Nevin Manimala

JAMA Netw Open. 2026 Jan 2;9(1):e2553146. doi: 10.1001/jamanetworkopen.2025.53146.

ABSTRACT

IMPORTANCE: Rates of metastatic colorectal cancer (mCRC) are rising among young adults. Disparities by race and ethnicity and neighborhood-level socioeconomic status (SES) among this population are understudied.

OBJECTIVE: To examine the association of race and ethnicity and neighborhood-level SES with mortality among a community-based sample of young adults with mCRC.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used a large electronic health record-derived database of young adults with cancer treated at 280 community-based US clinics between 2013 and 2021. Eligible patients were young adults aged 18 to 49 years diagnosed with de novo or recurrent mCRC. Patients were followed up until December 31, 2022. Data were analyzed from February 2024 to November 2025.

EXPOSURES: Race and ethnicity and neighborhood-level SES. Neighborhood-level SES was derived using census block group (2010 Census boundaries) and most recent address in the electronic health record. Five-year estimates from the American Community Survey (2015-2019) were used to compute the Yost Index, a composite measure of 7 variables that capture different aspects of neighborhood-level SES.

MAIN OUTCOME AND MEASURE: All-cause mortality and 1-, 2-, and 3-year survival from diagnosis. Survival was defined from date of de novo or recurrent mCRC diagnosis to date of death or December 31, 2022.

RESULTS: A total of 3115 young adults diagnosed with mCRC (mean [SD] age at diagnosis, 42.4 [5.9] years; 122 Asian [3.9%], 424 Black [13.6%], 395 Hispanic [12.7%], 1874 White [60.2%]; 1651 male [53.0%]). Survival differed significantly by race and ethnicity and neighborhood-level SES. At 3 years after diagnosis, Black patients had worse survival (41%; 95% CI, 36%-46%), while Asian (58%; 95% CI, 48%-66%) and Hispanic (53%; 95% CI, 48%-58%) patients had better survival compared with White patients (47%; 95% CI, 45%-49%). For neighborhood-level SES, 3-year survival was 41% (95% CI, 36%-45%) for patients in the lowest compared with 59% (95% CI, 54%-63%) in the highest quintile. In adjusted analyses, neighborhood-level SES was associated with mortality (Q1 vs Q5: hazard ratio [HR], 1.51; 95% CI, 1.24-1.82), while the HR for Black race and mortality was greater than 1 but not statistically significant (HR, 1.08; 95% CI, 0.90-1.31).

CONCLUSIONS: In this cohort study of young adults with mCRC, 3-year survival differed by race and ethnicity and neighborhood-level SES, but only the association between neighborhood-level SES and survival remained statistically significant after adjusting for covariates.

PMID:41505130 | DOI:10.1001/jamanetworkopen.2025.53146

JAMA Netw Open. 2026 Jan 2;9(1):e2553157. doi: 10.1001/jamanetworkopen.2025.53157.

ABSTRACT

IMPORTANCE: The Patient Protection and Affordable Care Act (ACA) requires private health insurers to cover recommended preventive services with no patient cost-sharing, but patients covered by these provisions still incur out-of-pocket (OOP) costs for which they should be exempt. To date, no work has assessed how gaps in enforcing the ACA’s cost-sharing exemption affect patients with chronic conditions, who have higher OOP costs overall, which increases the financial burden from their health care.

OBJECTIVE: To determine the relative incidence, magnitude, and determinants of cost-sharing for preventive care among individuals with chronic conditions compared with individuals without such conditions.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used propensity score matching of patients insured through their employers or the ACA Marketplaces, using claims and remittance data from Symphony Health Solutions’ Integrated DataVerse from 2017 to 2020. Analysis was completed between November 2024 and November 2025.

EXPOSURE: Presence of ambulatory care-sensitive conditions (ACSCs) compared with no chronic conditions.

MAIN OUTCOMES AND MEASURES: Primary outcomes included the incidence and amount of costs levied for preventive care. Secondary outcomes included the incidence of cost-sharing for preventive care specifically due to service code misclassification and visit complexity.

RESULTS: A total of 1 262 414 patients (800 693 female patients [63.42%]; mean [SD] age at the time of visit, 54.46 [12.40] years) received 5 236 253 preventive services over 1 984 354 unique visits. The likelihood of a preventive service resulting in cost-sharing was significantly greater among patients with ACSCs compared with those without ACSCs (17.91% [95% CI, 17.69%-17.95%] vs 15.64% [95% CI, 15.69%-15.95%]; P < .001). Propensity score-matched models found that individuals with ACSCs had a 19.20% increase (95% CI, 18.87%-19.18%; P < .001) in the probability of facing OOP costs for preventive care, and a 20.69% (95% CI, 19.19%-20.91%; P < .001) increase in expected preventive OOP costs overall.

