Category: Nevin Manimala

JMIR Hum Factors. 2026 May 5;13:e86152. doi: 10.2196/86152.

ABSTRACT

BACKGROUND: Digital remote monitoring using smartphones and wearable devices is a promising solution for psychosis management, where precise, time-sensitive intervention is crucial. Combining active symptom monitoring (ASM) and passive sensing (PS) can support self-management by allowing remote, low-burden mental health monitoring.

OBJECTIVE: This study aimed to explore (1) views on collecting data using ASM and PS methods and comfort levels with different types of data gathered via these methods, (2) views on using smartphones and wearable devices in the context of mental health care, and (3) the ownership and usage of smartphones and wearable devices.

METHODS: We conducted a cross-sectional survey study with service users with psychosis in the United Kingdom between March 2023 and March 2024.

RESULTS: A total of 309 participants completed the survey. They reported mixed views on using ASM and PS technologies for monitoring mental health, with more participants endorsing the concept than opposing it (ASM: n=145, 46.9% and PS: n=132, 42.7%). However, the type of data gathered using these methods was an important factor. Collecting personal information was deemed less acceptable (P<.001) than other data types (physical health, mental health, environment, and nonpersonal device information).

CONCLUSIONS: We found that participants were comfortable with using apps and wearables for digital remote monitoring, though personal information was less acceptable than other data types due to privacy and surveillance concerns. This highlights the importance of further exploring trust issues related to digital monitoring and ensuring that end users have choices regarding the types of data that digital systems gather and share with mental health services.

PMID:42085662 | DOI:10.2196/86152

Turk Arch Pediatr. 2026 Mar 23;61(5):438-443. doi: 10.65717/TurkArchPediatr.2026.25309.

ABSTRACT

OBJECTIVE: Serum Krebs von den Lungen-6 (KL-6) level increases in interstitial lung disease and lung cancer. The present study investigated whether there was an increase in serum KL-6 levels in patients with bone sarcoma who were considered positive for lung metastasis.

MATERIALS AND METHODS: Serum samples were collected from patients diagnosed with Ewing sarcoma and osteosarcoma before starting chemotherapy. The samples were frozen and stored at -80°C, and serum KL-6 level was measured using enzyme-linked immunosorbent assay.

RESULTS: Serum samples of 47 patients and 42 healthy volunteers were evaluated. At the time of diagnosis, 10 patients had pulmonary tumor metastasis. Patients were followed up for a median of 43 months (1-125 months). At the time of diagnosis, the median KL-6 level of patients with lung metastases was 38.15 U/mL (10.6-155.6 U/mL), while the KL-6 level of patients without lung metastases was 15.2 U/mL (10.7-188.3 U/mL). The difference between these 2 groups was borderline significant (P = .051). The median KL-6 value of the control group was 14.85 U/mL (10.3-188.6 U/mL). When the patients with lung metastasis at the time of diagnosis were compared with the healthy control group, the KL-6 level of the patients was statistically significantly higher than the control group (P = .017).

CONCLUSION: In this pilot study, it was found that serum KL-6 levels were elevated in patients with lung metastasis at the time of diagnosis compared to healthy controls. Serum KL-6 level may be used as an additional parameter to detect pulmonary metastasis, and further studies are needed to confirm this observation.

PMID:42084889 | DOI:10.65717/TurkArchPediatr.2026.25309

Turk Arch Pediatr. 2026 May 4;61(5):406-413. doi: 10.65717/TurkArchPediatr.2026.25344.

ABSTRACT

OBJECTIVE: “Nutrition Friendly School Initiative” (NFSI) project intends to improve school health by increasing sensitivity about healthy feeding and active life and supporting good practices on this topic. The study aimed to evaluate the effect of this project on eating habits and anthropometric values in school-aged children.

