Category: Nevin Manimala

JMIR Public Health Surveill. 2026 Apr 29;12:e82792. doi: 10.2196/82792.

ABSTRACT

BACKGROUND: Although recovery is a central tenet of the US substance use disorder service delivery system, empirical research on youth recovery remains limited and underdeveloped. Notably, no population-based representative surveys, either in the United States or internationally, currently assess recovery status among secondary school-aged youth (aged 14-18 years). Consequently, little is known about how many youth identify as being in recovery or about their characteristics and needs.

OBJECTIVE: This study presents the first statewide representative estimate of adolescent self-reported recovery (ASR), derived from a large Midwestern state in the United States.

METHODS: We used data from the 2024 Illinois Youth Survey, a weighted, statewide representative survey of students from 8th, 10th, and 12th grades across Illinois. We examined the prevalence of ASR with a widely used single-item question, “Do you consider yourself to be in recovery?” The question was presented after an instruction directing students to consider only substance use when responding. We estimated the prevalence of ASR and conducted descriptive analyses to characterize this group.

RESULTS: Among the 6871 participating students from the 10th and 12th grades, the prevalence of ASR was 3.3% (95% CI 2.6%-4.1%). Among participants with ASR, 51.1% (118/231) were female, 39% (90/231) identified as Latino or Latina, 38.1% (88/231) identified as White, and 13% (30/231) identified as Black or African American. The average age of participants with ASR was 16.5 (SD 1.14) years. Participants with ASR were demographically diverse, and a little over half received free or reduced-price lunch.

CONCLUSIONS: Findings suggest that financial recovery capital may be particularly important for participants with ASR. This study provides the first population-based estimate of the prevalence of ASR and underscores the importance of including recovery status in large-scale surveys to inform and strengthen recovery support systems.

PMID:42054636 | DOI:10.2196/82792

J Med Internet Res. 2026 Apr 29;28:e81485. doi: 10.2196/81485.

ABSTRACT

BACKGROUND: Podcasts provide a platform for delivering patient information. They have the potential to enhance patient engagement in shared decision-making (SDM), reduce anxiety in relation to hospital visits, and improve patient satisfaction. However, their impact on these outcomes in the context of hospital visits remains underexplored.

OBJECTIVE: This study aimed to examine whether podcasts influence patients’ (1) engagement in SDM, (2) anxiety after the hospital visit, and (3) satisfaction with the hospital visit.

METHODS: A quasi-experimental design with a nonequivalent comparison group was used. The study was conducted in 3 specialized outpatient clinics at a Danish hospital. Patients were allocated to one of 2 groups: the intervention group, which received access to informational podcasts in addition to standard written information before their hospital visit, and the comparison group, which received only the standard written information. All patients received validated questionnaires to assess SDM (9-item Shared Decision-Making Questionnaire [SDM-Q-9]), anxiety (State-Trait Anxiety Inventory-State), and satisfaction after the consultation.

RESULTS: A total of 240 patients participated. Compared with the control group, the intervention group showed a 15% higher level of SDM (SDM-Q-9) scores (adjusted relative difference=1.15, 95% CI 1.05-1.26; P=.18). Subgroup analyses indicated a statistically significant effect among patients with low health literacy (adjusted relative difference=1.81, 95% CI 1.42-2.32; P=.002). Anxiety scores were 9% lower (adjusted relative difference=0.91, 95% CI 0.84-0.99; P=.23), and satisfaction with previsit information increased by 14% (adjusted relative difference=1.14, 95% CI 1.07-1.21; P=.003).

CONCLUSIONS: Informational podcasts, provided as a supplement to traditional written information, may offer modest support for patient engagement in SDM, particularly among patients with low health literacy. Podcasts also appear to improve satisfaction with previsit information more broadly. Effects on previsit anxiety were inconclusive.

PMID:42054634 | DOI:10.2196/81485

JCO Oncol Pract. 2026 Apr 29:OP2500963. doi: 10.1200/OP-25-00963. Online ahead of print.

ABSTRACT

PURPOSE: It has been theorized that antibiotic therapy (ABT) affects response to immune checkpoint inhibition (ICI) by inducing dysbiosis of the gut microbiome (GM). To investigate the association between ABT and real-world overall survival (rwOS)/progression-free survival (rwPFS) in patients with metastatic renal cell carcinoma (mRCC) receiving ICI versus tyrosine kinase inhibitors (TKIs).

