Category: Nevin Manimala

Health Aff (Millwood). 2025 Aug;44(8):953-962. doi: 10.1377/hlthaff.2024.01494.

ABSTRACT

Nonprofit hospital workers represent a significant portion of the US health care workforce. Previous research indicates that wage inequalities exist within nonprofit hospitals, varying by hospital characteristics. To explore whether these inequalities have grown over time, particularly during the COVID-19 pandemic, we used Internal Revenue Service Form 990 and Medicare cost reports from the period 2009-23 to examine trends in wages and wage inequalities within nonprofit hospitals and assess differences by hospital characteristics. Persistent and widening wage inequalities in most years were observed, except during some years of the pandemic. Because hospitals are often large employers, wage inequality within them may reflect and reinforce broader patterns of local economic inequality, making this a relevant metric for evaluating the social benefit of nonprofit hospitals.

PMID:40758930 | DOI:10.1377/hlthaff.2024.01494

Health Aff (Millwood). 2025 Aug;44(8):1005-1010. doi: 10.1377/hlthaff.2024.01394.

ABSTRACT

Between 2018 and 2022, remote physiologic monitoring (RPM) claims increased, especially for Black (25,253 percent) and Hispanic (5,051 percent) Medicare patients. After adjustment for age, sex, and clinical factors, in 2022, Black and Hispanic Medicare patients had 88 percent and 84 percent higher RPM use rates, respectively, compared with White patients.

PMID:40758929 | DOI:10.1377/hlthaff.2024.01394

Health Aff (Millwood). 2025 Aug;44(8):925-932. doi: 10.1377/hlthaff.2025.00144.

ABSTRACT

The mental health of US children and adolescents has reached a crisis point. As of 2023, 18 percent of adolescents had experienced a major depressive episode in the past year-more than double the percentage in 2010-and one-fifth of teens had seriously considered suicide. This article describes the alarming growth in the teen prevalence of mood disorders, suicidal ideation and death, and fatal drug overdoses and in the volume of pediatric patients visiting emergency departments and hospitals for mental health diagnoses. The crisis varies by sex and disproportionately affects LGBTQ+, rural, and racially and economically marginalized youth. For example, among LGBTQ+ high school students, nearly two in three report persistent sadness or hopelessness, and one-fifth have attempted suicide. Increased access to social media and lethal agents (for example, firearms and fentanyl) and deficiencies in behavioral health care are likely contributors. Although further research is needed to fully understand the etiologies of the youth mental health crisis and the effectiveness of individual interventions, the lack of political will-not evidence-poses the greatest barrier to meaningful action.

PMID:40758927 | DOI:10.1377/hlthaff.2025.00144

Health Aff (Millwood). 2025 Aug;44(8):996-1004. doi: 10.1377/hlthaff.2024.01659.

ABSTRACT

The COVID-19 public health emergency disrupted access to in-person behavioral health treatment beginning in the spring of 2020. This prompted federal telehealth flexibilities that have permitted the initiation of controlled medications, including prescription stimulants for attention-deficit/hyperactivity disorder, via telehealth and without an in-person medical evaluation. In a national sample of child and adult Medicaid and Children’s Health Insurance Program (CHIP) enrollees, we found that the start of the public health emergency was associated with an immediate level increase of 24.7 telehealth-only stimulant initiations per 100,000 enrollees per month and an immediate level reduction of 53.5 in-person initiations per 100,000 enrollees per month. Key subgroups, including young adult and female enrollees, used telehealth for stimulant initiations at least as much as the overall Medicaid/CHIP sample. Still, total initiation rates during the public health emergency remained below pre-public health emergency levels through December 2022. These findings may inform considerations about extending telehealth flexibilities, showing that among Medicaid/CHIP enrollees, telehealth compensated for much of the pre-public health emergency levels of in-person stimulant initiations, but it did not appear to contribute to stimulant overprescribing that could elevate risks for misuse and diversion.