MATERIALS AND METHODS: A total of 516 children from 2 nutrition friendly schools and 4 nonnutrition friendly schools are included. Eating habits and behaviors are evaluated by questionnaires. Weight and height z scores, weight for height and body mass index percentages were calculated. Eating habits and anthropometric values were compared between schools that are and are not nutrition friendly.

RESULTS: Students from nutrition-friendly schools were consuming fruits more frequently. Their families also preferred homemade foods. Most of the children had a tendency to consume vegetables, vegetable meals, and fruits. Malnutrition was present in 102 (19.8%) of the children, whereas 328 (63.5%) were normal and 86 (16.7%) were overweight and obese. Overweight and obesity were higher in control group (n=48, 19.0% vs. n=38, 14.4%, P=.342), but this was not statistically significant.

CONCLUSION: The “Nutrition Friendly School” project had a positive effect on eating behaviors, but no relation was present with obesity. Besides supporting the NFSI, the importance of the family and environment should be remembered, and the education of the people responsible for feeding the child should be taken in consideration.

PMID:42084885 | DOI:10.65717/TurkArchPediatr.2026.25344

JAMA Netw Open. 2026 May 1;9(5):e2610789. doi: 10.1001/jamanetworkopen.2026.10789.

ABSTRACT

IMPORTANCE: The 988 Suicide & Crisis Lifeline (998 Lifeline) receives millions of contacts annually. Adequate staffing of 988 Lifeline centers may be important for timely, high-quality service, but little information exists on current staffing levels or difficulties.

OBJECTIVES: To describe 988 Lifeline center staffing and assess staffing-related difficulties.

DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, a survey was fielded between May 6 and July 25, 2025, to all 206 centers in the 988 Lifeline network in the US and territories. Eligible respondents were individuals in leadership positions (eg, executive directors, vice presidents).

MAIN OUTCOMES AND MEASURES: The survey measured staffing levels, shift coverage, modalities (telephone, text, and/or chat), operation of non-988 lines (eg, 211, local lines), proportions of paid and volunteer staff, remote and/or in-person work arrangements, and 4 domains of staffing difficulty: adequate staffing for the volume of contacts, acquiring funding to hire, recruiting staff, and retaining staff. Responses were linked with administrative data on location, presence of state 988 telecommunications fees, and subnetwork services (eg, national backup, Spanish language).

RESULTS: Leaders at 159 of the 206 centers completed the survey (77% response rate), 71% (102 of 144) reported that their center was understaffed, and 89% (141 of 159) indicated difficulty acquiring resources to hire. Leaders at centers offering remote work reported greater difficulty in obtaining these resources compared with centers without remote work (94% [89 of 95] vs 81% [50 of 62]; odds ratio [OR], 3.40; 95% CI, 1.21-9.68; P = .02) but less difficulty recruiting staff (76% [72 of 95] vs 89% [55 of 62]; OR, 0.39; 95% CI, 0.14-0.98; P = .04). Respondents from centers with all paid staff reported greater difficulty recruiting compared with centers using at least some volunteers (86% [102 of 118] vs 66% [27 of 41]; OR, 3.28; 95% CI, 1.42-7.60; P = .006). Leaders at centers handling only 988 contacts reported less difficulty retaining staff than those also handling non-988 lines (63% [17 of 27] vs 83% [109 of 132]; OR, 0.36; 95% CI, 0.14-0.92; P = .03). Wide 95% CIs indicate uncertainty in the magnitude of these results.

CONCLUSIONS AND RELEVANCE: In this cross-sectional survey study of 988 Lifeline leaders, results suggested that most centers struggled to find resources to keep the center fully staffed. If staffing challenges persist, centers could face risks to staff well-being and service quality. Financing and operational strategies that support recruitment and retention will be critical to sustaining the quality and accessibility of 988 Lifeline centers.

PMID:42084871 | DOI:10.1001/jamanetworkopen.2026.10789

JAMA Netw Open. 2026 May 1;9(5):e2610810. doi: 10.1001/jamanetworkopen.2026.10810.

