Category: Nevin Manimala

JAMA Netw Open. 2026 Mar 2;9(3):e261068. doi: 10.1001/jamanetworkopen.2026.1068.

ABSTRACT

IMPORTANCE: State-level abortion restrictions in the US enforced after the June 2022 Dobbs v Jackson Women’s Health Organization Supreme Court decision have worsened geographic, racial, and socioeconomic inequities in abortion access, warranting investigation of experiences for individuals who travel out of state to seek abortion care.

OBJECTIVES: To highlight the obstacles abortion seekers must overcome to obtain care, to identify common barriers and facilitators of interstate abortion travel, and to offer recommendations for abortion organizations, policymakers, and advocates to expand access for individuals living in states with abortion bans.

DESIGN, SETTING, AND PARTICIPANTS: This qualitative study analyzed data obtained from out-of-state participants collected as part of a larger cross-sectional, mixed-methods study. All English- and Spanish-speaking patients from out of state who were at least 16 years of age and medically cleared for research attending 2 abortion clinics in Illinois between September and November 2023 were eligible.

MAIN OUTCOMES AND MEASURES: Participants completed a self-administered survey and a semistructured interview. Directed content analysis was used to identify emergent and crosscutting themes.

RESULTS: In total, 33 individuals (all self-identified as female or a woman) completed the survey and interview. Most participants were between 20 and 24 years of age (n = 12 [36%]) or 30 years or older (n = 12 [36%]), and from southern US states with a total abortion ban (n = 25 [76%]). From the time participants decided to terminate their pregnancy to the day of the abortion appointment, they experienced a median of 14.0 days of delay, with a mean (SD) of 29.6 (36.5) days of delay. Patient journeys of seeking abortion were categorized into 3 phases: information gathering, planning finances and travel, and traveling and completing the appointment. Participants reflected on how restrictive policies in their home states deepened abortion stigma and stifled access to accurate information. Most participants encountered their longest delays in the information-gathering phase, as they had to find legitimate clinics, often without any referrals, and navigate the complex web of laws between states. When patients had personal financial security, strong social support, or were in geographic proximity to a state in which abortion was legal, their journeys were facilitated.

CONCLUSIONS AND RELEVANCE: In this cross-sectional qualitative study of participants traveling across state lines for abortion, the policy landscape and abortion stigma of the home state, information and resource availability, and interpersonal support shaped their journeys in the post-Dobbs landscape. To improve cross-state abortion access for individuals in states with abortion restrictions or bans, policy change should be coupled with increased visibility of accurate information, charitable funding, and abortion stigma reduction. Abortion support organizations and the public should continue to enable access through social support services, such as volunteer drivers and abortion doulas.

PMID:41801198 | DOI:10.1001/jamanetworkopen.2026.1068

JAMA Netw Open. 2026 Mar 2;9(3):e261092. doi: 10.1001/jamanetworkopen.2026.1092.

ABSTRACT

IMPORTANCE: Smartphones are a pervasive feature of adolescents’ daily lives, raising concern about how smartphones are used in contexts such as school that require sustained attention and self-regulation.

OBJECTIVES: To describe youths’ smartphone use during each hour of the school day and examine whether smartphone use during school is associated with poorer cognitive control, a key developmental process underlying academic success.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study of youths aged 11 to 18 years from the Southeastern US objectively assessed smartphone use every hour for 14 consecutive days between April 8, 2021, and February 2, 2022 (cohort 1), and February 1, 2023, and December 11, 2024 (cohort 2), providing thousands of data points to capture actual engagement.

MAIN OUTCOMES AND MEASURES: The iPhone iOS (Apple) screen time report captured smartphone use at every hour. Cognitive control was measured in the older cohort using a go/no-go task, with the signal detection metric d’ quantifying inhibitory control.

