04108-x. Online ahead of print.

ABSTRACT

BACKGROUND AND AIM: This study investigated the relationship between preoperative Modified 5-item Frailty Score (mFI-5) and long-term survival as well as 30-day postoperative complications in patients who underwent radical cystectomy for bladder cancer.

METHODS: Patients who underwent radical cystectomy between 2012-2023 were analyzed and divided into two groups based on their mFI-5 scores: low-risk (≤ 1) and high-risk (≥ 2). Overall survival (OS), cancer-specific survival (CSS), and 30-day postoperative complications were compared between these groups. Additionally, Cox proportional hazards regression analysis was used to examine the impact of the mFI-5 score on OS and CSS.

RESULTS: Our study included 288 patients with an average age of 63.8 ± 9.1 years at the time of surgery. Patients with a low mFI-5 score comprised 77.4% (n = 223) of the cohort, while 22.6% (n = 65) had a high mFI-5 score. The majority of patients had advanced-stage disease (pT3-pT4 for 53.8% (n = 155)). Patients with a high mFI-5 score demonstrated significantly worse OS and CSS compared to those with a low mFI-5 score (p = 0.002 and p = 0.007, respectively). Although 30-day mortality rates were significantly higher in the high mFI-5 score group (p = 0.002), the difference in overall complication rates was not statistically significant (p = 0.120). In multivariate Cox proportional hazards analysis, the mFI-5 score was identified as an independent predictor for both OS and CSS (p = 0.001 and p = 0.003, respectively).

CONCLUSION: mFI-5 score can provide valuable prognostic information regarding survival after radical cystectomy in bladder cancer patients, based on preoperative findings. It is an independent predictor of long-term survival.

PMID:41042491 | DOI:10.1007/s11845-025-04108-x

Infection. 2025 Oct 3. doi: 10.1007/s15010-025-02644-3. Online ahead of print.

ABSTRACT

BACKGROUND: Sepsis survivors are affected by a broad spectrum of long-term impairments, which overlap with Long-Covid and sequelae after influenza in their clinical presentation. However, we lack comparative assessments on the burden of long-term outcomes, particularly with patients being recruited from the same, contemporary patient population. Therefore we compared long-term outcomes after respiratory sepsis (RS), SARS-CoV-2-associated sepsis (SS) and influenza-associated sepsis (IS).

METHODS: Retrospective, population-based cohort study. We included patients > 15 years hospitalized with RS, SS and IS between 01/2020 and 12/2020 in Germany, who received intensive care unit treatment. We compared mortality, readmissions, prevalence of diagnoses in the cognitive, psychological or medical domain, and the number of impaired domains in the 12 months post-discharge between the three survivor cohorts, adjusting for between-group differences in relevant covariates by inverse propensity score weighting based on generalized propensity scores.

RESULTS: Our study included 12,854 patients, of which 8,201 were RS, 3,964 SS and 689 IS survivors. RS survivors had a considerably higher risk for 12-month mortality compared to SS and IS survivors (relative risk, 1.77 [95% CI, 1.54-2.03]; P < 0.001 and relative risk, 1.37 [95% CI, 1.14-1.65]; P = 0.001, respectively). They were more often rehospitalized, affected by multiple domain impairments, cognitive decline and impairments related to the severity of acute disease, e.g. complications of the tracheostoma, compared to survivors after SS and IS. RS survivors had a lower risk for being affected by medical diagnoses compared to SS. Risks for psychological diagnoses did not differ between RS and the other survivor groups.

CONCLUSIONS: Although respiratory sepsis survivors seem to be affected by more severe long-term impairments, the overall burden of post-acute sequelae among all survivor groups is high. This warrants efforts to provide targeted aftercare for all survivor populations after life-threatening infections.

PMID:41042487 | DOI:10.1007/s15010-025-02644-3

Sports Med. 2025 Oct 3. doi: 10.1007/s40279-025-02303-5. Online ahead of print.

ABSTRACT

BACKGROUND: With the increasing use of artificial intelligence in healthcare and sports science, large language models (LLMs) are being explored as tools for delivering personalized, evidence-based guidance to athletes.

OBJECTIVE: This study evaluated the capabilities of LLMs (ChatGPT-3.5, ChatGPT-4, and Google Bard) to deliver evidence-based advice on sleep and jet lag for athletes.

