Nevin Manimala

JAMA Netw Open. 2025 May 1;8(5):e2510319. doi: 10.1001/jamanetworkopen.2025.10319.

ABSTRACT

IMPORTANCE: Although individual prosociality, defined as voluntary behavior intended to benefit another, is known to promote help-seeking behaviors among adolescents, it remains unclear whether a prosocial community, such as the classroom, also facilitates these behaviors.

OBJECTIVE: To investigate the associations of classroom-level and individual-level prosociality with help-seeking behaviors, considering age and gender, and to examine moderation effects of being bullied.

DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, annual surveys were conducted via questionnaire among students in Japanese junior and senior high schools from 2020 to 2023. The first wave was administered from October 1 to November 7, 2020, followed by the second wave from June 4 to July 13, 2021, the third wave from June 17 to July 19, 2022, and the fourth wave from June 19 to July 28, 2023.

EXPOSURE: Classroom-level prosociality was defined as the mean prosociality of all students within a classroom, while individual-level prosociality was measured as the deviation from this classroom mean. Prosociality was assessed using the prosocial subscale of the self-reported Strengths and Difficulties Questionnaire.

MAIN OUTCOMES AND MEASURES: Generalized mixed-effects models estimated the associations of classroom-level and individual-level prosociality with help-seeking behaviors (including poor help-seeking and seeking help from friends, family members, homeroom teachers, and physicians) while considering subgroups based on grades and gender, as well as the moderation effect of being bullied. Help-seeking behaviors were evaluated by a question about seeking help for one’s mental health problems (“Are you currently consulting anyone to discuss your psychological stress or mental health problems?”), with multiple options. The robustness of the main findings were tested by models stratified by survey year.

RESULTS: The analysis included 21 845 participants (mean [SD] school grade, 10.4 [1.2]; 16.6% junior high school students and 83.4% senior high school students; 53.3% boys). Classroom-level prosociality was associated with a higher rate of help-seeking from friends among senior high school students (odds ratio [OR], 1.26, 95% CI, 1.17-1.35), which confirmed the robustness. No moderation effect of being bullied was found in this association. Higher individual-level prosociality was associated with increased help-seeking from various sources across nearly all models and subgroups, regardless of being bullied (friends: OR, 1.15 [95% CI, 1.13-1.17]; P < .001; family members: OR, 1.09 [95% CI, 1.07-1.11]; P < .001; homeroom teachers: OR, 1.15 [95% CI, 1.10-1.19]; P < .001; school nurses: OR, 1.19 [95% CI, 1.12-1.28]; P < .001; and physicians: OR, 1.14 [95% CI, 1.07-1.20]; P < .001).

CONCLUSIONS AND RELEVANCE: This cross-sectional study of 21 845 students found that both classroom-level and individual-level prosociality were associated with higher rates of help-seeking from peers among senior high school students, while accounting for individual characteristics. Enhancing classroom prosociality could foster help-seeking behaviors through reciprocal peer support, benefiting even those who experienced bullying.

PMID:40372756 | DOI:10.1001/jamanetworkopen.2025.10319

JAMA Netw Open. 2025 May 1;8(5):e2510325. doi: 10.1001/jamanetworkopen.2025.10325.

ABSTRACT

IMPORTANCE: Patient demographic and socioeconomic characteristics are associated with differential delays in access to emergency care. However, less is known about the association between demographic, socioeconomic, and emergency medical services (EMS) agency factors and ambulance patient offload times (APOT), a critical measure of timely access to emergency care.

OBJECTIVE: To determine the association between ambulance offload times and demographic, socioeconomic, and EMS agency factors, uncover disparities in offload delays, and investigate factors associated with long APOT.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study was conducted using offload data from the California EMS Authority and local EMS agencies (LEMSA), population data from the US Census Bureau, and demographic and socioeconomic data from the Centers for Disease Control and Prevention’s Social Vulnerability Index. California local EMS agencies participated from January 1, 2021, to June 30, 2023.

EXPOSURE: A total of 30 community demographic, socioeconomic, and LEMSA factors were assessed.