CONCLUSION AND RELEVANCE: These findings suggest that patients with chronic conditions were more likely to experience cost-sharing for preventive care and had greater expected spending overall. Standardizing insurer practices regarding cost-sharing exemptions can improve equitable access to high-value preventive care.

PMID:41505129 | DOI:10.1001/jamanetworkopen.2025.53157

JAMA Netw Open. 2026 Jan 2;9(1):e2553179. doi: 10.1001/jamanetworkopen.2025.53179.

ABSTRACT

IMPORTANCE: Influenza and tetanus-diphtheria-acellular pertussis (Tdap) vaccinations during pregnancy offer protection to infants from infections. However, evidence about their effectiveness against hospitalization and emergency department (ED) visits associated with influenza and pertussis remains limited.

OBJECTIVE: This study aimed to evaluate the association of maternal influenza and Tdap vaccinations with influenza- and pertussis-related hospitalizations and ED visits in infants younger than 6 months.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study used the health care utilization databases from the Lombardy region of Italy. Pregnant individuals who received the influenza and Tdap vaccine among all live-birth pregnancies in 2018 to 2022 were included. Each vaccinated mother was matched with a nonvaccinated counterpart based on month and year of delivery, gestational age at birth, and pregnancy multiplicity. Analyses were performed from April 2024 to February 2025.

EXPOSURES: Exposures of interest were influenza and Tdap vaccinations during pregnancy.

MAIN OUTCOMES AND MEASURES: The primary outcomes were infant hospitalizations or ED visits due to influenza and pertussis. Cox regression models were fitted to estimate the hazard ratio (HR) of each outcome associated with the corresponding maternal vaccine. Vaccine effectiveness (VE) was calculated as VE = (1 – HR) × 100%.

RESULTS: This study included 53 448 pregnant individuals who received the Tdap vaccine and 5347 who received influenza vaccine. The maternal vaccination coverage (ie, proportion of vaccinated pregnant individuals among those eligible) was 5359 (6.4%) for influenza and 70 119 (41.0%) for Tdap, respectively. Infants born to mothers who received the influenza and Tdap vaccine had a lower risk of hospitalization or ED visit for influenza (VE, 69.7%; 95% CI, 8.7%-90.0%) and pertussis (VE, 88.6%; 95% CI, 11.5%-98.5%), respectively.

CONCLUSIONS AND RELEVANCE: This study found that maternal influenza and Tdap vaccinations were associated with reduced influenza- and pertussis-related hospitalization or ED visits in infants younger than 6 months. Given the low vaccination coverage, it is crucial to implement maternal vaccination campaigns to enhance infant health outcomes.

PMID:41505127 | DOI:10.1001/jamanetworkopen.2025.53179

JAMA Netw Open. 2026 Jan 2;9(1):e2552652. doi: 10.1001/jamanetworkopen.2025.52652.

ABSTRACT

IMPORTANCE: The results of the 2024 US general election highlight both progress and potential threats to the health of lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) populations. Understanding the scope and potential implications of these measures is critical for developing public health resilience strategies that promote equitable access to care for all individuals.

OBJECTIVE: To review 2024 state-level ballot initiatives with potential health implications for LGBTQ+ people and to highlight strategies for strengthening public health resilience against anti-LGBTQ+ legislation.

EVIDENCE REVIEW: Using the National Conference of State Legislatures (NCSL) database, 154 records from the 2024 US general election were screened. Following coauthor consensus, 101 records were excluded based on their NCSL topic and/or unclear relationship to LGBTQ+ health. Fifty-three ballot measures were assessed for eligibility; 13 were excluded for having only perceived indirect or upstream implications for LGBTQ+ health; and 18 were excluded for not aligning with the primary domains identified by coauthor consensus: (1) reproductive health and abortion access; (2) gender-affirming care; (3) access to HIV and other sexually transmitted infection prevention, testing, and treatment; (4) marriage and family planning; and (5) mental health.