ABSTRACT

IMPORTANCE: Inpatient care is costly, and an aging population, hospital bed shortages, and practitioner shortages stretch inpatient capacity. Alternative modalities of acute care delivery may support growing demands.

OBJECTIVE: To compare outcomes of hospital at home (HaH) vs traditional inpatient hospital admissions and to assess facility-level variability in HaH utilization.

DESIGN, SETTING, AND PARTICIPANTS: This propensity score-matched, retrospective, comparative effectiveness research study used data for age-qualifying (≥65 years) fee-for-service Medicare beneficiaries admitted from January 1, 2021, through December 1, 2022, within HaH-waivered US hospitals that had 12 or more HaH admissions. Analyses were completed from November 2024 to March 2026.

EXPOSURE: HaH vs traditional inpatient hospitalization.

MAIN OUTCOMES AND MEASURES: Primary clinical outcomes were in-hospital mortality and hospital readmissions and emergency department (ED) visits within 30 days of index admission discharge. Facility-level characteristics were assessed for facilities that had HaH admissions above and below the median (≥149 admissions). Conditional logistic regression was used for dichotomous outcomes, with adjusted odds ratios (aORs) and 95% CIs reported. Log-transformed linear regression was used for skewed continuous outcomes within matched pairs, with adjusted percentage changes and 95% CIs reported.

RESULTS: Among 15 871 Medicare beneficiaries (4174 HaH and 11 697 traditional inpatient admissions), the overall mean (SD) age was 77.4 (8.0) years, and 8396 beneficiaries (56.2%) were female. Of 313 HaH-waivered hospitals, 68 were eligible for inclusion, and 11 hospitals accounted for approximately 50% of all HaH admissions. Compared with traditional inpatient admissions, HaH admissions were associated with lower in-hospital mortality (16 of 4174 admissions [0.4%] vs 423 of 11 697 admissions [3.6%]; aOR, 0.09; 95% CI, 0.06-0.16) and lower ED use within 30 days of discharge (366 of 4174 admissions [8.8%] vs 1164 of 11 697 admissions [10.0%]; aOR, 0.86; 95% CI, 0.76-0.97), with no significant difference in readmissions within 30 days of discharge (490 of 4174 admissions [11.7%] vs 1282 of 11 697 admissions [11.0%]; aOR, 1.07; 95% CI, 0.96-1.20).

CONCLUSIONS AND RELEVANCE: In this retrospective comparative effectiveness research study of Medicare beneficiaries, HaH was associated with lower in-hospital mortality and ED use within 30 days of discharge, but not hospital readmissions within 30 days, compared with traditional inpatient care. These findings support HaH as an approach that may maintain similar or better short-term outcomes among appropriately selected patients; future studies should evaluate implementation and equity.

PMID:42084870 | DOI:10.1001/jamanetworkopen.2026.10810

JAMA Netw Open. 2026 May 1;9(5):e2610831. doi: 10.1001/jamanetworkopen.2026.10831.

ABSTRACT

IMPORTANCE: Drug overdose is a leading cause of death among US veterans with homeless experience. Medications for opioid use disorder (MOUD) reduce overdose and all-cause mortality, yet receipt remains low among veterans with homeless experience. Identifying factors associated with MOUD receipt in Department of Veterans Affairs (VA) permanent supportive housing (PSH) can inform strategies to support MOUD implementation and advance health equity.

OBJECTIVE: To identify demographic, clinical, and service-related factors associated with MOUD receipt among veterans with homeless experience with opioid use disorder (OUD) in the Housing and Urban Development-VA Supportive Housing (HUD-VASH) program.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used linked national VA administrative and electronic health record data. US veterans with OUD entering HUD-VASH between October 1, 2017, and September 30, 2021, were followed up for 12 months after move-in. Eligible participants were diagnosed with OUD as defined by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision criteria within 5 years before or 1 year after move-in. Sequential logistic regression models examined associations between demographic, clinical, and service utilization factors and MOUD receipt. Statistical analyses were conducted between May 2025 and February 2026.