MAIN OUTCOMES AND MEASURES: The main outcome was weighted mean APOT, calculated from APOT measures obtained from the California Emergency Medical Services Authroity and LEMSAs. The association between APOT and area demographic and socioeconomic characteristics was assessed using linear regression.

RESULTS: In this retrospective study from January 1, 2021, to June 30, 2023, 5 913 399 offloads were observed across 34 California LEMSAs with median (IQR) of 0.3% (0.2%-0.4%) American Indian or Alaska Native residents, 7.1% (4.7%-1.5%) Asian residents, 2.2% (1.6%-4.9%) Black residents, 33.1% (22.5%-48.7%) Hispanic or Latino residents, 0.3% (0.2%-0.4%) Native Hawaiian or Pacific Islander residents, 4.1% (3.1%-4.9%) multiracial, and 0.4% (0.4%-0.5%) residents in the additional race category; 17.2% (14.7%-22.8%) residents living below 150% of the poverty line; and 15.7% (13.5%-20.1%) aged 65 years or older. The weighted mean (SD) APOT across California was 42.8 (27.3) minutes; the median (IQR) across LEMSAs was 27.0 (15.5-48.3) minutes. Sequential unadjusted linear regressions of the 30 characteristics revealed 11 that were significantly associated with APOT. Least absolute shrinkage and selection operator penalization identified Black race, being aged 65 years or older, and total offloads (all log-transformed) as the variables most associated with APOT. A 3.3% absolute increase in Black residents, from 1.6% (25th percentile) to 4.9% (75th percentile), was associated with an unadjusted 17.4-minute (95% CI 10.3-24.5) increase in APOT. This increase remained significant, at 11.75 (95% CI 1.9-21.6) minutes, after adjustments for demographic, socioeconomic, and LEMSA characteristics.

CONCLUSIONS AND RELEVANCE: This cohort study of 5.9 million ambulance offloads found that the proportion of Black residents was the factor most significantly associated with longer APOT. These findings have direct implications for patients, EMS systems, and hospitals, as APOT may be an important component of health disparities in emergency care.

PMID:40372755 | DOI:10.1001/jamanetworkopen.2025.10325

JAMA Netw Open. 2025 May 1;8(5):e2510386. doi: 10.1001/jamanetworkopen.2025.10386.

ABSTRACT

IMPORTANCE: Digital health technologies include patient portals, telehealth, mobile health, and web-based resources; they have the potential to expand health care access, increase quality of care, and improve health outcomes. An emerging literature describes factors associated with disparities between Spanish and English speakers with the use of digital health tools and documents.

OBJECTIVE: To characterize barriers and facilitators and to inform hypothesis-generating questions and intervention planning associated with digital health technology use among Spanish-speaking populations in the US.

EVIDENCE REVIEW: Between January 2023 and April 2024, PubMed, Scopus, Web of Science, and Google Scholar were searched for publications between January 2013 and April 2024. Systematic reviews, protocols, editorials, abstracts, unpublished literature, non-peer-reviewed literature, and non-US-based and non-English studies were excluded. The Covidence platform was used to avoid duplicate records, and an abstract and full-text screening were then conducted for exclusions. Unstructured text in the final dataset was thematically analyzed.

FINDINGS: Of 688 publications searched, 192 were excluded as duplications, 277 were excluded from abstract screenings, and 113 were excluded from full-text screenings. Among the 106 included studies (68% of which were published between 2019 and 2024), 73 (69%) used quantitative methods, 15 (14%) used qualitative methods, and 18 (17%) used applied mixed methods. The primary technologies studied were characterized as portal (21% [n = 22]), telehealth (42% [n = 45]), mobile health (16% [n = 17]), web-based resources (9% [n = 10]), and mixed (studies reporting >1 technology; 11% [n = 12]). Compared with English speakers, studies revealed consistently lower portal account activation, portal use, telehealth adoption, and online resource use among Spanish speakers. Barriers to use across all technologies included limited access to technology and Wi-Fi, low literacy, and limited digital literacy. Barriers to portal and telehealth use included lack of awareness of digital tools, limited patient-facing instructions in Spanish, and interpreter-related challenges. Facilitators cited across multiple technologies included use of text messaging and social media interventions, interventions involving care partners and/or interpreters, and culturally and linguistically tailored Spanish materials.