METHODS: In total, 5,237 patients with mRCC from a nationwide electronic health record-derived deidentified database who received ICI or TKI first-line after diagnosis were included. ABT exposure was stratified by exposure (yes or no), timing (before v after treatment initiation v none), excretion modes (hepatic v renal excretion v none), and administration routes (oral v intravenous v none). Three-month landmark Kaplan-Meier estimation and log-rank tests were used to compare rwOS/rwPFS among ABT groups. Multivariable Cox proportional hazards models with time-varying coefficients investigated the association between rwPFS, rwOS, ABT, and treatment modality.

RESULTS: ABT exposure was negatively associated with rwOS/rwPFS in both ICI (rwOS [23.9 v 33.6 months, P = .029]; rwPFS [8.8 v 11.6 months, P < .001]) and TKI (rwOS [17.4 v 26.2 months, P < .001]; rwPFS [8.0 v 9.7 months, P < .001]) recipients. For ICI patients only, a negative correlation between ABT after treatment initiation (rwOS, P = .003, rwPFS <0.001) and oral administration route (rwOS P = .004, rwPFS P = .001) was identified. In time-varying Cox proportional models, the effect of ABT on rwPFS beyond 12 months was only statistically significant in ICI patients (ICI, hazard ratio [HR], 1.67, P = .013; TKI, HR, 0.95; P = .7).

CONCLUSION: In our observational study, we identified a potential unique and complex association between ABT and rwOS/rwPFS in patients with mRCC receiving ICI. We found a negative correlation between ABT use after treatment initiation or via the oral route on oncologic outcomes in ICI patients. Moreover, there appears to be an ICI-specific negative association of ABT on rwPFS beyond 1 year. Our findings are associative, but they emphasize the importance of antibiotic stewardship in this space.

PMID:42054627 | DOI:10.1200/OP-25-00963

Eur J Public Health. 2026 Apr 11;36(3):ckag064. doi: 10.1093/eurpub/ckag064.

ABSTRACT

The COVID-19 pandemic has changed work organization in hospitals, notably with the expansion of telework. This study aimed to assess perceptions of telework among hospital workers throughout the pandemic and to identify factors associated with telework perceptions in the post-pandemic period. An observational cross-sectional study was conducted from October to December 2023. All hospital workers, regardless of their occupation or status, were invited to participate in an online survey. Perceptions of telework were assessed using visual analog scales, ranging from 0 (very negative) to 100 (very positive), across three periods: before the COVID-19 pandemic, during the first French lockdown, and after the pandemic. A total of 882 hospital workers were included in the analysis. Throughout the pandemic, 41.4% reported adopting telework. Overall, perceptions of telework became significantly more positive over time, rising from a mean score of 54.3 ± 25.3 before the pandemic, to 62.7 ± 27.4 during the first lockdown, and to 66.0 ± 27.5 after the pandemic (P < .001). Experiencing telework for the first time was associated with more favorable perceptions, with high levels sustained among those who continued teleworking post-pandemic. Perceptions of telework improved significantly among hospital workers throughout the pandemic with notable shifts in work practices, with nearly one third of participants teleworking in the post-pandemic period. Experiencing telework was associated with more positive perceptions.

PMID:42054081 | DOI:10.1093/eurpub/ckag064

Eur J Public Health. 2026 Apr 11;36(3):ckag032. doi: 10.1093/eurpub/ckag032.

ABSTRACT

China’s “one-child policy” limited many households in China to only one child. This policy had an impact on birth outcomes due to the birth order effects, as firstborn infants typically have lower birth weights. This study aimed to estimate the impact of the “universal two-child policy” on birth weight in China by analyzing individual-level data collected from a major tertiary obstetrics hospital located in Shanghai, the largest metropolitan area in China. Medical records for all births were obtained from a major metropolitan obstetrics hospital between 2013 and 2018. Using difference-in-differences (DID) and quantile DID (QDID) methods while controlling for maternal characteristics and socioeconomic factors, we examined the policy’s impact on birth weight. Analyses included stratification by maternal migrant status, age, and delivery mode. Insurance was found to mediate the treatment effect significantly. Analysis of 133 358 live births showed the policy increased birth weight by 21 g, corresponding to approximately 0.04 standard deviations of birth weight in our sample, with effects varying across maternal age groups and residency status. Insurance coverage mediated 41.3% of the total effect on birth weight. The “universal two-child policy” demonstrated beneficial impact on birth weight in China during the study period, particularly affecting older women, Shanghai residents, and those with natural births.

PMID:42054080 | DOI:10.1093/eurpub/ckag032

JAMA Netw Open. 2026 Apr 1;9(4):e269091. doi: 10.1001/jamanetworkopen.2026.9091.