FINDINGS: Of 154 state-level ballot measures from the 2024 US general election, 22 (14%) were recognized as potentially having noteworthy health implications for LGBTQ+ communities across 5 domains. The majority of identified ballot measures (18 measures [81.8%]) were protective. The remaining were harmful (3 measures [13.6%]) or had a limited scope of implications (1 measure [4.5%]). Most protective measures (14 measures [77.8%]) passed. Four protective measures (22.2%) failed, and 2 of 3 harmful ballot measures (66.7%) passed.

CONCLUSIONS AND RELEVANCE: In the 2024 general election, most state-level legislation that could have health implications for LGBTQ+ individuals and communities was protective. Of all proposed legislation, most passed.

PMID:41505126 | DOI:10.1001/jamanetworkopen.2025.52652

JAMA Oncol. 2026 Jan 8. doi: 10.1001/jamaoncol.2025.5869. Online ahead of print.

ABSTRACT

IMPORTANCE: While preliminary evidence suggests that sodium-glucose cotransporter 2 (SGLT2) inhibitors for diabetes may have antitumorigenic effects, their potential benefits in prostate cancer remain unexplored. Understanding their association with outcomes among patients undergoing hormone therapy could inform future adjunct treatment strategies.

OBJECTIVE: To evaluate whether the use of SGLT2 inhibitors is associated with clinical outcomes in patients with prostate cancer receiving hormone therapy.

DESIGN, SETTING, AND PARTICIPANTS: This population-based, sequential target trial emulation of monthly cohorts used territory-wide electronic health records (January 1, 1993, to April 30, 2025) from the Hong Kong Hospital Authority, covering a population of approximately 7.5 million. Adult men diagnosed with prostate cancer who initiated androgen deprivation therapy (ADT) were included. Follow-up extended through April 2025, and data were analyzed from June to October 2025.

EXPOSURES: Use of SGLT2 inhibitors (primarily dapagliflozin and empagliflozin) initiated during hormone therapy and maintained for at least 1 month. Comparator groups included nonusers of SGLT2 inhibitors.

MAIN OUTCOMES AND MEASURES: The primary outcome was time to ADT failure. Secondary outcomes include time to next-generation hormonal agent failure, disease-specific survival, and overall survival. Both intention-to-treat and per-protocol analyses were conducted using complementary log-log model regression to provide the hazard ratio (HR) estimate.

RESULTS: Among 14 223 eligible patients (median [IQR] age at enrollment, 74 [68-80] years) with a median follow-up of 66 months (95% CI, 65-67 months), intention-to-treat SGLT2 inhibitor use was associated with reduced risk of ADT failure (HR, 0.63; 95% CI, 0.41-0.95; P = .03) and next-generation hormonal agent failure (HR, 0.44; 95% CI, 0.20-0.97; P = .04). Sensitivity analyses confirmed robustness of these findings across different comparator subgroups. Metformin monotherapy was not associated with disease progression but was associated with improved overall survival (HR, 0.59; 95% CI, 0.42-0.83; P = .002). No statistically significant outcome differences were observed between dapagliflozin and empagliflozin.

CONCLUSIONS AND RELEVANCE: In this cohort study with a target trial emulation design, SGLT2 inhibitor use was associated with delayed hormone therapy failure in patients with prostate cancer, suggesting a potential oncologic benefit beyond glucose lowering. These findings support the potential of SGLT2 inhibitors in treatment for prostate cancer.

PMID:41505116 | DOI:10.1001/jamaoncol.2025.5869

J Osteopath Med. 2026 Jan 9. doi: 10.1515/jom-2025-0145. Online ahead of print.

ABSTRACT

CONTEXT: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a life-sustaining therapy for severe refractory cardiogenic shock. Although VA-ECMO provides various degrees of cardiopulmonary support, mortality rates remain high. Serum biomarkers have potential to identify the rising risk of mortality in patients receiving ECMO, but evidence supporting their prognostic value is inconsistent.

OBJECTIVES: This study aims to systematically investigate existing evidence on the relationship between biomarkers and mortality in adult patients with refractory cardiogenic shock undergoing VA-ECMO support.

METHODS: A systematic review was conducted conforming to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Analogous search strings were developed to complete a comprehensive literature search across multiple databases that included Embase, Scopus, PubMed, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Search limits include studies published in the last 5 years (>2018) and in the English language. The inclusion criteria were: all genders aged 18 and older being treated for cardiogenic shock with VA-ECMO and intra-ECMO biomarker data with corresponding mortality data. Biomarkers included in the criteria were: lactate, creatinine, bilirubin, aspartate transaminase (AST), alanine transaminase (ALT), troponin, C-reactive protein (CRP), and white blood cell (WBC) count. Identified articles were included within the main findings after unanimous approval by all authors. The quality of the evidence was assessed systematically utilizing a standardized and validated checklist.