CONCLUSIONS AND RELEVANCE: The results of this scoping review suggest that Spanish-speaking persons in the US faced technology, language, and literacy-related barriers to digital technology use. Embracing support for care partners, facilitating text message or social media-oriented workflows, and ensuring that materials are linguistically and culturally tailored represent approaches for health systems, electronic health record vendors, and community health organizations to mitigate these disparities.

PMID:40372754 | DOI:10.1001/jamanetworkopen.2025.10386

JAMA Netw Open. 2025 May 1;8(5):e2510512. doi: 10.1001/jamanetworkopen.2025.10512.

ABSTRACT

IMPORTANCE: Despite receiving postacute rehabilitation services, many older women with a recent hip fracture repair are unable to return to their prefracture level of function. Whether testosterone therapy can enhance recovery after hip fracture in older women with persistent mobility impairments has not been fully examined.

OBJECTIVE: To evaluate the effects of a supervised exercise program combined with topical testosterone therapy on functional outcomes in older women with a recent hip fracture.

DESIGN, SETTING, AND PARTICIPANTS: This phase 3 double-blind, placebo-controlled randomized clinical trial, Starting a Testosterone and Exercise Program After Hip Injury (STEP-HI), was conducted at 8 US sites between December 2018 and August 2023. Participants were women aged 65 years or older with a recent surgical repair of a nonpathologic femur fracture, met objective criteria for mobility impairment, and were community dwelling after discharge from rehabilitation. During the first 14 months of the trial, participants were randomly assigned to 1 of 3 treatment groups: exercise plus topical testosterone gel, exercise plus placebo gel, or enhanced usual care. Statistical analysis, using a modified intention-to-treat approach, was performed from November 2023 to November 2024.

INTERVENTIONS: For 24 weeks, the 2 exercise groups underwent a supervised, multimodal high-intensity exercise program that included progressive resistance training with trained and certified exercise interventionists. Testosterone was provided in the form of a topical gel (generic 1.0% testosterone), and the placebo gel was chemically identical but without testosterone. The enhanced usual care group was prescribed a self-administered low-intensity home-based exercise program and a staff-led monthly health education session.

MAIN OUTCOMES AND MEASURES: The primary outcome was the between-group difference in the change in the 6-minute walking distance (6MWD) from baseline to 24 weeks.

RESULTS: Among the 129 women randomized (54 to the exercise plus testosterone group, 55 to the exercise plus placebo group, and 20 to the enhanced usual care group; mean [SD] age, 79.3 [8.4] years) included in the STEP-HI trial (122 (94.6%) provided primary outcome data for baseline and at least 1 time point (12 or 24 weeks). The mean (SD) change in the 6MWD between baseline and 24 weeks was not significantly different for exercise plus topical testosterone gel (n = 53; 42.7 [8.2] m) compared with exercise plus placebo gel (n = 51; 40.5 [8.4] m) and enhanced usual care (n = 18; 37.7 [14.8] m).

CONCLUSIONS AND RELEVANCE: In the STEP-HI randomized clinical trial, supervised exercise training combined with testosterone therapy conducted in older women recovering from a hip fracture did not lead to significant improvement in 6MWD compared with supervised exercise alone. Adding testosterone therapy to exercise may not provide further benefits for long-distance mobility. Whether it can improve physical performance and mobility for short distances in this patient population warrants further study.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02938923.

PMID:40372752 | DOI:10.1001/jamanetworkopen.2025.10512

JAMA Ophthalmol. 2025 May 15. doi: 10.1001/jamaophthalmol.2025.1080. Online ahead of print.

ABSTRACT

IMPORTANCE: The optimal timing for secondary intraocular lens (IOL) implantation in children with bilateral aphakia remains uncertain, with important implications for long-term visual outcomes and the risk of complications such as glaucoma. Determining when to implant to achieve the best visual outcomes while minimizing complications is critical for improving clinical decision-making in pediatric cataract management.