EXPOSURE: Demographic, clinical, and service-related factors.

MAIN OUTCOMES AND MEASURES: Receipt of MOUD (buprenorphine, methadone, or extended-release naltrexone) within 12 months after HUD VASH move-in.

RESULTS: Among 10 110 veterans with OUD, the mean (SD) age was 53.2 (12.0) years (9297 male [92%]; 3211 Black [32%], 606 Hispanic [6%], 5537 White [55%]); 1685 veterans (17%) received MOUD. Older age (age 55 to 64 years: adjusted odds ratio [AOR], 0.52 [0.42-0.64]) and non-Hispanic Black race (AOR, 0.47 [95% CI, 0.40-0.55]) were associated with lower odds of MOUD receipt, while depression (AOR, 1.24 [95% CI, 1.05-1.46]) and greater behavioral health engagement was associated with higher odds of receipt. Having 1 or more instances of inpatient hospitalization was associated with lower odds of MOUD receipt (AOR, 0.74 [95% CI, 0.64-0.87]).

CONCLUSIONS AND RELEVANCE: In this cohort study of veterans with homeless experience with OUD, 1 in 6 veterans received MOUD within a year of entering PSH. Lower rates of MOUD receipt among older veterans and veterans from racial minority groups highlighted persistent inequities, regardless of housing status.

PMID:42084867 | DOI:10.1001/jamanetworkopen.2026.10831

JAMA Netw Open. 2026 May 1;9(5):e2610839. doi: 10.1001/jamanetworkopen.2026.10839.

ABSTRACT

IMPORTANCE: Allogeneic hematopoietic cell transplant (HCT) is curative for hematologic cancers, yet access remains inequitable for racially and ethnically underrepresented and socioeconomically disadvantaged populations, making the goal of having a suitable donor for every patient who needs a transplant challenging. The ACCESS trial broadened access by enrolling patients without matched donors, who instead received an HCT from a mismatched unrelated donor.

OBJECTIVE: To compare baseline characteristics of ACCESS trial participants with participants enrolled in a similar clinical trial and a patient-reported outcome (PRO) protocol cohort.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included adult participants (aged ≥18 years) from 3 cohorts-the ACCESS trial (2021-2024), BMT CTN 1703 trial (2019-2021), and Center for International Blood and Marrow Transplant Research (CIBMTR) PRO Protocol observational study (2020-2025)-who completed a baseline PRO survey. The ACCESS and PRO Protocol cohorts were stratified by conditioning intensity (myeloablative [MAC] vs reduced-intensity and nonmyeloablative [RIC/NMA]); all BMT CTN 1703 participants received RIC/NMA.

EXPOSURE: Hematopoietic cell transplant.

MAIN OUTCOMES AND MEASURES: Racial and ethnic diversity, insurance type, education, and income were compared among cohorts using counts and percentages, and socioeconomic and structural disadvantage were measured using the Social Vulnerability Index and Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy.