PMID:40758925 | DOI:10.1377/hlthaff.2024.01659

Health Aff (Millwood). 2025 Aug;44(8):943-952. doi: 10.1377/hlthaff.2025.00266.

ABSTRACT

Obstetricians and gynecologists (OB-GYNs) provide essential health care to women across their lifespan. Yet nearly half of US counties have no OB-GYNs, with nonmetropolitan communities disproportionately affected. Targeted Regulation of Abortion Providers (TRAP) laws, spurred by the 1992 US Supreme Court decision in Planned Parenthood v. Casey, impose regulatory burdens on abortion providers and may have influenced whether and where OB-GYNs choose to practice, which has not yet been comprehensively studied. Using a staggered difference-in-differences design and county-level data, we found that TRAP laws were associated with an average reduction of 4.67 percent in the density of OB-GYNs per 100,000 women ages 15-44 during the period 1993-2021, between Casey and the Dobbs v. Jackson Women’s Health Organization decision in 2022. TRAP laws affected both general and fellowship-trained OB-GYNs, as well as counties without abortion facilities. Concerningly, TRAP laws led to lower physician density in nonmetropolitan counties-a difference that persisted for a decade. As OB-GYN shortages are projected to worsen and TRAP laws are still in effect in twenty-four states, policy makers should consider the long-run effects of TRAP laws on women’s access to health care and their potential to exacerbate geographic disparities in access to care.

PMID:40758924 | DOI:10.1377/hlthaff.2025.00266

Health Aff (Millwood). 2025 Aug;44(8):977-985. doi: 10.1377/hlthaff.2025.00037.

ABSTRACT

Despite coverage regulations requiring most insurers to cover pre-exposure prophylaxis (PrEP) without cost sharing, insurance coverage issues and cost-sharing practices persist. In this study, we assessed the prevalence of denials and cost sharing associated with PrEP among sexual and gender minority people in the US. Between August 2022 and July 2023, we recruited, via geosocial networking applications, sexual and gender minority people, who completed a screening survey for an HIV prevention study. Of 11,410 participants reporting current or former PrEP use, 23.7 percent had ever experienced a denial for their PrEP, ranging from 8.5 percent for generic tenofovir disoproxil fumarate and emtricitabine to 48.2 percent for Descovy. In addition, 34.6 percent reported cost sharing within the prior two years. The majority (58.3 percent) of cost-sharing instances were for laboratory bloodwork, and most (61.5 percent) were among privately insured people. Continued insurance denials and cost sharing associated with PrEP necessitate further policy intervention to address gaps in coverage, billing errors, and challenges resulting from formulary tiering.

PMID:40758923 | DOI:10.1377/hlthaff.2025.00037

Health Aff (Millwood). 2025 Aug;44(8):963-969. doi: 10.1377/hlthaff.2025.00019.

ABSTRACT

In 2016, in response to two federal court decisions, the Centers for Medicare and Medicaid Services began allowing geographically urban hospitals to be dually classified as both rural and urban simultaneously. This dual classification enables hospitals to use urban wage indexes for calculating Medicare reimbursements, while also benefiting from Medicare policies solely intended to support rural health. Using Medicare cost reports and impact files, we documented a substantial increase in administratively rural hospitals in the US, driven by the dual classification of existing hospitals located in urban areas, which rose from 3 in 2017 to 425 in 2023, with prevalence varying by state. More than three-quarters of dually classified hospitals were nonprofit, including many large academic medical centers in metropolitan areas. Congress should ensure that federal programs supporting rural health are directed solely to geographically rural hospitals.

PMID:40758922 | DOI:10.1377/hlthaff.2025.00019

Health Aff (Millwood). 2025 Aug;44(8):1011-1017. doi: 10.1377/hlthaff.2024.01224.

ABSTRACT

Adopted children are likely to have health needs that exceed those of other children. Health insurance is critical for access to care in the US. We studied health insurance coverage of adopted children in the US and found variation across adoption statuses and, among adoptees, variation by the immigration status of adoptees and adoptive parents.

