Nevin Manimala

JAMA Netw Open. 2026 Jun 1;9(6):e2619372. doi: 10.1001/jamanetworkopen.2026.19372.

ABSTRACT

IMPORTANCE: Digital health services are expanding, yet community readiness for digital care varies widely. Without a validated, granular measure of readiness, health systems and policymakers cannot reliably enable targeted support or monitor equitable deployment.

OBJECTIVE: To develop and validate a reproducible census tract-level index of community digital health readiness integrating socioeconomic conditions, access to care, and digital connectivity.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional index development and validation study analyzed public data from 2018 to 2022. The Digital Health Index (DHI) was constructed from 21 indicators with equal weighting representing 3 domains: socioeconomic, health access, and connectivity. Content validity was assessed using a 2-round Delphi panel including 37 experts. Structural validity was assessed with exploratory and confirmatory factor analyses. Convergent validity was assessed against the Social Vulnerability Index (SVI), Area Deprivation Index (ADI), and Digital Divide Index (DDI). External validity was assessed using health care spending. Robustness was assessed using leave-one-out, weight-perturbation, and group-based cross-validation analysis. Data were analyzed between June 2023 and April 2026.

MAIN OUTCOMES AND MEASURES: Primary outcomes were validation metrics, including factor structure fit indices, correlations with established indices, association with health care spending per capita, and Delphi consensus rates for each indicator. Robustness outcomes included stability of tract rankings under indicator removal or weight changes.

RESULTS: The DHI was computed for 85 396 US census tracts across all 50 states. DHI scores correlated with SVI, ADI, and DDI scores (Spearman ρ = 0.61-0.84) but prioritized different low-readiness communities, with only 33% to 44% overlap between tracts in the highest DHI decile and those in the highest SVI, ADI, or DDI deciles. Health care spending showed similar inverse associations across indices. DHI rankings remained stable in sensitivity analyses. All 21 indicators met Delphi consensus criteria after 1 or 2 rounds.

CONCLUSIONS AND RELEVANCE: In this cross-sectional index development and validation study, a reproducible measure of community digital health readiness was constructed at the census tract level, integrating socioeconomic, access, and connectivity factors. The DHI may help health systems, public agencies, and researchers identify communities requiring support and track readiness over time as digital health and artificial intelligence initiatives expand.

PMID:42313384 | DOI:10.1001/jamanetworkopen.2026.19372

JAMA Netw Open. 2026 Jun 1;9(6):e2619396. doi: 10.1001/jamanetworkopen.2026.19396.

ABSTRACT

IMPORTANCE: Maternal mental health disorders are among the leading causes of maternal morbidity and mortality. In the US, the 2022 Supreme Court decision in Dobbs v. Jackson Women’s Health Organization and ensuing state-level abortion restrictions have raised concerns that such policies may worsen maternal health and mental health outcomes.

OBJECTIVE: To examine the association of the implementation of Texas Senate Bill 8 (SB8) abortion law, which banned abortions after embryonic cardiac activity in September 2021, with maternal mental health outcomes.

DESIGN, SETTING, AND PARTICIPANTS: This repeated cross-sectional study used a difference-in-differences (DiD) design with pooled data from the 2016 to 2023 National Survey of Children’s Health. The nationally representative sample included US mothers aged 18 to 49 years who lived with at least 1 child aged 0 to 17 years. Data were analyzed from April to October 2025.

EXPOSURE: Mothers residing in Texas represented the treatment group, and mothers in states without abortion bans (Alaska, Arizona, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Kansas, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, Vermont, Virginia, Washington, and Wyoming) served as the control group.

MAIN OUTCOMES AND MEASURES: The primary outcome was mothers’ self-reported fair or poor mental and emotional health. Logistic regression models, adjusted for child-, mother-, and household-level characteristics, were used to estimate changes in the probability of mental health outcomes for mothers coinciding with SB8 implementation. Similar models were estimated with maternal physical health and fathers’ mental health as outcomes for sensitivity analyses.

RESULTS: The sample included 4323 mothers in Texas (47.2% [95% CI, 45.1%-49.4%] aged 30-39 years) and 152 573 mothers in nonban states (47.1% [95% CI, 46.4%-47.7%] aged 30-39 years). Compared with mothers in nonban states, those in Texas experienced a statistically significant increase in the likelihood of reporting fair or poor mental health following SB8’s implementation (DiD estimate, 2.52 percentage points; 95% CI, 0.02-5.01 percentage points). The largest increases were observed among mothers of children with public insurance (DiD estimate, 7.06 percentage points; 95% CI, 0.83-13.29 percentage points). No significant outcomes were observed for mothers’ physical health outcomes or fathers’ mental health in the sensitivity analyses.