RESULTS: A total of 79 participants (mean [SD] age, 15.10 [2.04] years; 41 [51.9%] female) participated in the study. Youths were using their smartphones during every hour of the school day, spending a total of 2.22 hours of the school day on their smartphones. Youths aged 15 to 18 years spent more time on their smartphones during school hours than those aged 11 to 14 years (mean [SD], 23.28 [18.34] vs 11.57 [16.83] min/h; F1,76 = 28.82, P < .001, η2 = 0.28). Youths spent a mean (SD) of 40.14 (39.56) minutes on social media and 13.85 (25.22) minutes on entertainment apps during school hours. Youths checked their smartphones a mean (SD) of 64.46 (32.83) times during school hours. More frequent smartphone checking was associated with lower d’ values (F1,28 = 4.8, P = .04, η2 = 0.15), indicating poorer cognitive control.

CONCLUSIONS AND RELEVANCE: This cross-sectional study found that youths use smartphones approximately one-third of the school day; this use was associated with reduced cognitive control. These findings highlight the need for school-level policies and digital literacy programs that address not only overall screen time but also habitual smartphone-checking behaviors that fragment attention.

PMID:41801197 | DOI:10.1001/jamanetworkopen.2026.1092

JAMA Netw Open. 2026 Mar 2;9(3):e261194. doi: 10.1001/jamanetworkopen.2026.1194.

ABSTRACT

IMPORTANCE: Improving mental health through targeting behaviors like sleep and physical activity in treatment has been challenging, in part due to the challenge of measuring these factors in an accurate manner. Mobile technology can enable an understanding of the dynamic, complex associations between physical activity and sleep, but most prior mobile technology studies have had modest sample sizes and utilized cross-sectional, between-person designs, thus limiting their impact.

OBJECTIVE: To investigate the within-person associations between sleep, physical activity, and daily mood among individuals receiving mental health treatment to inform health behavior recommendations.

DESIGN, SETTING, AND PARTICIPANTS: This 12-month cohort study involved patients seeking mental health care at the University of Michigan academic medical center mental health care clinics. All participants were enrolled between May 13, 2020, and December 12, 2022. Data analysis was performed from September 2024 to June 2025.

EXPOSURES: Objective, wrist-based actigraphy measures of sleep (total sleep time, interrupted nighttime sleep, and napping) and physical activity (step count) were obtained.

MAIN OUTCOMES AND MEASURES: The primary outcome was participant-reported daily mood score, on a scale of 1 (worst mood) to 10 (best mood). Linear mixed-effects models were used to estimate associations among sleep, physical activity, and mood scores.

RESULTS: A total of 1476 participants (mean [SD] age, 36.5 [14.2] years; 1062 [72.0%] female) were included in the analysis. Sleep duration was associated with subsequent mood through an inverse U-shaped relationship, with both short and long sleep duration associated with poorer mood (quadratic term b = 0.027; 95% CI, -0.031 to -0.023). Notably, patients varied substantially in their optimal sleep duration (mean [SD], 6.8 [1.9] hours) for peak mood. Physical activity was positively associated with subsequent mood (linear term b = 0.160; 95% CI, 0.149 to 0.162; P < .001; quadratic term b =- 0.022; 95% CI, -0.027 to -0.017; P < .001), with diminishing associations at higher than usual activity for that individual. Conversely, daily mood was associated with subsequent sleep (linear term b = -1.377; 95% CI, -1.877 to -0.877; P < .001; quadratic term b = -0.394; 95% CI, -0.765 to -0.023; P = .037) and step count (linear term b = 0.020; 95% CI, 0.003 to 0.030; P = .02; quadratic term b = -0.010; 95% CI, -0.020 to -0.001; P = .03) in a wavelike manner.

CONCLUSIONS AND RELEVANCE: This cohort study of people seeking mental health care found complex, bidirectional associations between sleep, physical activity, and mood with individual variation in optimal sleep duration for mood scores. The findings advance progress toward effectively targeting health behaviors to improve mental health.