METHODS: Conducted in two phases between January and June 2024, the study first identified ten frequently asked questions on these topics with input from experts and LLMs. In the second phase, 20 experts (mean age 43.9 ± 9.0 years; ten females, ten males) assessed LLM responses using Google Forms surveys administered at two intervals (T1 and T2). Inter-rater reliability was evaluated using Fleiss’ Kappa, and intra-rater agreement using the Jaccard Similarity Index (JSI), and content validity through the content validity ratio (CVR). Differences among LLMs were analyzed using Friedman and Chi-square tests.

RESULTS: Experts’ response rates were high (100% at T1 and 95% at T2). Inter-rater reliability was minimal (Fleiss’ Kappa: 0.21-0.39), while intra-rater agreement was high, with 53% of experts achieving a JSI ≥ 0.75. ChatGPT-4 had the highest CVR for sleep (0.67) and was the only model with a valid CVR for jet lag (0.68). Google Bard showed the lowest CVR for jet lag (0%), with significant differences compared to ChatGPT-3.5 (p = 0.0073) and ChatGPT-4 (p < 0.0001). Reasons for inappropriate responses varied significantly for jet lag (p < 0.0001), with Google Bard criticized for insufficient information and frequent errors. ChatGPT-4 outperformed other models overall.

CONCLUSIONS: This study highlights the potential of LLMs, particularly ChatGPT-4, to provide evidence-based advice on sleep but underscores the need for improved accuracy and validation for jet lag recommendations.

PMID:41042486 | DOI:10.1007/s40279-025-02303-5

Sports Med. 2025 Oct 3. doi: 10.1007/s40279-025-02306-2. Online ahead of print.

ABSTRACT

BACKGROUND: Normative dual-task (concurrent cognitive and motor task) tandem gait has not been developed. Currently, only individual baseline data are used for tandem gait assessment post concussion.

OBJECTIVE: The object was to (1) determine factors associated with single-task and dual-task tandem gait time among collegiate athletes across multiple institutions, and (2) provide robust normative data for single-task and dual-task tandem gait time based on clinically relevant factors.

METHODS: Data were analyzed from 2,137 unique collegiate athletes (19.0 ± 1.1 years, 48.9% female, 23.7% with concussion history) from 2015 to 2022 during pre-injury baseline concussion testing from three universities. Tandem gait was performed under single- and dual-task conditions (serial subtraction by sixes/sevens, spelling five-letter words backward, reciting the months backward). The criteria for being a clinically relevant independent variable was (a) p value < 0.05, and (b) effect estimate of ≥ 1 s. Normative data based on established percentile thresholds were derived and stratified by clinically relevant factors.

RESULTS: None of the single-task tandem gait times were clinically relevant, while sex and contact level were for dual task. Mean (95% confidence interval) for overall single- and dual-task tandem gait times were 12.07 s (11.95, 12.19) and 16.51 s (16.29, 16.73), respectively.

CONCLUSION: Our results provide robust normative data for single- and dual-task tandem gait stratified by relevant patient factors that can be immediately used by clinicians and future researchers. Future research should compare the use of individual baseline versus normative data for acute concussion tracking.

PMID:41042485 | DOI:10.1007/s40279-025-02306-2

Reprod Sci. 2025 Oct 3. doi: 10.1007/s43032-025-01992-7. Online ahead of print.

ABSTRACT

The effect of polycystic ovary syndrome (PCOS) on the fatty acid (FA) content of follicular fluid (FF) is not fully understood. The present study aimed to determine whether the FA composition of FF phospholipids (PLs) and triglycerides (TGs) undergoes alterations in women with PCOS. A total of 40 subjects, including 20 PCOS patients and 20 controls, were enrolled. Thin-layer chromatography followed by gas chromatography was carried out to isolate FF lipid fractions and measure relative concentrations of their FAs, respectively. Percentages of individual FAs in FF PLs and TGs did not statistically differ between the control and PCOS groups (p > 0.05), other than palmitoleic acid, which significantly decreased and increased in PLs and TGs of women with PCOS, respectively (p < 0.05). There were positive correlations between intrafollicular levels of androgens and PL levels of several n-6 polyunsaturated FAs in the PCOS group (r > 0.4, p < 0.05). In addition, relative concentrations of eicosapentaenoic acid in both PL and TG fractions were inversely correlated with the fertilization rate (r < -0.4, p < 0.05). PCOS women with positive pregnancy outcomes also had higher PL and TG stearic acid with concomitant lower docosahexaenoic acid and peroxidizability index in PL and TG fractions, respectively (p < 0.05). It could be concluded that PCOS was associated with minor alterations in the FA composition of FF PLs and TGs. Furthermore, there were differential fraction-dependent associations between FF FA profile and biochemical and reproductive parameters in women with PCOS.