RESULTS: Baseline surveys were completed by 208 participants in the ACCESS trial (median [range] age at transplant, 62.3 [20.4-78.9] years; 108 male [51.9%]), 122 participants in the PRO Protocol study (median [range] age at transplant, 63.9 [21.1-78.0] years; 67 male [54.9%]), and 342 participants in the BMT CTN 1703 trial (median [range] age at transplant, 66.9 [20.7-78.6] years; 218 male [63.7%]). Participants in ACCESS were more racially and ethnically diverse, with 15 (7.2%), 25 (12.1%), 46 (22.2%), 110 (53.1%), and 11 (5.3%) of Asian, Black or African American, Hispanic or Latino, White, and other race and ethnicity, respectively, compared with 4 (3.3%), 2 (1.6%), 8 (6.6%) 104 (85.2%), and 4 (3.3%), respectively, in the PRO Protocol and 10 (3.0%), 0, 16 (4.8%), 302 (91.0%), and 4 (1.2%), respectively, in the BMT CTN 1703 trial. Participants in ACCESS were more likely to have Medicaid (36 [18.1%]) vs PRO Protocol (8 [6.7%]) and BMT CTN 1703 (16 [5.1%]) participants and reported lower education (some college or an associate’s degree: 103 [49.5%] vs 73 [59.8%] in the PRO Protocol; postcollege education: 34 [17.3%] vs 35 [29.2%] in the PRO Protocol) and household income (<$40 000 annually: 25 [24.0%] vs 8 [11.6%] in the PRO Protocol and 7 [38.9%] in the BMT CTN 1703 trial). Median Social Vulnerability Index scores were highest among participants in the ACCESS MAC group (median [range], 0.72 [0.01-0.97] vs 0.61 [0.16-0.78] in the PRO Protocol MAC group), and 16 participants [27.6%] in the ACCESS MAC group reported moderate to severe financial toxicity. The ACCESS participants lived closer to transplant centers, especially in the RIC/NMA group (median [IQR], 28 [14-75] miles vs 47 [16-96] miles for BMT CTN 1703 participants and 49 [21-104] miles for PRO Protocol participants).

CONCLUSIONS AND RELEVANCE: This cross-sectional study of clinical trial participants and a clinical cohort found that the ACCESS trial enrolled a more racially and ethnically diverse and socioeconomically disadvantaged population. Trial designs that broaden eligibility could expand access to HCT, highlighting the need for systemic interventions to ensure equity.

PMID:42084866 | DOI:10.1001/jamanetworkopen.2026.10839

Vet Med Sci. 2026 May;12(3):e70981. doi: 10.1002/vms3.70981.

ABSTRACT

Neospora caninum (protozoa: Apicomplexa) is a major cause of economic losses in bovine production systems due to reproductive failure and abortion in cows. Although there is evidence of camelids being exposed to N. caninum, the importance of these animals in the parasite’s life cycle is unclear. Therefore, the present systematic review and meta-analysis was conducted for the first time to assess the seroprevalence of N. caninum in camels to improve understanding of the epidemiology of the disease and identify factors influencing its prevalence. Relevant scientific articles were retrieved from three databases (PubMed, Web of Science and Scopus) and the internet search engine Google Scholar without time limitations up to 1 August, 2025. Meta-analysis was performed using a random-effects model with 95% confidence intervals (CIs). Heterogeneity was assessed using Cochran’s Q and I²-statistic. Sources of heterogeneity were explored through subgroup and meta-regression analyses. A funnel plot, along with Begg’s and Egger’s tests, was used to detect publication bias. A total of 32 articles, including data on 12,749 camels, published between 1998 and 2025, met the final eligibility criteria. The pooled prevalence of N. caninum in camelids was 10% (95% CI: 7%-12%) with significant heterogeneity (I² = 93.75%, p < 0.0001). The highest seroprevalence was detected in Old World camelids at 14% (95% CI: 10%-19%), indicating greater susceptibility to N. caninum exposure. Higher prevalence rates were observed in Europe (14%, 95% CI: 7%-26%) and Asia (12%, 95% CI: 8%-18%) than in Australia (2%, 95% CI: 0%-8%). No significant differences in N. caninum seroprevalence were found between age groups, genders, host species, or diagnostic methods. The funnel plot and Begg’s and Egger’s tests indicated no substantial publication bias (Egger’s test: p = 0.07). Despite the relatively low seroprevalence of N. caninum in camelids, the present results indicate a wide distribution of this parasite worldwide. Further research is warranted to investigate the role of camels in the life cycle of N. caninum.

PMID:42084849 | DOI:10.1002/vms3.70981

Pharm Dev Technol. 2026 May 5:1-14. doi: 10.1080/10837450.2026.2668485. Online ahead of print.

