Category: Nevin Manimala

JAMA Netw Open. 2025 Aug 1;8(8):e2526912. doi: 10.1001/jamanetworkopen.2025.26912.

ABSTRACT

IMPORTANCE: Rural patients face unique barriers in obtaining high-quality cancer care. Research is lacking in determining whether these disparities translate to negative clinical outcomes.

OBJECTIVE: To determine if there are differences in the rate of biochemical recurrence in prostate cancer between rural and urban men.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used patient data that was abstracted from the North Carolina Prostate Cancer Comparative Effectiveness and Survivorship Study, a population-based cohort that prospectively followed patients with newly diagnosed prostate cancer from the Rapid Case Ascertainment system of the North Carolina Central Cancer Registry from January 1, 2011, to June 30, 2013. Patients were identified who had received either surgery or radiation within 1 year of diagnosis. Data were analyzed from January 2011 to December 2022.

EXPOSURE: Patients were categorized as rural or urban using the Rural-Urban Continuum Code.

MAIN OUTCOME AND MEASURES: Recurrence was determined by prostate-specific antigen testing. Demographic differences between rural and urban patients were assessed using 2-sample independent t test and χ2 test. Prostate cancer recurrence was analyzed using Cox proportional hazard models.

RESULTS: A total of 778 patients were included with a median (IQR) follow-up of 4.6 (2.0 to 6.9) years and a mean (SD) age of 63 (7.4) years. Additionally, 213 were Black men (27.4%), 565 were White men (72.6%), 350 were Medicare insured (45.1%), 324 had an income ranging from $40 000 to $90 000 (43.1%), 370 were a National Comprehensive Cancer Network (NCCN) intermediate risk group (47.6%), 449 were treated with radical prostatectomy (57.7%), and 690 were in good to excellent health (88.7%) with 191 living in a rural setting (24.6%). On univariable analysis, rural residence (hazard ratio [HR], 2.19 [95% CI, 1.38 to 3.46]; P < .001), NCCN risk group (HR, 4.13 [95% CI, 2.25 to 7.57]; P < .001), and having had fewer than 12 biopsies (HR, 1.70 [95% CI, 1.08 to 2.67]; P = .02) were significantly associated with biochemical recurrence. On multivariable analysis adjusted for location of residence, marital status, overall health, number of cores biopsied, NCCN risk group, and treatment type, rural residence was significantly associated with recurrence (HR, 1.74 [95% CI, 1.07 to 2.82]; P = .03), while radiation therapy was inversely associated with recurrence (HR, 0.51 [95% CI, 0.31 to 0.85]; P = .01).

CONCLUSIONS AND RELEVANCE: In this cohort study of patients with newly diagnosed prostate cancer, rural patients with prostate cancer had higher rates of biochemical recurrence. The etiology of this disparity is unclear but is likely multifactorial. Factors that may play a role include socioeconomic status, delay and disruptions in care, and access to multidisciplinary cancer care.

PMID:40779263 | DOI:10.1001/jamanetworkopen.2025.26912

JAMA Health Forum. 2025 Aug 1;6(8):e252284. doi: 10.1001/jamahealthforum.2025.2284.

ABSTRACT

IMPORTANCE: Patient cost sharing liability has risen in recent years, increasing the costs associated with care for patient households and imposing collections challenges for hospitals and clinicians.

OBJECTIVE: To measure patient repayment of cost sharing over recent years, and how that varies across patient, hospital, and service characteristics.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study of billing and payment data from a revenue cycle management company examined patient accounts at 217 US hospitals from 2018 to 2024. Participants included 24.5 million and 6.2 million patient episodes of care with positive patient out-of-pocket liability for individuals with private insurance and Medicare Advantage, respectively.

MAIN OUTCOMES AND MEASURES: Percentage of owed patient cost sharing actually paid among patients with private insurance and Medicare Advantage measured over time, for inpatient and outpatient care and by bill size.