PMID:41042473 | DOI:10.1007/s43032-025-01992-7

Ann Surg Oncol. 2025 Oct 3. doi: 10.1245/s10434-025-18365-8. Online ahead of print.

NO ABSTRACT

PMID:41042464 | DOI:10.1245/s10434-025-18365-8

Infect Dis Ther. 2025 Oct 3. doi: 10.1007/s40121-025-01241-z. Online ahead of print.

ABSTRACT

INTRODUCTION: Respiratory syncytial virus (RSV) in older adults can cause a variable spectrum of symptoms, ranging from mild manifestations to hospitalization and sometimes adverse outcomes. However, its true epidemiological burden is underestimated due to non-specific symptoms, lack of standardized diagnostic criteria, limited lab confirmation, and inadequate attribution in administrative datasets.

METHODS: We conducted a time-series analysis using hospital discharge data from the Veneto Region, Italy, between 2018 and 2024. Respiratory infections (RI) and RSV-related hospitalizations were identified using International Classification of Diseases codes. A generalized additive mixed model (GAMM) was applied to weekly RI admissions, incorporating circulating pathogen data from the RespiVirNet surveillance system. Seasonal patterns and age-stratified risk were modeled using smoothing terms.

RESULTS: Among individuals aged ≥ 65 years, RSV accounted for an estimated 3.0% to 4.6% of RI hospitalizations. Age-specific hospitalization rates attributable to RSV were 26.8, 109.4, and 317.4 per 100,000 person-years in the 65-74, 75-84, and ≥ 85 age groups, respectively. Explicit RSV coding underestimated the true burden by a factor of up to 7.6. Incidence rates and underreporting were highest in post-acute COVID-19 seasons.

CONCLUSIONS: RSV-related hospitalizations in older adults are substantially underreported in administrative data. Improved surveillance and prospective clinical studies are needed to validate model estimates and assess diagnostic test performance. Statistical modeling represents a valid approach to estimate the burden of RSV hospitalizations in underdiagnosed populations, such as the elderly, when direct data are lacking.

PMID:41042450 | DOI:10.1007/s40121-025-01241-z

Infect Dis Ther. 2025 Oct 3. doi: 10.1007/s40121-025-01230-2. Online ahead of print.

ABSTRACT

INTRODUCTION: The aim of this study was to assess the relative vaccine effectiveness (rVE) of cell-based versus egg-based quadrivalent influenza vaccines (QIVc versus QIVe) in preventing test-confirmed influenza during the 2023-2024 US influenza season.

METHODS: rVE was estimated using a test-negative design applied to a large, linked, real-world dataset. QIVc or QIVe recipients aged 6 months-64 years who were tested for influenza within ± 7 days of an acute respiratory or febrile illness were included. rVE was estimated using doubly robust logistic regression. Analyses were performed for the full, pediatric, adult, outpatient and high-risk populations and by influenza type. Public health impact was assessed using a compartmental influenza burden averted model.

RESULTS: The analysis included 2119 QIVc-cases, 14,750 QIVc-controls, 14,559 QIVe-cases, and 75,351 QIVe-controls. QIVc was superior to QIVe in preventing test-confirmed influenza with an rVE of 19.8% (95% CI 15.7-23.8%) in the full population, and with rVEs of 19.6% (13.6-25.3%) in the pediatric population aged 6 months-17 years and 18.5% (12.1-24.5%) in adults aged 18-64 years. Consistent results were observed for all sensitivity and subgroup analyses against any influenza. If all vaccinated individuals aged 6 months-64 years in the US received QIVc over QIVe, an estimated 2,379,395 additional symptomatic illnesses would have been prevented, with proportionate reductions in related complications.

CONCLUSIONS: Our analysis showed superior effectiveness of QIVc over QIVe in preventing test-confirmed influenza among persons aged 6 months-64 years, and provided the first demonstration of superiority in pediatric populations from 6 months of age. A Graphical Abstract is availible for this article.

PMID:41042449 | DOI:10.1007/s40121-025-01230-2