ABSTRACT

IMPORTANCE: Patients with inflammatory bowel disease (IBD) are at increased risk of major adverse cardiovascular events (MACE), driven by chronic inflammation, endothelial dysfunction, and use of certain therapeutic regimens. Whether different IBD treatments mitigate this risk remains unclear.

OBJECTIVE: To examine the association of the use of immunomodulators or biologics vs 5-aminosalicylic acid (5-ASA) with risk of MACE among older patients with IBD.

DESIGN, SETTING, AND PARTICIPANTS: This comparative effectiveness study was conducted among a 15% Medicare claims sample of patients with IBD aged 65 years or older was identified, with entry defined by the first prescription of immunomodulators, biologics, or 5-ASA between January 1, 2012, and December 31, 2020. Follow-up extended to the outcome, switch or discontinuation of study drug, the study’s administrative end, or up to 3 years, whichever occurred first. Propensity score matching at a 1:3 ratio balanced demographics, comorbidities, and medication use between groups. Data analyses were conducted between January and September 2025.

EXPOSURES: Exposures were use of immunomodulators or biologics compared with 5-ASA, identified using National Drug Codes and Healthcare Common Procedure Coding System procedure codes.

MAIN OUTCOMES AND MEASURES: The primary outcome was time to the first emergency department or inpatient visit caused by a MACE, defined as myocardial infarction, stroke, or all-cause mortality. Hazard ratios (HRs) and 95% CIs for MACE risk with immunomodulators or biologics vs 5-ASA were estimated using Cox proportional hazards models.

RESULTS: A total of 16 387 patients (mean [SD] age, 74.73 [6.79] years; 9861 [60.18%] female) were included in the analysis. In the immunomodulators vs 5-ASA and biologics vs 5-ASA cohort, the mean (SD) ages were 74.05 (6.43) years and 73.68 (6.01) years, respectively, after matching. Both cohorts had more female participants (2580 [58.85%] and 1780 [58.09%], respectively). Baseline comorbidities were mostly balanced between groups. Compared with 5-ASA, there was no statistically significant difference in the risk of MACE for immunomodulators (HR, 0.84 [95% CI, 0.61-1.17]) or biologics (HR, 0.86 [95% CI, 0.59-1.24]), although point estimates were below 1.

CONCLUSIONS AND RELEVANCE: In this comparative effectiveness study of Medicare beneficiaries with IBD, there was no statistically significant difference in MACE risk between those who used immunomodulators or biologics vs 5-ASA.

PMID:42054028 | DOI:10.1001/jamanetworkopen.2026.9091

JAMA Netw Open. 2026 Apr 1;9(4):e269673. doi: 10.1001/jamanetworkopen.2026.9673.

ABSTRACT

IMPORTANCE: Hypertrophic cardiomyopathy (HCM) is associated with an elevated risk of sudden cardiac death, often preceded by an out-of-hospital cardiac arrest (OHCA). However, population-based estimates of OHCA risk in patients with HCM are limited.

OBJECTIVE: To estimate the risk of OHCA in patients with HCM and identify characteristics associated with OHCA.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used multiple Danish registers during an observation period ranging from June 1, 2001, to December 31, 2022, and included a nested case-control study. All Danish residents aged 18 to 85 years during the study period constituted the source population. Patients with HCM were identified using codes from the International Statistical Classification of Diseases, Tenth Revision. The cohort included patients with a first-time HCM diagnosis and exposure-matched controls. In the nested case-control study, patients with HCM who experienced OHCA were risk-set matched with controls with HCM and no OHCA at the index time. Analyses were performed between September 1 and November 30, 2025.

EXPOSURE: First-time diagnosis of HCM.

MAIN OUTCOMES AND MEASURES: Time to OHCA from exposure or the matching date was the primary outcome. Risk estimates were determined using the Aalen-Johansen estimator. Association between covariates and OHCA was determined by conditional logistic regression.

RESULTS: The cohort included a total of 29 240 individuals: 5901 patients with HCM (median age, 65 [IQR, 54-75] years; 3277 male [55.5%]) and 23 339 matched controls (median age, 65 [IQR, 55-75] years; 12 982 male [55.6%]). In the group aged 61 to 85 years, the 10-year risk of OHCA was 4.3% (95% CI, 3.4%-5.1%) in patients and 3.3% (95% CI, 3.0%-3.7%) in controls. In the group aged 18 to 60 years, the 10-year risk was 2.8% (95% CI, 1.9%-3.7%) in patients and 1.5% (95% CI, 1.2%-1.8%) in controls. The nested case-control study included 250 cases with HCM and OHCA (167 male [66.8%]; median age, 68 [IQR, 59-76] years) and 1000 controls with HCM and no OHCA (668 male [66.8%]; median age, 68 [IQR, 59-76] years). Heart failure, both recent and longer term, was associated with an increased rate of OHCA (hazard ratio, 3.63 [95% CI, 1.55-8.50] and 2.82 [95% CI, 1.88-4.22], respectively).