OBJECTIVE: To report the visual acuity (VA) and complications in children with bilateral aphakia after lensectomy for pediatric cataracts, undergoing secondary IOL implantation at different ages.

DESIGN, SETTING, AND PARTICIPANTS: This single-center prospective observational cohort study, conducted from 2014 to 2023, is a 7-year follow-up study. A total of 251 children met the inclusion criteria. After exclusion, 158 children were enrolled in this study. These 158 children (316 eyes) underwent lensectomy before the age of 2 years, followed by secondary IOL implantation between the ages of 2 and younger than 6 years in bilateral pediatric cataracts.

EXPOSURE: Study participants were categorized into 4 groups based on the timing of secondary IOL implantation (2 to <3 years, 3 to <4 years, 4 to <5 years, and 5 to <6 years).

MAIN OUTCOME AND MEASURE: Best-corrected VA (BCVA) outcomes at age 7 years after secondary IOL implantation in children with bilateral pediatric cataracts.

RESULTS: Among the 158 children included in the study, 103 (65.2%) were male. At age 7 years, the mean (SD) BCVA for children who underwent secondary IOL implantation was 0.49 (0.35) logMAR (Snellen equivalent, 20/62) at 2 to younger than 3 years, 0.59 (0.36) logMAR (Snellen equivalent, 20/78) at 3 to younger than 4 years, 0.60 (0.30) logMAR (Snellen equivalent, 20/80) at 4 to younger than 5 years, and 0.65 (0.34) logMAR (Snellen equivalent, 20/89) at 5 to younger than 6 years (P = .20). Glaucoma-related adverse events occurred in 47 eyes in total: 6 eyes (8.8%), 7 eyes (9.0%), 10 eyes (15.6%), and 24 eyes (22.6%) across the groups, respectively, with a statistical difference among the groups (P = .03).

CONCLUSIONS AND RELEVANCE: These findings suggest that secondary IOL implantation performed between the ages of 2 and younger than 6 years following bilateral pediatric cataract lensectomy can achieve comparable visual outcomes; however, the risk of glaucoma increases with older implantation age.

PMID:40372731 | DOI:10.1001/jamaophthalmol.2025.1080

JAMA Oncol. 2025 May 15. doi: 10.1001/jamaoncol.2025.1059. Online ahead of print.

ABSTRACT

IMPORTANCE: Postoperative radiotherapy remains underused for men with biochemical recurrence or adverse pathological features after radical prostatectomy (RP). Stereotactic body radiotherapy (SBRT) may improve utilization and poses potential radiobiological advantages.

OBJECTIVE: To evaluate physician-reported late toxic effects and 2-year patient-reported outcomes (PROs) following post-RP SBRT.

DESIGN, SETTING, AND PARTICIPANTS: This phase 2, single-arm trial was conducted in 2 academic centers in the US and included a comparator cohort. Men with post-RP prostate-specific antigen greater than 0.03 ng/mL or adverse pathologic features were included. Data were collected from February 2018 to March 2021, and data were analyzed from January to October 2024.

INTERVENTIONS: SBRT delivered at 30 to 34 Gy in 5 fractions to the prostate bed. Nodal irradiation, boost to gross disease, and/or hormonal therapy were delivered per physician discretion.

MAIN OUTCOMES AND MEASURES: Late toxic effects (more than 90 days after treatment) were graded according to Common Terminology Criteria for Adverse Events version 4.03. PROs were measured using Expanded Prostate Cancer Index-26. The proportion of men whose PROs had decrements greater than twice the threshold for minimal clinically important difference (MCID) at any point during the first 2 years were evaluated. The longitudinal PROs for men receiving SBRT was compared with a cohort of 200 men receiving postoperative conventionally fractionated radiotherapy (CFRT) using logistic regression, while adjusting for baseline scores, age, and receipt of nodal irradiation.