CONCLUSIONS AND RELEVANCE: In this repeated cross-sectional study, the implementation of an abortion ban in Texas was associated with a worsening of maternal mental health among reproductive-age mothers relative to mothers in states without such bans. These results underscore the association of abortion restrictions with maternal mental health and highlight the need to strengthen support in the post-Dobbs policy environment.

PMID:42313383 | DOI:10.1001/jamanetworkopen.2026.19396

JAMA Netw Open. 2026 Jun 1;9(6):e2619402. doi: 10.1001/jamanetworkopen.2026.19402.

ABSTRACT

IMPORTANCE: Syringe service programs (SSPs) deliver evidence-based harm reduction interventions to persons who inject drugs to reduce morbidity and mortality in this population, including syringe exchange, naloxone distribution, linkage to medications for opioid use disorder, and other services. In July 2025, a federal executive order threatened federal support for SSPs in the US.

OBJECTIVE: To estimate the potential long-term outcomes of halting federal funding for SSPs.

DESIGN, SETTING, AND PARTICIPANTS: This decision analytical model study used a closed cohort microsimulation model of the natural history of injection drug use and health outcomes among persons who inject drugs in the US from August 1, 2025, to August 2030. The model was populated with data from the Centers for Disease Control and Prevention’s National HIV Behavioral Surveillance system and published data to create representative cohorts of persons who inject drugs nationwide.

EXPOSURE: Cases in which total funding for SSPs was reduced by 11% and 80% were modeled. Within each case, 3 potential scenarios related to federal funding disruptions due to an executive order threatening funding for SSPs were modeled: (1) funding disruptions remain in place for 5 years, through August 2030; (2) funding returns to previous levels after 1 year, in August 2026; and (3) funding returns to 100% of previous levels in January 2029.

MAIN OUTCOMES: The primary outcome was 5-year all-cause and overdose mortality and nonfatal overdoses.

RESULTS: In a hypothetical study population of 3 694 500 persons who inject drugs (57.0% male; mean [SD] age, 49.5 [17.5] years), all-cause mortality increased by 0.1% (95% credible interval [CrI], 0-0.2%) to 5.0% (95% CrI, 0-0.8%), overdose mortality increased by 0.2% (95% CrI, -0.1% to 0.4%) to 6.9% (95% CrI, -4.3% to 14.4%), and nonfatal overdoses decreased by 0.1% (95% CrI, -0.2% to 0) to 4.2% (95% CrI, -7.8% to 0.1%) during 5 years across all scenarios. The worst-case scenario, in which there was sustained high levels of service disruption, resulted in 39 600 additional deaths and 15 600 additional overdose deaths among persons who inject drugs in the US. All-cause mortality and overdose mortality increased in most sensitivity analyses.

CONCLUSIONS AND RELEVANCE: In this decision analytical model study estimating the effects of reducing federal funding for SSPs, the findings suggest that mortality will increase among persons who inject drugs during the 5 years after loss of funding. Future studies are needed to understand clinical effects of funding changes.

PMID:42313382 | DOI:10.1001/jamanetworkopen.2026.19402

JAMA Netw Open. 2026 Jun 1;9(6):e2619409. doi: 10.1001/jamanetworkopen.2026.19409.

ABSTRACT

IMPORTANCE: Mild traumatic brain injury (mTBI) is associated with greater risk of musculoskeletal injury (MSKI). However, it is unclear whether mTBI is associated with risk of subsequent MSKI among US service members (SMs) with extended follow-up and whether this varies between male and female individuals.

OBJECTIVE: To test the association of mTBI with subsequent MSKI in a large study population of SMs with extended follow-up.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study included SMs with mTBI and propensity score-matched controls who joined between 2016 and 2020 across all branches of the US military and had medical record data until 2023. Data were analyzed from December 2024 to October 2025.

EXPOSURE: Medical record-derived mTBI.

MAIN OUTCOME AND MEASURES: mTBIs and MSKI events were identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes. To test associations of mTBI with subsequent overall MSKI, Cox proportional hazards and Aalen additive hazards models were fit to estimate relative and absolute effect sizes, respectively. Testing was completed for moderation by sex. All models were adjusted for demographic and military-relevant characteristics.