RESULTS: Across the full sample of 217 US hospitals (30.7 million patient episodes), mean (SD) patient liability per person, including those with no liability, was higher for individuals with private insurance ($375.41 [$51.55]) than those with Medicare Advantage ($172.50 [$14.84]). Consistent with high-deductible plan design with annual resetting, mean patient liability was higher for visits in January than December, particularly among the privately insured (eg, mean [SD] patient liability for visits among the privately insured in January: $479.44 [$29.21] vs December: $321.63 [$14.29]). Prior to the COVID-19 pandemic (January 2018-February 2020), mean repayment rates were 53.9% and 54.0% for patients with private or Medicare Advantage insurance, respectively, and repayment rates declined in more recent years. Across the entire sample, patients with private or Medicare Advantage insurance paid either 0% or 100% of their owed cost sharing in 92.2% and 94.1% of cases, respectively. Repayment rates varied by bill size with lower repayment rates on the largest bills and the smallest bills, and higher repayment rates on midsized bills.

CONCLUSIONS AND RELEVANCE: This cross-sectional study found that patient cost sharing repayments were incomplete and have fallen in more recent years, which result in both medical debts for patients and collections shortfalls for hospitals and clinicians. These findings suggest that changes to insurance plan design or the treatment of medical debt are among several factors that may contribute to observed results; if declines in cost sharing repayment continue, hospitals and clinicians may increasingly seek payment of cost sharing ahead of service, when allowable.

PMID:40779258 | DOI:10.1001/jamahealthforum.2025.2284

JAMA Health Forum. 2025 Aug 1;6(8):e252329. doi: 10.1001/jamahealthforum.2025.2329.

ABSTRACT

IMPORTANCE: Achieving equitable access to medicines requires understanding of how pharmaceutical use and spending vary by race and ethnicity across the US.

OBJECTIVE: To quantify variation in prescription drug utilization and spending per capita and per prevalent case by race, ethnicity, health condition, payer, and US state.

DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, the US Disease Expenditure project was extended to incorporate disaggregation by race and ethnicity for state-level retail prescription drug utilization and spending-in addition to 143 health conditions, 38 age and sex groups, and 4 payers (Medicare, Medicaid, private insurance, and out of pocket)-across the 2019 population in all 50 states and Washington, DC. Data were analyzed from October 2023 to April 2025.

EXPOSURE: Four mutually exclusive racial and ethnic groups (Asian or Pacific Islander, Black, Hispanic, and White).

MAIN OUTCOME AND MEASURES: Outcomes include prescriptions dispensed and spending for retail pharmaceuticals. Estimates were standardized by population size, population age, and-where data permitted-by disease burden (52 conditions). Das Gupta decomposition was used to estimate the relative contribution of 3 factors (disease prevalence, prescriptions per prevalent case, and spending per prescription) on observed disparities in age-standardized per capita pharmaceutical spending.

RESULTS: In 2019, age-standardized pharmaceutical utilization and spending per person with a given disease was substantially lower than the all-population mean for Black populations, close to the mean for Hispanic populations, and often higher than the mean for Asian or Pacific Islander and White populations. These trends-particularly those for the Black population-were generally consistent across 52 health conditions but varied widely across payers and US states. The decomposition analysis for these 52 conditions showed that differences in per capita pharmaceutical spending across race and ethnicity groups were primarily explained by disease prevalence for Black populations (associated with increased per capita spending) and by utilization rates per prevalent case for Hispanic populations (also associated with increased spending). In contrast, differences in drug price or product type (spending per prescription) contributed less to observed spending disparities.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, racial and ethnic disparities in medication use persisted, most notably the underutilization of medicines relative to disease burden among Black populations. These patterns varied by state, highlighting the need for local- and condition-specific approaches to advancing pharmacoequity in the US.

PMID:40779257 | DOI:10.1001/jamahealthforum.2025.2329

JAMA Health Forum. 2025 Aug 1;6(8):e252999. doi: 10.1001/jamahealthforum.2025.2999.

ABSTRACT

IMPORTANCE: Temporary Assistance for Needy Families (TANF) is a major federal cash assistance program for low-income families, but the program has strict eligibility criteria, meager cash benefits, and cumbersome administrative burdens that limit its effect. However, during the COVID-19 pandemic state TANF programs implemented policy changes to expand program access, including relaxed work requirements and additional income. Few studies have examined the association of these policy changes with health outcomes.