CONCLUSIONS AND RELEVANCE: The findings of this cohort study suggest that HCM was associated with an increased risk of OHCA in people aged 18 to 85 years. The rate of OHCA was associated with heart failure, underscoring the need for improved risk stratification to optimize primary prevention.

PMID:42054027 | DOI:10.1001/jamanetworkopen.2026.9673

JAMA Netw Open. 2026 Apr 1;9(4):e269753. doi: 10.1001/jamanetworkopen.2026.9753.

ABSTRACT

IMPORTANCE: Syringe services programs (SSPs) are evidence-based interventions that reduce bloodborne infections and injection-related harms among people who inject drugs, yet access remains limited and geographically uneven across the US.

OBJECTIVE: To quantify the travel time, distance, and cost required to reach the nearest SSP from population-weighted census tracts nationwide and to examine differences by urbanicity, state, and SSP legality.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional geospatial study linked all known SSP locations as of August 2024 to the population-weighted centroids of census tracts in the 50 US states and the District of Columbia. Analyses were conducted between December 2024 and February 2026.

MAIN OUTCOMES AND MEASURES: Population-weighted mean and median driving time, distance, and cost to access the nearest SSP, stratified by National Center for Health Statistics urban-rural county category and SSP legal status. Costs were estimated using 2024 Internal Revenue Service (IRS) medical mileage deduction rates and 2022 state-specific gasoline prices.

RESULTS: In 1338 SSPs across 83 780 census tracts, the population-weighted mean 1-way driving time to the nearest SSP was 46.1 minutes (95% CI, 45.7-46.5 minutes) and the median was 23.3 minutes (IQR, 12.2-58.5 minutes). Altogether, 23.1% of the population lived more than 60 minutes from an SSP and 12.6% lived over 120 minutes away. The mean 1-way driving distance was 41.8 miles (95% CI, 41.3-42.2 miles). The mean 1-way driving cost was $8.77 (95% CI, $8.68-$8.86) using the 2024 IRS mileage rate and $6.91 (95% CI, $6.84-$6.98) using state mean gasoline prices in 2022. In states where SSPs were legal, mean driving time was 30.1 minutes (95% CI, 29.8-30.4 minutes) and mean cost by IRS mileage rates was $4.94 (IQR, $4.88-$5.00), compared with 110.7 minutes (95% CI, 109.6-111.8 minutes) and $24.19 (IQR, $23.92-$24.46) in states where SSPs were illegal.

CONCLUSIONS AND RELEVANCE: This cross-sectional study of travel burden to SSPs found substantial geographic and financial barriers to accessing SSPs across the US, particularly in nonmetropolitan areas. Targeting new SSPs to areas with the greatest travel burden could improve utilization and reduce drug-related morbidity.

PMID:42054025 | DOI:10.1001/jamanetworkopen.2026.9753

JAMA Netw Open. 2026 Apr 1;9(4):e269816. doi: 10.1001/jamanetworkopen.2026.9816.

ABSTRACT

IMPORTANCE: Approximately 10% of cancers are attributable to heritable germline variants, yet identification of individuals at risk remains suboptimal.

OBJECTIVE: To assess the feasibility of personal history and family health history (FHH) risk assessment technology via the electronic medical record (EMR) to enhance identification of patients at risk for a broad array of inherited cancer syndromes.

DESIGN, SETTING, AND PARTICIPANTS: This single-arm, nonrandomized clinical trial was completed from October 1, 2021, to September 1, 2023, with no follow-up period in unselected patients receiving care at Vanderbilt University Medical Center. Adult patients (aged ≥18 years) were invited through their EMR patient portals to complete an eligibility survey. Eligible participants completed the survey, were English speaking, and had no prior genetic counseling. The data analysis was performed between August 15 and November 7, 2025.

INTERVENTION: Electronic medical record-integrated risk assessment platform that collected self-reported personal history and FHH to assess risk for 24 hereditary cancer syndromes.

MAIN OUTCOMES AND MEASURES: The primary outcome was the completion rate of the risk assessment platform. Secondary outcomes included the percentage of newly identified participants meeting guideline criteria for genetic counseling and whether previsit FHH collection increased genetic counseling capacity by decreasing time spent in counseling.