PMID:41801196 | DOI:10.1001/jamanetworkopen.2026.1194

JAMA Neurol. 2026 Mar 9. doi: 10.1001/jamaneurol.2026.0204. Online ahead of print.

ABSTRACT

IMPORTANCE: Psychiatric disturbances are common in epilepsy and are associated with increased risk of premature mortality, lower quality of life, and poor response to antiseizure medications (ASMs).

OBJECTIVE: To evaluate the role of psychiatric disturbances at the time of epilepsy diagnosis in predicting risk of future treatment resistance in focal epilepsy.

DESIGN, SETTING, AND PARTICIPANTS: The Human Epilepsy Project (HEP) is a prospective, observational, international, and multicenter cohort study with follow-up for up to 6 years. Participants with newly diagnosed focal epilepsy, enrolled within 4 months of initiating ASM treatment, between the ages 18 and 60 years, and without significant other comorbidities were recruited during the open period of 2012 to 2020. Data analysis was performed from January to September 2025.

EXPOSURE: Presence of a psychiatric diagnosis.

MAIN OUTCOMES AND MEASURES: Presence of psychiatric diagnosis (mood/anxiety disorders) measured by Mini International Neuropsychiatric Interview (MINI) and/or suicidality measured by Columbia-Suicide Severity Rating Scale (C-SSRS) at enrollment. Treatment response included the following outcomes: treatment resistant (TR), defined as failure of first 2 adequate ASM trials (ongoing seizures at/above therapeutic doses); treatment sensitive (TS), defined by a minimum period of seizure freedom on first 2 adequate ASM trials (12 months/3-fold greatest pretreatment seizure-free interval, whichever is longer); and indeterminate (neither TR/TS).

RESULTS: Of 376 enrolled adults, 347 (median [IQR] age at seizure onset, 33 [23-44] years; 209 female [60.2%]) completed the MINI and C-SSRS at enrollment. Of these individuals, 191 (55%) were TS, 83 (24%) TR, and 73 (21%) indeterminate. The rate of psychiatric disturbance (mood/anxiety disorder; suicidality) at epilepsy diagnosis was 38% (n = 133). Fifty-seven (16%) had mood/anxiety disorder(s) without suicidality, and 75 (22%) expressed suicidality with or without a psychiatric disorder. Suicidality at epilepsy diagnosis was associated with greater than 2-fold risk of developing TR (relative risk [RR], 2.02; 95% CI, 1.32-3.09; P = .001). There were no significant overall associations between mood/anxiety disorders and TR. Suicidality alone significantly increased TR probability from 16.3% (95% CI, 11.3%-21.3%) in those with no psychiatric disturbance to 47.1% (RR, 2.89; 95% CI, 1.65-5.05; P < .001). Anxiety disorder alone increased TR probability to 32.9% (RR, 2.02; 95% CI, 1.10-3.71; P = .02), although this was not statistically significant after correcting for multiple comparisons. There was no significant change in TR probability when mood disorder alone was present; however, presence of mood disorder with suicidality increased TR probability to 39.6% (RR, 2.43; 95% CI, 1.26-4.68; P = .008).

CONCLUSIONS AND RELEVANCE: Results of this cohort study reveal that suicidality at the time of focal epilepsy diagnosis was associated with future drug resistance and may be a marker of more severe neuropathology. Psychiatric screening at time of diagnosis may facilitate early identification of patients at risk for treatment refractory epilepsy syndromes.

PMID:41801192 | DOI:10.1001/jamaneurol.2026.0204

West Afr J Med. 2025 Aug 29;42(8):668-676.

ABSTRACT

BACKGROUND: Kidney transplantation in Nigeria has witnessed remarkable advancements. Availability of suitable and willing living donors is one of the major factors leading to its success. The aim of this study was to identify and analyze the reasons for exclusion of potential living kidney donors in a transplant program at a tertiary hospital in Southeast Nigeria. This is important in order to improve donor screening, maximize the living donor pool and ensure donor safety.