RESULTS: The mean (SD) age of the 26 784 participants (13 392 with mTBI and 13 392 controls without mTBI) was 20.0 (2.8) years, and 4585 (17.1%) were female. During 34 156 person-years of follow-up, there were 14 330 MSKI events. Compared with no mTBI, mTBI was associated with a greater hazard of subsequent MSKI (hazard ratio [HR], 2.24; 95% CI, 2.16-2.32). On the absolute scale, mTBI, compared with no mTBI, was associated with an additional 258 MSKI events per 100 000 person-days (Aalen additive hazard = 2.58 × 10-3; SE, 1.17 × 10-6). Although there was no significant interaction in associations of mTBI with subsequent MSKI by sex (P for interaction = .37), mTBI was associated with greater hazard of MSKI in models among female SMs only (HR, 2.28; 95% CI, 1.92-2.70), and in models among male SMs only (HR, 2.20; 95% CI, 2.11-2.29).

CONCLUSIONS AND RELEVANCE: In this cohort study of US SMs, mTBI was associated with greater hazard of subsequent MSKI on the relative and absolute scales. Female SMs had a greater hazard of MSKI, but there was no significant moderation by sex for associations between mTBI and MSKI. Findings can inform patient counseling on MSKI risk following mTBI.

PMID:42313381 | DOI:10.1001/jamanetworkopen.2026.19409

Ophthalmic Physiol Opt. 2026 May;46(2):355-365. doi: 10.1007/s44402-026-00038-y. Epub 2026 Mar 2.

ABSTRACT

PURPOSE: Many reports in the literature have proposed the use of percentile curves for tracking ocular growth and monitoring myopic development. Recently, this practice has been criticised, particularly its inability to accurately track myopia onset and progression due to the inclusion of multiple refractive groups. This work assesses the validity of this criticism and proposes corrected curves tailored to specific refractive development trajectories.

METHODS: The longitudinal biometric data of 1999 Chinese schoolchildren (10,766 measurements) in the Anyang Childhood Eye Study were analysed. Children were categorised into emmetropic and myopic subgroups based on the progression of their cycloplegic spherical equivalent (SE) refractive error. Percentile curves were generated for the axial length (AL), axial growth (dAL), axial length/corneal radius (AL/CR) ratio and cycloplegic SE using the Lambda-Mu-Sigma (LMS) method, stratified by sex and refractive group.

RESULTS: Distinct percentile curves for emmetropic and myopising eyes revealed significant differences compared with traditional population-based curves, confirming that whole-population curves underestimate myopia risk and overestimate treatment effects. Girls demonstrated greater myopic progression and axial elongation than boys. SE percentile curves, stratified by age of myopia onset, were presented to estimate progression trajectories.

CONCLUSION: This study presents percentile curves for ocular biometry and refractive error to enhance the ability to detect early myopic changes and monitor myopia control interventions. Recommendations include using SE curves based on cycloplegic refraction as the primary reference, developing sex- and region-specific models and avoiding reliance on AL alone.

PMID:42313375 | DOI:10.1007/s44402-026-00038-y

Ophthalmic Physiol Opt. 2026 May;46(2):252-260. doi: 10.1007/s44402-026-00033-3. Epub 2026 Feb 27.

ABSTRACT

INTRODUCTION: The Spanish Low Vision Quality of Life Questionnaire (SLVQOL) assesses vision-related quality of life effectively but requires significant administration time. This study aimed to develop and validate a psychometrically robust short-form version (SF-SLVQOL) using Rasch analysis to reduce respondent burden while maintaining measurement precision in Spanish-speaking populations with visual impairment.

METHODS: Data from the original SLVQOL validation study (n = 365; 170 visually impaired, 195 controls) were reanalysed using Partial Credit Model analysis in WINSTEPS. Items were systematically reduced through iterative removal based on point-biserial correlations (< 0.4) and misfit statistics (infit/outfit outside 0.7-1.3). The resulting SF-SLVQOL was evaluated for structural validity (unidimensionality, local independence, monotonicity), internal consistency (Cronbach’s alpha), criterion validity (correlation with original SLVQOL), construct validity (convergent validity with NEI VFQ-25, known-groups validity across ICD-11 visual impairment categories), differential item functioning by gender and test-retest reliability.

RESULTS: The 6-item SF-SLVQOL demonstrated excellent unidimensionality (essential unidimensionality = 93.6%, variance explained = 79.3%), optimal internal consistency (α = 1.00) and high criterion validity (r = 0.95 with original SLVQOL). Convergent validity with the NEI VFQ-25 was confirmed (r = 0.69). The known-groups analysis showed significant discrimination between visual impairment levels (H = 132.67, p < 0.001). Person reliability (0.91) indicated the ability to distinguish 4.3 performance levels. Test-retest reliability was acceptable (ICC = 0.753; 95% CI: 0.569-0.864) with a repeatability limit of 4.89 points.