OBJECTIVE: To analyze the association between TANF policy changes during the COVID-19 pandemic and breastfeeding initiation and duration.

DESIGN, SETTING, AND PARTICIPANTS: This study used serial cross-sectional national data from the Pregnancy Risk Assessment Monitoring System (2017-2020) and a quasi-experimental difference-in-differences analysis to examine whether TANF policy changes affected breastfeeding behaviors among likely TANF participants compared with likely nonparticipants. Multivariable linear regression analyses were conducted that adjusted for individual and state-level covariates. The study was conducted between November 2024 and May 2025.

EXPOSURES: Gave birth in a state that implemented TANF policy changes (eg, 1-time cash payments, waiving in-person interviews and work requirements, and extending time limits).

MAIN OUTCOMES AND MEASURES: Self-reported measures of whether breastfeeding was initiated and breastfeeding duration in weeks.

RESULTS: The sample included 138 700 individuals; the likely TANF participants were less likely to be White (~33%) or married (~37%), were younger (~29% were 20-24 years of age), had lower incomes (~$30 000), and were more likely to have 2 or more previous births (~39%) compared with the likely nonparticipants. The TANF policy changes that expanded eligibility and decreased administrative burdens were associated with increased breastfeeding initiation and duration; eg, waiving sanctions was associated with increased breastfeeding initiation (2.59 percentage points [95% CI, 0.13-5.06 percentage points]) and automatic recertification was associated with increased breastfeeding duration (0.49 weeks [95% CI, 0.04-0.94 weeks]). Providing 1-time cash payments was also associated with increased breastfeeding duration (1 week [95% CI, 0.42-1.58 weeks]). These positive associations were found across all racial and ethnic groups, although some 95% CIs included the null.

CONCLUSIONS AND RELEVANCE: In this quasi-experimental study, state TANF policies that expanded eligibility, increased cash payments, and decreased administrative burdens were associated with increased breastfeeding initiation and duration. These findings inform active policymaking on antipoverty policies.

PMID:40779256 | DOI:10.1001/jamahealthforum.2025.2999

Int J Clin Oncol. 2025 Aug 8. doi: 10.1007/s10147-025-02846-7. Online ahead of print.

ABSTRACT

BACKGROUND: A post-marketing surveillance (PMS) study was conducted in Japan to assess real-world outcomes with radium-223 treatment in men with metastatic castration-resistant prostate cancer (mCRPC). Results from the treatment period showed that radium-223 was generally well tolerated. Follow-up was subsequently extended to 3 years to collect data on fracture events. Results of the extended follow-up are now reported.

METHODS: This prospective, non-interventional, multicenter, single-cohort PMS study enrolled men with CRPC and bone metastases treated with radium-223 under clinical practice. Extended follow-up lasted until 3 years after the first administration of radium-223. Data on clinical fractures and survival were collected.

RESULTS: A total of 334 patients were enrolled, with a median follow-up of 15.3 months (range 1-50). The overall incidence proportion of fractures reported as adverse events was 7.76% (95% confidence interval [CI] 5.09-11.25%), with a fracture incidence rate of 5.22 patients [with fracture]/100 person-years (PY). Patients who received bone-modifying agents (BMAs) had a numerically lower incidence of fractures (5.85%; 3.46/100PY vs 9.93%; 7.92/100PY). Median overall survival was 26.32 months (95% CI 21.65-not reached).

CONCLUSION: Compared with existing reference data, there was no obvious increase in the incidence of clinical fractures in Japanese patients with mCRPC who were treated with radium-223 under clinical practice. As is already well known for androgen deprivation, BMAs may also be useful in reducing bone fracture after radium-223.

PMID:40779218 | DOI:10.1007/s10147-025-02846-7

Int J Colorectal Dis. 2025 Aug 8;40(1):173. doi: 10.1007/s00384-025-04975-x.

ABSTRACT

PURPOSE: To assess the effect of computed tomography angiography (CTA) and three-dimensional (3D) reconstruction on laparoscopic colectomy in patients with colon cancer.