METHODS: This was a retrospective study of kidney transplant register and medical records at the transplant clinic of Federal Medical Center Umuahia, Southeast Nigeria. Relevant clinical data of potential living kidney donors who presented for pre-donation evaluation over a period of 8 years were collated in excel sheet and analyzed using SPSS version 23.0. Tables, charts and graphs were used to illustrate some data.

RESULTS: Pre-donation evaluation records of sixty four potential living donors were retrieved. Median age was 23 (IQR=19-39) years There were 62 males and 2 females with M:F ratio of 31:1. Majority were unskilled workers (83%) and unrelated to prospective recipients (61%). Among those related to the patients (39%), there were more second-degree relatives (22%) than first degree relatives (17%). Out of the 64 potential kidney donors, 13 (20%) eventually donated while 51(80%) did not. Factors that prevented eventual kidney donation included immunological incompatibility (32.8%), albuminuria (11%), hypertension (9%), financial motivation (9%), nephrolithiasis (4.7%), donor withdrawal from donation process (4.7%), Hepatitis B infection (3%), prediabetes (3%) and abnormal cardiac function (1.5%).

CONCLUSION: The potential living donors evaluated were mostly young males that were unrelated to their potential recipients. Immunologic incompatibility was the leading cause of failure to donate a kidney; mainly from donor-recipient significant HLA mismatches.

PMID:41801162

Public Health Res (Southampt). 2026 Mar;14(3):1-120. doi: 10.3310/GJSR2325.

ABSTRACT

METHODS: This study employed an interdisciplinary approach to assess the impact of agricultural production modifications and dietary changes on ammonia emissions, health outcomes and health inequalities. Statistical and econometric methods were applied to analyse agricultural emission trends and dietary patterns. Spatial data analysis and numerical modelling techniques were used to simulate the dispersion and transformation of atmospheric pollutants. Health impact modelling estimated mortality and morbidity outcomes under various policy scenarios, while cost-effectiveness and cost-benefit analyses supported decision-making. A participatory approach involving multistakeholder engagement was utilised to enhance policy relevance and implementation feasibility. A systematic scoping review of academic studies on agricultural-derived air pollution and clinically coded outcomes revealed very limited research on this topic, which presents an inconsistent picture as to whether agricultural-derived particulate matter affects health.

RESULTS: Key findings indicate that dietary modifications have greater potential health benefits than direct reductions in particulate matter exposure from ammonia emissions. Small reductions in meat and dairy consumption, supported by taxation and subsidies, could help achieve environmental and health targets. A 20% meat and dairy tax, coupled with a 20% subsidy on fruits and vegetables, could reduce meat consumption by 21.5% and increase fruit and vegetable intake by up to 13.5%. These dietary shifts also significantly lower greenhouse gas emissions and water use. While ammonia’s environmental effects are well documented, its direct health impacts remain uncertain. Epidemiological studies suggest a possible association between ammonium-derived particulate matter and increased mortality and cardiorespiratory diseases, though findings are inconsistent. Toxicological assessments indicate limited intrinsic toxicity of ammonium nitrate and sulfate. A ‘high-ambition mitigation’ scenario integrating ammonia reduction measures with dietary shifts could prevent 67,000 premature deaths and 270,000 cases of respiratory diseases over 30 years. Notably, older adults and lower-income populations would experience the greatest health benefits. Most farm-based ammonia reduction strategies demonstrated net economic benefits, with only a few measures having limited abatement potential. Additionally, reduced greenhouse gas emissions further amplified the benefits of each scenario.