RESULTS: Of 100 patients treated with post-RP SBRT, the median (IQR) age was 68.5 (63.9-71.4) years, and the median (IQR) follow-up was 43 (37-53) months. Cumulative incidence of late grade 2 and 3 genitourinary toxic effects was 25% and 4%, respectively, and of late grade 2 and 3 gastrointestinal tract toxic effects was 3% and 3%, respectively. The proportion of patients with decrements more than 2-fold the MCID in PROs was 38.9% (37 of 95) for urinary incontinence, 17.9% (17 of 95) for urinary irritation, and 34.1% (31 of 91) for bowel function. Compared with the CFRT cohort, the adjusted odds ratio for patients receiving SBRT experiencing decrements more than 2-fold the MCID was 1.55 (95% CI, 0.87-2.76; P = .14) for urinary incontinence, 0.94 (95% CI, 0.46-1.94; P = .87) for urinary irritation, and 1.03 (95% CI, 0.57-1.84; P = .93) for bowel function.

CONCLUSIONS AND RELEVANCE: In this nonrandomized clinical trial, post-RP SBRT was well-tolerated, with no measurably different decline in urinary or bowel PROs through 2 years compared with CFRT. Randomized studies and longer follow-up will better define the toxic effects and efficacy profile of post-RP SBRT.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03541850.

PMID:40372727 | DOI:10.1001/jamaoncol.2025.1059

Rheumatology (Oxford). 2025 May 15:keaf248. doi: 10.1093/rheumatology/keaf248. Online ahead of print.

ABSTRACT

OBJECTIVES: B cell depletion therapy has been used for over two decades to treat systemic lupus erythematosus (SLE), but there is a lack of studies reporting its impact on damage progression. This study aims to assess the effectiveness of rituximab in slowing damage acquisition.

METHODS: We selected 380 patients 190 treated with rituximab and 190 controls, based on matched sex and age of onset, with standard immunosuppressive therapies-to compare the damage they developed, assessed by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR DI). A secondary analysis of 111 patients was conducted to evaluate DI progression.

RESULTS: The majority of patients were female (94.1%) and caucasian (45.4%). Severe disease manifestations and higher titers of anti-dsDNA antibodies (86 U/ml vs 62 U/ml; p= 0.012) were seen in the rituximab group, in which SLICC/ACR DI was also higher (1.3 vs 0.9; p= 0,02). In the secondary analysis the SLICC/ACR DI mean had no statistical difference between the two groups (0.4 vs 0,6; p= 0.33), but we identified a statistical significance between the two groups regarding their DI progression (58.2% in the control group vs 44.2% in the rituximab).

CONCLUSION: As an effective B cell depleting therapy, rituximab is a valid therapeutic option for SLE patients, especially in those with refractory or life-threatening manifestations. While patients treated with rituximab initially had higher damage, their rate of damage progression was slower compared with those receiving standard therapies.

PMID:40372703 | DOI:10.1093/rheumatology/keaf248

Environ Sci Pollut Res Int. 2025 May 15. doi: 10.1007/s11356-025-36506-0. Online ahead of print.

ABSTRACT

Mercury (Hg) is a heavy metal of global concern because of its persistence in the environment and its ability to bioaccumulate and biomagnify in ecosystems. Despite evidence of extensive environmental pollution in the Copperbelt Province, few studies have investigated Hg contamination in the Kafue River and its tributaries in Kitwe District, Zambia. Total Hg concentrations were determined in soil, sediments, and tilapia by inductively coupled plasma mass spectrometer (ICP-MS) from the mining areas and non-mining areas. There were significant differences in the population means for soil samples (Mean _(mining) = 1.066, Mean _(non-mining) = 0.041, p $\le 0.05$ ) and sediment samples (Mean _(mining) = 1.304, Mean _(non-mining) = 0.034), p $\le 0.05$ ) between mining and non-mining areas. There were also statistically significant differences in the population means for fish samples (Mean _(mining) = 0.015, Mean _(non-mining) = 0.007, p $\le 0.05$ ) between mining and non-mining areas. The levels of Hg in the soil and sediments from the mining area were higher than the United States Environmental Protection Agency (USEPA) reference values of 0.3 mg/kg and 0.2 mg/kg, respectively. There was a weak positive correlation between the size of the fish (length) and Hg accumulation in the Kitwe mining area (r = 0.232, P = 0.1166). The observed correlation between Hg accumulation and length of fish was not statistically significant (P > 0.05). The EDI from the consumption of fish from the mining area was below the USEPA and WHO/FAO maximum tolerable daily intake of 0.1 µg/kg/day and 0.23 µg/kg, respectively. The THQ < 1 was also reported in the current study, suggesting that the exposure level may not cause adverse health effects during a lifetime in the human population. Although the EDI and THQ < 1 in the current study were below the USEPA and WHO/FAO maximum tolerable limit, the presence of Hg in fish in this area must be monitored due to its ability to bioaccumulate in large and predatory fish. The lower EDI value reported in the current study might be attributed to the smaller size of the tilapia fish specimens, resulting in low bioaccumulation of Hg. Since the Hg levels in sediments were above the USEPA limit, we recommend further studies on the bioavailability of Hg in humans and other fish species in the region, particularly carnivorous fish, due to Hg biomagnification to offer a clearer perspective on the environmental and health impacts.