METHODS: Patients with colon cancer who were treated at Zhejiang Cancer Hospital between August 2020 and December 2022 were included in this pilot, randomized controlled trial. The participants were randomly assigned to either the CTA group, in which patients underwent preoperative CTA and 3D reconstruction, or the control group, in which patients underwent preoperative enhanced abdominal and pelvic CT examinations. The primary outcome was the duration of the operation. The secondary outcomes included intraoperative blood loss, length of hospital stay, number of lymph node dissections, fasting duration, duration of tube drainage, overall survival (OS), and progression-free survival (PFS). To minimize statistical bias, patients were stratified into subgroups on the basis of tumor location (left colon or right colon). Additionally, variations in the middle colonic artery (MCA), inferior mesenteric artery (IMA), and colonic branches of superior mesenteric artery (cbSMA) classifications were documented.

RESULTS: A total of 82 patients (41 in each group) were included in the analysis. The CTA group had significantly shorter operation durations (123.68 ± 26.09 vs. 154.12 ± 33.15 min, P < 0.001) and fasting durations (median 4.00 vs. 5.00 days, P < 0.001) as well as reduced intraoperative blood loss (median 50.00 vs. 100.00 mL, P = 0.001) compared to the control group; these differences were observed in the overall colon cancer cohort and in the left and right colon subgroups. However, no significant differences were observed between the two groups in terms of lymph node dissection, tube drainage duration, hospitalization duration, OS or PFS. In the CTA group, the proportions of patients with different IMA types were as follows: Type A (60.97%), Type B (9.76%), Type C (17.07%), and Type D (12.20%); the proportions of patients with different MCA types were as follows: Type A (78.05%), Type B (12.20%), Type C (7.31%), and Type D (2.44%); and the proportions of patients with different cbSMA types were as follows: Type A (65.85%), Type B (7.32%), Type C (17.07%), and Type D (9.76%). Patients with a tumor size ≥ 5 cm, preoperative intestinal obstruction, postoperative pathological serosal invasion, lymph node metastasis, and stage III disease had significantly worse OS and PFS than those with a tumor size < 5 cm (P = 0.007, P = 0.026), no preoperative intestinal obstruction (P = 0.015, P = 0.019), no serosal invasion (P = 0.001, P = 0.001), no lymph node metastasis (P = 0.016, P = 0.001), and stage I-II disease (P = 0.013, P = 0.001). However, no significant differences in OS or PFS were observed between patients who underwent preoperative CTA examination and the control group (P = 0.551, P = 0.591), between male and female patients (P = 0.402, P = 0.361), or between patients with and without postoperative complications (P = 0.561, P = 0.520). Finally, multivariate Cox proportional hazards regression analysis revealed that serosal invasion (P = 0.013; P = 0.009), lymph node metastasis (P = 0.029; P = 0.043), and tumor stage (P = 0.002; P = 0.001) were independent prognostic factors that affected the OS and PFS of patients with colon cancer.

CONCLUSION: Preoperative CTA and 3D reconstruction provide essential information for laparoscopic surgery, facilitate the optimization of surgical procedures, and support improved postoperative recovery for patients with colon cancer, suggesting promising clinical applications.

PMID:40779208 | DOI:10.1007/s00384-025-04975-x

Acta Parasitol. 2025 Aug 8;70(4):172. doi: 10.1007/s11686-025-01109-9.

ABSTRACT

BACKGROUND: Human ascariasis a soil-transmitted helminthiasis (STH) is still considered a neglected tropical disease by the World Health Organization continues to pose a serious public health concern, particularly in developing nations with poor sanitation, hygiene, and health awareness. Unlike prior prevalence studies relying solely on fecal analysis, this study utilized an innovative strategy to assess drug efficacy. The study aimed to assess the effectiveness of anthelmintic therapy and identify risk factors associated with Ascaris lumbricoides infection among school-aged children in rural Khyber Pakhtunkhwa, Pakistan.