LIMITATIONS: Despite robust modelling techniques and multistakeholder engagement, several limitations exist. The direct health effects of ammonia-derived particulate matter remain an area of uncertainty, necessitating further epidemiological research. Additionally, while economic and environmental benefits were quantified, behavioural responses to policy interventions – such as consumer acceptance of dietary changes – require further exploration. The study primarily focused on UK-specific data, limiting generalisability to other regions with different agricultural practices and policy landscapes. Finally, unintended consequences of dietary shifts on food security and cultural preferences were not fully explored, indicating the need for future research to refine policy recommendations. The Assessing Mitigation Pathways to Realise Public Health Benefits of Air Pollutant Emission Reductions from Agriculture project provides a comprehensive, interdisciplinary framework for evaluating integrated policy measures. It underscores the importance of sustainable agricultural and dietary transitions in achieving cobenefits for public health and environmental sustainability, while emphasising the need for continued research to address remaining uncertainties.

FUTURE WORK: More detailed spatial and temporal analyses are required to fully understand the potential importance of significant local sources on human health in specific areas/times of year. There is a need to better align evidence of studies, such as Assessing Mitigation Pathways to Realise Public Health Benefits of Air Pollutant Emission Reductions from Agriculture, with toxicological studies which suggest that (pure) ammonium nitrate and sulfate have only very modest toxicity.

STUDY REGISTRATION: This study is registered as PROSPERO CRD42020172116.

FUNDING: This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: NIHR129440) and is published in full in Public Health Research; Vol. 14, No. 3. See the NIHR Funding and Awards website for further award information.

PMID:41801161 | DOI:10.3310/GJSR2325

Int J Periodontics Restorative Dent. 2026 Mar 9;0(0):1-28. doi: 10.11607/prd.7963. Online ahead of print.

ABSTRACT

The purpose of the present study was to investigate an association of contact point-attachment level distance (CP-AL) with presence/absence of interdental papilla between maxillary central incisors. CP-AL distance may be a non-invasive representative for the classic contact point-bone crest distance (CP-BC) which is being used to determine the presence of interdental papilla as per existing knowledge. Total 195 systemically healthy patients were recruited with age ranging 18-45years in this cross-sectional study. Clinical parameters included were CP-BC, CP-AL, contact point-papilla tip (CP-PT), contact point- interproximal cementoenamel junction (CP-iCEJ), and periodontal phenotype (PP). The height of black triangle (CP-PT) and presence/absence of papilla, both were statistically significantly and positively correlated with CP-BC and CP-AL distance. The statistically significant and positive association was also observed between CP-AL distance and height of black triangle. The results suggested that increase in 0.57mm of CP-AL distance resulted in 1unit increase in measurement of height of black triangle. Furthermore, receiver-operating characteristic (ROC) analysis showed the threshold value of CP-AL distance at or above which there would be presence of black triangle was 3.5mm. Contact point-attachment level distance which is a non-invasive method could be used as an alternative to contact point-bone crest distance to assess papilla presence/absence.

PMID:41801150 | DOI:10.11607/prd.7963

Scand J Clin Lab Invest. 2026 Mar 9:1-10. doi: 10.1080/00365513.2026.2640367. Online ahead of print.

ABSTRACT

Several methods are available to differentiate non-fibrosis from advanced liver fibrosis; however, data regarding intermediate stages remain limited. A total of 246 patients with chronic hepatitis B (CHB) were enrolled and classified into four groups according to fibrosis stage: non- or mild fibrosis (Group A), significant fibrosis (Group B), progressive fibrosis (Group C), and cirrhosis (Group D). The serum chitinase-3-like protein 1 (CHI3L1) levels in Groups A, B, C, and D were 40.33, 52.96, 92.28, and 153.63 μg/L, respectively. Significant differences were observed between Groups A and B (p = 0.040), Groups C and D (p < 0.0001), and Groups B and D (p < 0.0001). The percentage of regulatory T cells (Tregs) was 0.67 in the CHB-low fibrosis (CHB-L) group and 0.26 in the CHB-moderate to severe fibrosis (CHB-MS) group, representing a statistically significant difference (p = 0.039). The T helper 17 cells (Th17)/Treg ratio was 10.00 in the CHB-L group and 61.26 in the CHB-MS group, representing a statistically significant difference (p = 0.010). For predicting significant fibrosis, progressive fibrosis, and cirrhosis, the area under the curve (AUC) for the combined conventional markers – hyaluronic acid, laminin, type III procollagen N-terminal peptide, collagen type IV, and cholyglycine were 0.736, whereas those for CHI3L1 and Th17/Treg were 0.774 and 0.750, respectively. The combination of CHI3L1 and Th17/Treg cells yielded an AUC of 0.814, demonstrating the highest sensitivity (100%) and high specificity. These findings suggest that CHI3L1 combined with Th17/Treg cells may serve as a novel biomarker for staging hepatitis B virus-related liver fibrosis.