RESULTS: Our search yielded 1,033 studies, with 650 studies remaining after the removal of duplicates, leaving 538 studies to be screened for title and abstract study relevance. Subsequently, 112 studies remained for full-text review. Reasons for exclusion during full-text review include conference abstract, no mention of specific biomarkers, and wrong comparison of treatment modalities. Five studies remained for data extraction. Data gathered from five retrospective cohort studies reported a total of 589 patients supported by VA-ECMO following a diagnosis of cardiogenic shock, with the most common inciting factor being postcardiac surgery. Most patients were male. The age range for all participants was between 45 and 77 years. Common comorbidities include diabetes mellitus, hypertension, and vascular disease. Overall mortality was 59.9 % (353/589) based on survival to 30-day post-ECMO initiation or hospital discharge. In three of the studies, the patients in the survivor cohort had statistically significant lower intra-ECMO lactate levels compared to the non-survivors (p<0.01). One of the studies found statistically significant differences between survivors and non-survivors in the intra-ECMO values for serum lactate (p<0.001), creatinine (p<0.023), bilirubin (p<0.001), AST (p<0.05), and ALT (p<0.05). Another study reported statistically significant differences in nadir lactate levels through 24 and 48 h of ECMO initiation in survivors vs. non-survivors (p=0.001 and p=0.001 respectively).

CONCLUSIONS: Serum lactate was the biomarker most utilized to assess the risk of mortality. Serum creatinine (Scr), bilirubin, AST, and ALT also demonstrated significance in predicting mortality, although not as widely studied as serum lactate. Future research is needed to further investigate the usage of Scr, bilirubin, AST, and ALT to better assess their significance, regarding VA-ECMO mortality in patients diagnosed with cardiogenic shock. Further research is also warranted to investigate the minimal concentration of these biomarkers and their association with mortality to allow clinicians a better predictor of a patient’s mortality risk while receiving VA-ECMO.

PMID:41505108 | DOI:10.1515/jom-2025-0145

Curr Med Sci. 2026 Jan 8. doi: 10.1007/s11596-025-00160-x. Online ahead of print.

ABSTRACT

OBJECTIVE: The benefits of caffeine to human health have been widely reported, but the association between caffeine intake and mortality among patients with chronic kidney disease (CKD) has been rarely reported in large epidemiologic studies. This study aimed to investigate the association between caffeine intake and mortality among CKD patients.

METHODS: Our study was conducted among non-dialysis CKD patients in the 2003-2016 National Health and Nutrition Examination Survey (NHANES). Weighted COX regression analysis was used to explore the linear relationship between caffeine intake and mortality among CKD patients (including all-cause mortality, as well as mortality due to cardiovascular disease, cancer, cerebrovascular disease, nephropathy, and influenza or pneumonia). Restricted cubic spline analysis was performed to explore the nonlinear relationship. Finally, threshold effects were analyzed through fitting a two-piecewise linear regression model.

RESULTS: In a fully adjusted model, no significant linear association was found between caffeine intake and mortality. However, there was a U-shaped association between caffeine intake and all-cause mortality (inflection point: 277 mg). Moreover, there was a J-shaped association between caffeine intake and cardiovascular mortality (inflection point: 252 mg) and cancer mortality (inflection point: 79 mg).

CONCLUSION: All-cause mortality was reduced in CKD patients when caffeine intake was less than 277 mg (about 1.85 cups of Americano). However, excessive caffeine intake was associated with increased all-cause mortality, cardiovascular mortality and cancer mortality in this population.

PMID:41505074 | DOI:10.1007/s11596-025-00160-x

Radiol Med. 2026 Jan 8. doi: 10.1007/s11547-025-02170-0. Online ahead of print.

ABSTRACT

PURPOSE: This meta-analysis evaluates the diagnostic performance of computed tomography (CT)-based artificial intelligence (AI) models versus radiologists for preoperative microvascular invasion (MVI) detection in hepatocellular carcinoma (HCC).

METHODS: A systematic literature search was conducted in PubMed, Embase, and Web of Science to identify studies published up to February 2025 focusing on the diagnostic accuracy of CT-based AI models for the preoperative detection of MVI in HCC, compared with the diagnostic performance of radiologists. A bivariate random-effects model was employed to calculate the pooled sensitivity, specificity, and area under the curve (AUC), all presented with 95% confidence intervals (CIs). Heterogeneity among studies was assessed using the I² statistic. The methodological quality of included studies was evaluated using a modified version of the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool.