METHODS: This was a prospective, community-based interventional study in which 1,675 school-aged children were randomly allocated to receive one of three anthelmintic drugs: pyrantel pamoate (n = 592), mebendazole (n = 553), or albendazole (n = 530). The primary outcome, deworming efficacy, was measured by the post-treatment expulsion and identification of Ascaris lumbricoides worms in stool samples collected within 1-2 days. A well-structured questionnaire was administrated to evaluate key environmental, behavioral, and socioeconomic risk factors contributing to ascariasis.

RESULTS: The overall prevalence of A. lumbricoides infection was found to be 15.1%, univariate logistic regression analysis identified several statistically significant predictors of Ascaris lumbricoides infection. Age was a significant factor, individuals aged 8-14 years had lower odds (OR = 0.58, 95% CI: 0.42-0.80, p < 0.001) and those ≥ 14 years had higher odds (OR = 1.47, 95% CI: 1.04-2.06, p = 0.03) than children aged 0-7 years. Drug regimen was the most influential factor: children treated with Pyrantel pamoate exhibited markedly elevated odds (OR = 6.76; 95% CI: 4.49-10.18; p < 0.001), followed by those receiving Mebendazole (OR = 1.50; p = 0.03), relative to Albendazole. Significant district-level differences exist, with Mardan (OR = 0.06, p < 0.001) and Swabi (OR = 0.04, p < 0.001) having significantly lower risk of ascariasis than Abbottabad. Battagram had comparable odds to Abbottabad, indicating no significant difference (OR = 1.01 p = 0.98). Key protective factors included wearing footwear (OR = 0.32; p < 0.001), clean fingernails (OR = 0.54; p < 0.001), access to a washroom (OR = 0.47; p < 0.001), and drinking tap water (OR = 0.44; p = 0.01). Conversely, middle household income (OR = 2.26; p < 0.001) and participation in deworming programmes (OR = 5.75; p = 0.03) were associated with increased infection risk, possibly reflecting selection bias and high-risk areas. Similarly, Multivariable logistic regression model revealed independent effects of age ≥ 14 years (AOR = 6.64; p < 0.001), middle income (AOR = 1.79; p < 0.001), rural location (AOR = 1.78; p = 0.01), and district (e.g., Battagram: AOR = 1.82; p = 0.03). Mebendazole (AOR = 7.73) and Pyrantel pamoate (AOR = 7.37) were significant predictors (p < 0.001). Gender, hygiene behaviours, and other factors did not indicate a statistically significant connection (p > 0.05).

CONCLUSIONS: The low prevalence of A. lumbricoides infection in the current study was due to evidence-based method, which provides precise evaluation of infection burden and treatment efficacy. To reduce the incidence of ascariasis in endemic locations, the study emphasizes the critical need for efficient public health interventions, such as health education, better sanitation infrastructure, frequent deworming campaigns, and community-based awareness initiatives.

PMID:40779205 | DOI:10.1007/s11686-025-01109-9

Mol Biol Rep. 2025 Aug 8;52(1):809. doi: 10.1007/s11033-025-10873-w.

ABSTRACT

BACKGROUND: Breast cancer is a prevalent malignancy in women worldwide, with recurrence and treatment-related side effects posing significant challenges. Immunotherapy has shown promise, yet an immunosuppressive tumor microenvironment can hinder its effectiveness. Emerging evidence suggests that probiotics, particularly Lactobacillus species, may positively influence immune responses and tumor progression in the context of cancer therapy.

METHODS: This study evaluated the effects of Lactobacillus reuteri PTCC1058 on tumor development and immune responses in a mouse model of breast cancer induced by 4T1 mouse breast carcinoma cells. Female BALB/c mice were divided into probiotic and control groups, receiving oral supplementation of the probiotic or PBS, respectively, for 30 days before and after tumor induction. Tumor volume and survival were assessed over 70 days. The expression levels of key immune mediators, tumor Necrosis Factor alpha (TNF alpha), Interleukin 10 (IL-10), transforming growth factor beta (TGF-β), Indoleamine 2,3-dioxygenase (IDO), and Fas ligand (FasL) were measured using quantitative real-time PCR, and histopathological analysis was conducted on tumor tissues.