PMID:41801145 | DOI:10.1080/00365513.2026.2640367

J Med Econ. 2026 Dec;29(1):761-771. doi: 10.1080/13696998.2026.2635880. Epub 2026 Mar 9.

ABSTRACT

OBJECTIVE: To compare mortality, healthcare utilization, and costs between patients with symptomatic and asymptomatic mixed aortic valve disease (MAVD).

METHODS: We analyzed Optum United Health Care database for US patients with aortic insufficiency (AI) claims (2017-2024) and prior/concurrent aortic stenosis (AS) claims, requiring 12 months continuous enrollment. Patients with baseline aortic valve replacement (AVR) were excluded. Symptomatic MAVD (SMAVD) was defined as ≥2 baseline visits for heart failure, angina, dyspnea, or syncope. Outcomes included mortality, time to home health/skilled nursing facility (SNF), and annualized healthcare utilization and costs, analyzed using Cox proportional hazard and general linear models.

RESULTS: Among 132,361 MAVD patients, 73.62% (n = 97,448) were symptomatic at diagnosis. Of initially asymptomatic patients, 58.94% became symptomatic within 5 years. Only 22% received AVR within 5 years. SMAVD patients had higher mortality (HR 1.48, 95% CI 1.44-1.53), home health utilization (HR 1.32, 95% CI 1.30-1.35), SNF admissions (HR 1.38, 95% CI 1.35-1.41), and $11,120 higher annual costs.

CONCLUSIONS: SMAVD patients experience significantly worse outcomes than asymptomatic patients. Early detection and timely interventions are critical to reducing MAVD’s healthcare burden.

PMID:41801137 | DOI:10.1080/13696998.2026.2635880

NCHS Data Brief. 2026 Feb;(550). doi: 10.15620/cdc/174642.

ABSTRACT

INTRODUCTION: This report describes trends in the timing of prenatal care initiation from 2016 (the first year for which national data are available) to 2024. Changes by maternal age, race and Hispanic origin, and late (beginning in the third trimester) or no care by state of residence also are shown from 2021 to 2024.

METHODS: This report uses data from the natality data file from the National Vital Statistics System. The vital statistics natality file is based on information from birth certificates and includes information for all births occurring in the United States. The month in which prenatal care began is calculated from the “Date of the first prenatal visit” item on the birth certificate and the gestational age of the newborn based on the obstetric estimate of gestation.

KEY FINDINGS: After increasing from 2016 (77.1%) to 2021 (78.3%), prenatal care beginning in the first trimester decreased to 75.5% in 2024. From 2021 to 2024, care beginning in the second trimester increased from 15.4% to 17.3% and late or no care increased from 6.3% to 7.3%. From 2021 to 2024, prenatal care beginning in the first trimester decreased, while care beginning in the second trimester and late and no care increased, for all maternal age groups. Over the same period, first trimester prenatal care decreased, while second trimester prenatal care and late and no care increased, for nearly all race and Hispanic-origin groups. From 2021 to 2024, late or no care increased in 36 states and the District of Columbia.

PMID:41801132 | DOI:10.15620/cdc/174642