PMID:40372695 | DOI:10.1007/s11356-025-36506-0

Environ Sci Pollut Res Int. 2025 May 15. doi: 10.1007/s11356-025-36437-w. Online ahead of print.

ABSTRACT

The aim of this article is to assess whether the collapse of the Fundão tailings dam still impacts the surface water quality of the Doce River in the state of Minas Gerais (Brazil). The records of 15 water quality parameters were evaluated, comparing data from before and after the accident. Nine sampling points were selected, six of which corresponded to water intakes for the water supply systems. The records showed that after the collapse of the Fundão Dam, there was an increase in the percentage of non-conforming values for dissolved Fe, dissolved Al, true color, turbidity, and total suspended solids, but a reduction in total Mn and total Pb, based on the Normative Consideration COPAM/2008. The time series analysis showed no trends, with Levene’s test indicating variance changes only for dissolved Fe, total dissolved solids, and dissolved Al. Mann-Whitney tests revealed no median changes in key parameters after the Fundão Dam collapse. For the seven trace metals evaluated (As, Cd, Cr, Pb, Hg, Ni and Zn), the Mann-Whitney and Pettitt tests allow us to infer that there was a change in the median concentrations and an abrupt change in the data series after the dam rupture. It is not possible to associate any plausible cause for the changes observed in some tests and monitoring stations in the records prior to the accident. For records after the accident, the prospect of the Doce River’s recovery still lacks greater statistical robustness, emphasizing the relevance of maintenance of water quality monitoring stations in the Doce River channel.

PMID:40372694 | DOI:10.1007/s11356-025-36437-w

Environ Sci Pollut Res Int. 2025 May 15. doi: 10.1007/s11356-025-36505-1. Online ahead of print.

ABSTRACT

The current investigation’s objective is to compare various pentanol/biogas/diesel fuel mixes’ performance and exhaust parameters in a dual fuel engine. The varied flow rates of gaseous fuel (10, 20, and 30 L per minute) and pentanol fractions (10, 15, and 20%) in conventional diesel at various engine loads (20, 60, and 100%) were studied. Response surface approach was used to assess the researched variables in order to get the best model. The entire range of the proposed multivariate models was statistically significant in the current analysis, demonstrating the great accuracy of the models. Additionally, the values of the independent parameters were defined using the desirability technique to get the highest performance and the lowest engine-out emissions. As per the modeling results, the ideal operation condition was found at an engine load of 83%, a pentanol ratio of 10%, and a biogas flow rate of 30 L per minute. In particular, the use of biogas instead of fossil fuels is valuable both economically and in terms of climate studies. The projected values for the relevant reaction parameters at the recommended point were 22% brake thermal efficiency, 56 ppm unburned hydrocarbon emissions, 0.09% carbon monoxide emissions, 102 ppm nitrogen oxides emissions, and 24% emitted smoke. The response surface approach might be utilized to properly model and optimize a diesel engine that runs on a ternary mix, as demonstrated by the high desirability of 0.74 for derived models. The fuel used can be utilized to minimize the pollution coming out of tailpipe of diesel engines and also helps in enhancing the performance of the engine as compared to natural diesel.

PMID:40372693 | DOI:10.1007/s11356-025-36505-1