RESULTS: Probiotic treatment exhibited a trend towards reduced tumor volume and improved survival, although not statistically significant (p > 0.05). Key immune mediators showed significant changes, with TGF-β, IL-10, and IDO expressions downregulated and TNF-α and FasL upregulated in the probiotic group (P < 0.01). Histopathological analysis revealed reduced pleomorphism, mitotic activity, and focal necrosis in the probiotic group.

CONCLUSION: The findings indicate that L. reuteri PTCC1058 may modulate the tumor microenvironment and influence immune responses in breast cancer. While further research is necessary to validate these results, probiotics could represent a complementary therapeutic strategy in breast cancer treatment.

PMID:40779195 | DOI:10.1007/s11033-025-10873-w

Environ Monit Assess. 2025 Aug 8;197(9):997. doi: 10.1007/s10661-025-14445-0.

ABSTRACT

Heavy metals(loids) in scrap metal recycling sites pose serious risks to human and environmental health. In this study, the health risks of multiple heavy metals(loids) (i.e., Cd, Cu, Mn, Ni, Pb, and Zn) via soil and crop exposure at a traditional metal recycling site in Vietnam with approximately 1000 years of operation were evaluated. The soil and the 20 most common crops within four groups (rice, leafy vegetables, nonleafy vegetables, and brassica vegetables) were collected. The pollution index (PI) values of the soil (1.01-4.80) ranged from moderately polluted to heavily polluted. Metal accumulation in crops (mg/kg, fresh weight) was in the order of Mn (9.95) > Zn (8.23) > Cu (1.50) > Ni (0.14) > As = Cd (0.04) > Pb (0.03). The results revealed high noncancer (hazard index (HI) = 7.1) and cancer (incremental lifetime cancer risk (ILCR) = 4.31 × 10^-3) risks to the exposed community. Rice contributed to 84.1% of the total HI and 82.5% of the total ILCR, indicating a high health risk via rice consumption. To reduce health risks, rice, cabbage, fish mint, lemongrass, lettuce, and marjoram should not be grown in the study area. Pollutant management (e.g., pollutant source reduction, selection of proper crop cultivation, remediation of metal-contaminated soil, and reduction of metal uptake by crops) at scattered metal recycling sites should receive adequate attention to reduce the high noncancer and cancer health risks to inhabitants.

PMID:40779183 | DOI:10.1007/s10661-025-14445-0

Acta Neurochir (Wien). 2025 Aug 8;167(1):218. doi: 10.1007/s00701-025-06632-2.

ABSTRACT

PURPOSE: The increasing availability of advanced neuroimaging has led to a rise in incidental findings among pediatric patients. Management strategies include immediate surgical intervention, observation or surgery upon progression. These are influenced by imaging characteristics, lesion behavior over time, patient/family preferences, and the lesion’s surgical risks. The thalamus’s eloquent location often warrants a more conservative approach. Identifying features predictive of growth could help inform clinical decisions regarding surveillance and potential intervention.

METHODS: We retrospectively analyzed 44 pediatric patients with 46 thalamic incidentalomas, assessing radiological characteristics, temporal changes, and factors predictive of progression. Progression was defined as a change in size and/or new/increased contrast enhancement. Prognostic factors for progression (demographics, initial tumor volume, extension beyond thalamus, changes in enhancement, margin characteristics) were assessed for significance.

RESULTS: Of 46 incidentalomas, 40 were followed longitudinally. Nine incidentalomas (22.5%) showed regression, while nine (22.5%) progressed. The average time to regression was 947 days, and to progression, 516 days. Three patients underwent biopsy due to progressive changes; each was diagnosed with low-grade glioma. Statistical analysis revealed that initial incidentaloma volume, extension beyond the thalamus, and contrast enhancement were significantly associated with progression (p = 0.025, p < 0.001, and p = 0.001, respectively).

CONCLUSIONS: Most pediatric thalamic incidentalomas are small, stable, and likely low-grade. However, approximately one-fifth exhibit progressive features, warranting prolonged surveillance. Larger initial volume, extra-thalamic extension, and contrast enhancement are significant predictors of progression and may justify earlier intervention. Individualized management remains essential, balancing natural history with surgical risk.

PMID:40779174 | DOI:10.1007/s00701-025-06632-2