ABSTRACT

Lornoxicam (LX) is a potent non-steroidal anti-inflammatory drug (NSAID) whose long-term oral administration is limited by gastrointestinal adverse effects. The present study aimed to develop and evaluate LX-loaded proniosomal topical gels as a strategy to enhance dermal permeation and anti-inflammatory efficacy, with direct comparison to a conventional LX gel. LX-loaded proniosomal Gels were formulated by combining lecithin, cholesterol, and a non-ionic surfactant. A conventional gel formulation was also prepared to compare its effectiveness with the proniosomal gel formulation. The vesicle size, Polydispersity index (PDI), zeta potential (ZP), encapsulation efficiency, morphology, in-vitro LX release, ex-vivo, and finally, the anti-inflammatory efficacy of both formulations was thoroughly characterized. For the proniosomal variants, vesicle sizes were recorded at 373 ± 29 nm for Span 60-based proniosomes (NS) and 230 ± 28 nm for Tween 80-based proniosomes (NT), with corresponding PDI values of 0.23 and 0.31 and zeta potentials of -26 mV and -28 mV, respectively. Encapsulation efficiency exceeded 88% across both formulations. Notably, ex vivo evaluations demonstrated markedly improved skin permeation in the proniosomal gels. The Fluxes measured 51. µg/cm²/hr. for NS, 18.7 relative to the standard gel (12.4). These findings were corroborated by anti-inflammatory efficacy studies, which revealed statistically significant improvements with the proniosomal gel (p < 0.05) compared to the standard formulation.

PMID:42084848 | DOI:10.1080/10837450.2026.2668485

Pharmacoeconomics. 2026 May 5. doi: 10.1007/s40273-026-01616-1. Online ahead of print.

ABSTRACT

BACKGROUND: Pulmonary arterial hypertension (PAH) is a rare, progressive condition associated with high per-patient treatment costs and substantial clinical burden. Interpreting cost-effectiveness evidence for rare diseases remains challenging when uniform thresholds are applied across conditions that differ markedly in prevalence and scale of healthcare production.

OBJECTIVE: The aim of this study was to estimate a prevalence-adjusted effective cost-effectiveness threshold for PAH and illustrate how disease prevalence and production scale influence the interpretation of cost-effectiveness evidence under a fixed health care budget.

METHODS: We applied a previously developed prevalence-adjusted cost-effectiveness threshold framework, referred to as a generalized dynamic prevalence (GeDP) approach, to PAH using nationally representative disease prevalence data from the Medical Expenditure Panel Survey. A flexible statistical transformation was used to accommodate the highly right skewed distribution of disease prevalence and to estimate the relationship between prevalence and effective thresholds. The analysis was anchored to an empirically estimated US health opportunity cost benchmark and applied to PAH, with comparisons to selected common and rare diseases. Illustrative scenarios examined how effective thresholds evolve under changes in disease prevalence over time.

RESULTS: Effective cost-effectiveness thresholds increased as disease prevalence declined, reflecting production-side scale effects rather than differences in societal preferences. For PAH (prevalence ≈ 0.013%), the prevalence-adjusted effective threshold was estimated at US$582,270 per QALY (95% CI 581,319-583,163), representing more than a five-fold increase relative to the reference opportunity-cost benchmark of US$104,000 per QALY applied to highly prevalent conditions. Dynamic scenarios showed that effective cost-effectiveness thresholds decline as prevalence changes over time, with larger adjustments observed for initially rare conditions.

CONCLUSION: Applying a uniform cost-effectiveness threshold across diseases implicitly assumes homogeneous production conditions and opportunity costs. Prevalence-adjusted effective thresholds derived under the GeDP framework provide a quantitative, descriptive approach for contextualizing cost-effectiveness evidence for rare diseases such as PAH without redefining societal willingness to pay or prescribing decision rules. This approach can complement existing pharmacoeconomic evaluations by improving transparency around the role of prevalence and scale in shaping opportunity costs.

PMID:42084829 | DOI:10.1007/s40273-026-01616-1