RESULTS: Of 918 identified studies, 32 studies with 3,709 cases were included. For the internal validation set, the pooled sensitivity, specificity, and AUC for detecting MVI in HCC were 0.83 (95% CI 0.79-0.87), 0.81 (95% CI 0.76-0.86), and 0.89 (95% CI 0.86-0.92), respectively. Radiologists achieved a sensitivity of 0.82 (95% CI 0.63-0.93), specificity of 0.65 (95% CI 0.45-0.81), and AUC of 0.80 (95% CI 0.77-0.84).

CONCLUSIONS: CT-based AI may have the potential to outperform radiologists in predicting MVI in HCC. However, existing evidence is limited by study heterogeneity and limited number of the direct comparison between AI and radiologists. Prospective multicenter studies are needed to validate its clinical utility.

PMID:41505041 | DOI:10.1007/s11547-025-02170-0

Eur Phys J E Soft Matter. 2026 Jan 8;49(1-2):1. doi: 10.1140/epje/s10189-025-00544-w.

ABSTRACT

This work investigates chiral particles, which break mirror symmetry, in turbulent Taylor-Couette flow. These particles generally display a translation-rotation coupling moving through a quiescent fluid. Here, we performed experiments using large chiral particles (typical size 5mm) in turbulent Taylor-Couette flow, for Reynolds numbers $9·{10}^3\le \text{Re}\le 1.5·{10}^5$ . The density-matched chiral particles are studied in a dilute regime $(\varphi =1.7·{10}^{–4})$ , where their location and orientation are tracked over time to investigate the particle-fluid coupling. We investigate whether the translation-rotation coupling observed at low Reynolds numbers is still observable over the measured high Reynolds numbers, using the tracked location and orientation. Similarly, we verify whether the chiral particles display a preferred location or orientation, and whether the left-handed and right-handed particles show different rotation statistics. The location data show that the chiral particles closely follow the structure of Taylor vortices. Hence, the orientation data and rotation data of the chiral particles are split between the Taylor vortices and particle chiralities. The results show no difference in rotation and orientation dynamics between chiralities. Rather, the particle dynamics are flow-dominated, where the flow vorticity determines the specific particle dynamics.

PMID:41505007 | DOI:10.1140/epje/s10189-025-00544-w

Arch Osteoporos. 2026 Jan 8;21(1):20. doi: 10.1007/s11657-025-01635-z.

ABSTRACT

In the U.S’s largest integrated health system, during a 24-year period (1999-2022), bisphosphonate treatment initiation for fracture prevention in men shifted towards higher-risk populations, including older men and those with prior fracture and frailty.

PURPOSE: To evaluate 24-year trends in bisphosphonate (BP) initiation among older U.S. male Veterans and shifts in demographic and clinical characteristics of BP-treated men over time.

METHODS: U.S. national Veterans Health Administration (VHA) data (1999-2022) were queried to identify men aged ≥ 50 years with a first prescription for an FDA-approved BP for fracture prevention. Age, race, ethnicity, BP drug and route, prior fracture, and, in those aged ≥ 65 years, Veterans Affairs Frailty Index (VA-FI), were examined across five time periods. Temporal trends were analyzed using chi-square and nonparametric trend tests.

RESULTS: A total of 298,340 men initiated a BP during 1999-2022, of whom 233,857 (78.4%) were aged ≥ 65 years. BP initiation rose sharply after FDA approval of BPs for men in 2000, peaked in 2004-2005, then declined by about 50% between 2006 and 2012, and then plateaued. Over time, the proportion of BP initiators aged < 65 years declined from a peak of 28.2% during the middle time period (2008-2012) to a nadir of 13.3% during the final years (2018-2022, p < 0.001 for trend). Among the subset of men age 65 and older who initiated BP, the proportion with prior fracture increased from 8.3% in 1999-2002 to 24.5% in 2018-2022 (p < 0.001). Notably, over half of the men who initiated BP during 1999-2002 were classified as non-frail, whereas in the most recent time period (2018-2022), over half of BP initiators were frail (mildly, moderately, or severely) and only 14.8% of them were non-frail (p < 0.001).

CONCLUSION: In the VHA, BP initiating patterns shifted over time towards treating older men, with much larger proportions of men who had a prior fracture and were classified as frail.

PMID:41504976 | DOI:10.1007/s11657-025-01635-z