PMID:40758921 | DOI:10.1377/hlthaff.2024.01224

Phytopathology. 2025 Aug 4. doi: 10.1094/PHYTO-05-25-0187-R. Online ahead of print.

ABSTRACT

Measuring individual components of pathogen reproduction is key to understanding mechanisms underlying rate-reducing quantitative resistance (QR). Simulation models predict that lesion expansion plays a key role in seasonal epidemics of foliar diseases, but measuring lesion growth with sufficient precision and scale to test these predictions under field conditions has remained impractical. We used deep learning-based image analysis to track 6889 individual lesions caused by Zymoseptoria tritici on 14 wheat cultivars across two field seasons, enabling 27,218 precise and objective measurements of lesion growth in the field. Lesion appearance traits reflecting specific interactions between particular host and pathogen genotypes were consistently associated with lesion growth, whereas overall effects of host genotype and environment were modest. Both host cultivar and cultivar-by-environment interaction effects on lesion growth were highly significant and moderately heritable (h2 ≥ 0.40). After excluding a single outlier cultivar, a strong and statistically significant association between lesion growth and overall QR was found. Lesion expansion appears to be an important component of QR to STB in most-but not all-wheat cultivars, underscoring its potential as a selection target. By facilitating the dissection of individual resistance components, our approach can support more targeted, knowledge-based breeding for durable QR.

PMID:40758903 | DOI:10.1094/PHYTO-05-25-0187-R

J Magn Reson Imaging. 2025 Aug 4. doi: 10.1002/jmri.70056. Online ahead of print.

ABSTRACT

BACKGROUND: The effect of the positron emission tomography (PET) modality in hybrid PET/MR scanners on MR spectral quality is unclear.

PURPOSE: To evaluate spectral quality, quantification, and repeatability of brain MR spectroscopy (MRS) acquired on PET/MR and standalone MR scanners.

STUDY TYPE: Prospective.

SUBJECTS: 23 healthy adults (male/female = 11/12, age = 27 ± 11 years).

FIELD STRENGTH/SEQUENCE: 3T, semi-localized by adiabatic selective refocusing.

ASSESSMENT: Single voxel MR spectra were acquired with GE Signa PET/MR and Siemens Prisma Fit MR scanners in healthy volunteers, and additionally with a GE Premier MR scanner in vitro. Spectral quality, metabolite concentrations, and repeatability were evaluated.

STATISTICAL TESTS: Linear mixed models assessed signal-to-noise ratio (SNR), full width at half maximum (FWHM), and metabolites/total creatine (tCr). Intraclass correlation coefficients (ICCs) determined repeatability; mean squared error (MSE) evaluated accuracy of quantification. Values are reported as mean ± standard deviation. Significance was determined by p ≤ 0.05.

RESULTS: In vivo spectra acquired using the Siemens standalone MR showed significantly higher SNR (PET/MR: 118.8 ± 19.1, MR: 132.2 ± 24.4) but significantly broader FWHM (PET/MR: 7.2 ± 1.8 Hz, MR: 8.4 ± 2.5 Hz) compared to PET/MR. All metabolite ratios were significantly higher in spectra acquired on the standalone MR. Within-session repeatability was good (ICC > 0.75), and between-session repeatability was moderate to excellent (ICC 0.5 to > 0.90) for all metabolites in vivo. In vitro spectra acquired with the PET/MR had significantly higher SNR (329.1 ± 46.1) than the Siemens standalone MR (150.8 ± 49.3) but significantly lower than the GE standalone MR (395.9 ± 33.7). The PET/MR produced narrower FWHM (2.1 ± 0.4 Hz) than the Siemens standalone MR (4.1 ± 1.7 Hz) but broader than the GE standalone MR (1.6 ± 0.1 Hz) and lower MSE for some metabolites.

DATA CONCLUSION: MR spectral quality appears uncompromised when acquired with hybrid PET/MR compared to standalone MR.

PMID:40758419 | DOI:10.1002/jmri.70056