RESULTS: A total of 1685 patients were consented to participate (mean [SD] age, 55.4 [15.1] years; 1217 female [72.2%]; 95 of Black or African American [5.6%] 1405 of White [83.4%], and 181 of other [multiracial, other, or unknown] [10.6%] race; 38 of Hispanic or Latino [2.3%], 1388 of non-Hispanic or Latino [82.4%], and 111 of unknown [6.6%] ethnicity). Among participants consented, 1483 (88.0%) were provided access to the risk assessment, 1106 (74.6%) started the assessment, 636 (57.5%) completed it, and 544 (49.1%) received a risk report. Younger age and unknown race and ethnicity were the only significant variables associated with completion (mean [SD] age, 53.5 [15.3] vs 56.9 [14.8] years for completers vs noncompleters, respectively; unknown race, 77 [14.2%] vs 43 [7.6%] for noncompleters; unknown ethnicity, 49 [9.0%] vs 20 [3.6%] for completers vs noncompleters, respectively). Among participants who completed the risk assessment, 155 (28.5%) met guideline criteria for genetic counseling, yet 74 (47.7%) were previously identified as at risk by billing codes. A total of 31 participants (20.0%) eligible for genetic counseling attended. Manual outreach efforts and counseling duration did not differ between risk assessment-assisted and usual care visits.

CONCLUSIONS AND RELEVANCE: In this nonrandomized clinical trial, almost one-third of the population met national genetic counseling criteria for an inherited cancer syndrome, highlighting a substantial gap in usual care identification. Integrating patient-facing FHH collection and assessment tools for primary care patients improves inherited cancer risk identification and highlights opportunities to further enhance both risk assessment processes and genetic counseling attendance.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05079334.

PMID:42054024 | DOI:10.1001/jamanetworkopen.2026.9816

JAMA Netw Open. 2026 Apr 1;9(4):e269828. doi: 10.1001/jamanetworkopen.2026.9828.

ABSTRACT

IMPORTANCE: Studies have demonstrated lower odds of survival from out-of-hospital cardiac arrest (OHCA) during nighttime hours, but this has not been studied in North America since 2013, and it is unclear what factors might explain this survival difference.

OBJECTIVE: To identify whether OHCA survival during nighttime hours remains lower than during daytime hours using contemporary data and whether it can be explained by variable patient physiology or emergency care factors.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study included adults (aged ≥18 years) with OHCA in the Cardiac Arrest Registry for Enhanced Survival from 2013 to 2024.

EXPOSURE: Daytime was defined as 7:00 am to 10:59 pm, and nighttime was defined as 11:00 pm to 6:59 am.

MAIN OUTCOME AND MEASURES: Primary outcomes were sustained return of spontaneous circulation (ROSC) and neurologically favorable survival (Cerebral Performance Category score of 2 or more). A multilevel mixed-effects logistic regression model with prehospital agency as a random effect and patient or treatment characteristics as fixed effects was used. A similar analysis of postresuscitation survival was performed among patients with sustained ROSC, adjusting for the time-to-cardiopulmonary resuscitation interval and defibrillation status. A mediation analysis was performed to identify whether the prehospital response interval mediates the association.

RESULTS: Of 1 151 845 patients in the registry, 874 415 were eligible and included in the analysis, and the median (IQR) age in the cohort was 64 (52-75) years with 557 515 males (63.8%) and 181 878 Black or African American patients (20.8%), 146 352 Hispanic or Latino patients (16.7%), and 447 646 White patients (51.2%). A minority of OHCA responses occurred at nighttime (241 967 [27.7%]), and the odds of sustained ROSC and neurologically favorable survival were lower at nighttime than daytime (sustained ROSC: 62 548 [25.8%] vs 193 486 [30.6%]; adjusted odds ratio [aOR], 0.85; 95% CI, 0.84-0.86; neurologically favorable survival: 16 234 [6.7%] vs 58 542 [9.3%]; aOR, 0.84; 95% CI, 0.82-0.86). Among those with sustained ROSC, the odds of postresuscitation survival at nighttime were also lower than daytime (aOR, 0.93; 95% CI, 0.90-0.95). The prehospital response interval partially mediated the nighttime survival disadvantage, with approximately 12.6% of the total effect mediated by the response interval.

CONCLUSIONS AND RELEVANCE: In this cohort study of OHCA, nighttime response was associated with lower adjusted odds of sustained ROSC, neurologically favorable survival, and postresuscitation survival. Emergency care factors accounted for only a portion of the decreased odds of survival at nighttime.

PMID:42054023 | DOI:10.1001/jamanetworkopen.2026.9828