CONCLUSION: The SF-SLVQOL successfully reduces administration time by 76% while maintaining robust psychometric properties, offering clinicians and researchers an efficient tool for assessing vision-related quality of life in Spanish-speaking populations.

PMID:42313373 | DOI:10.1007/s44402-026-00033-3

J Prev (2022). 2026 Jun 18. doi: 10.1007/s10935-026-00924-8. Online ahead of print.

ABSTRACT

Cochrane reviews provide high-quality evidence syntheses. To guide the production and dissemination of new Cochrane reviews, an evidence map based on the characteristics of existing reviews is necessary. This study is a scoping review that aimed to create an evidence map of Cochrane reviews on nutrition and physical activity (PA) in healthy and at-risk populations, describe stakeholder involvement in review production and assess the dissemination of these reviews. This scoping review follows a registered protocol and adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA ScR) guideline. Eligible studies were Cochrane reviews on nutrition and PA for healthy and at-risk populations that were identified in the Cochrane Database of Systematic Reviews through to 22 January 2026 and selected independently by two researchers from 2043 search hits. Extracted data included bibliographic, population, and intervention or concept characteristics, information on stakeholder involvement in review production and open-access Altmetric data on the online and scientific attention towards Cochrane reviews. Data were processed into meaningful categories and synthesised using descriptive statistics. The included Cochrane reviews (n = 260) were published between 1999 and 2026. Review focus was on nutrition (n = 193, 74%), PA (n = 39, 15%), and nutrition + PA (n = 28, 11%). Most reviews included any populations by age and sex (n = 52, 20%) or specific populations by age (adults: n = 62, 24%; children: n = 54, 21%; and child-caregiver dyads: n = 50, 19%). The interventions or concepts were predominantly non-digital (n = 230, 88%), included mainly nutrition components (e.g. supplementation: n = 104, 40%; diet: n = 68, 26%), and were conducted in any unspecified settings (e.g. community, population; n = 226, 87%). The outcomes were mainly disease-related (e.g. disease prevention and risk factor reduction; n = 129, 50%) and reproductive (e.g. maternal and child health promotion; n = 56, 22%). There were less or no reviews with the following characteristics: (1) populations of older adults and males, (2) interventions or concepts with digital modality and with components targeting PA promotion, behaviour change, and other factors (e.g. policy), (3) specific settings (e.g. vulnerable, organisational), (4) outcomes targeting general health promotion and psychosocial (e.g. behavioural, cognitive, and mental) functioning. Involvement of various stakeholders (e.g. consumers, clinicians, and advisory boards) was reported in the production of 32% of Cochrane reviews. Online attention was highest for reviews with nutrition components (i.e. supplementation and diet) while scientific attention was highest for reviews with mixed components (i.e. PA and supplementation). New Cochrane reviews on nutrition and PA need to target specific populations (especially older adults and males) and settings, assess digital interventions or concepts, and focus on components and outcomes targeting physical and mental health promotion. Stakeholder involvement in review production and online and scientific attention could be further promoted to potentially improve review uptake in practice.

PMID:42313345 | DOI:10.1007/s10935-026-00924-8

J Interv Card Electrophysiol. 2026 Jun 18. doi: 10.1007/s10840-026-02361-3. Online ahead of print.

ABSTRACT

BACKGROUND: Esophageal injury following radiofrequency ablation for atrial fibrillation is closely associated with esophageal temperature. Studies suggest that discontinuous ablation may prevent excessive esophageal temperature rise; however, the temperature characteristics of discontinuous ablation strategy during ultra-high-power short-duration ablation remain unexplored.

METHODS: Fresh porcine cardiac tissue was used. A 15-mm deep vertical hole was drilled from the endocardial surface, and a temperature probe was inserted. The QDOT catheter (Biosense Webster) was positioned at the endocardial site of probe insertion, and the lesion was created using a 90 W, 4-s ablation strategy. After a predefined interval, a second lesion was created.Based on the inter-lesion time interval, samples were divided into four groups: 10 s (group 1), 20 s (group 2), 40 s (group 3), and 60 s (group 4). Temperature was recorded every 10 s.

RESULTS: Temperature curves in groups 1 and 2 exhibited a unimodal pattern, whereas groups 3 and 4 showed a bimodal pattern. Mean peak temperatures differed among groups: group 1, 39.1 °C (38.6-39.5 °C); group 2, 38.4 °C (38.0-38.7 °C); group 3, peak 38.0 °C (37.5-38.2 °C) with a sub-peak of 37.3 °C (37.1-37.5 °C); group 4, peak 37.8 °C (37.5-38.0 °C) with a sub-peak of 37.3 °C (36.9-37.6 °C). Peak temperatures differed significantly among groups (P < 0.0001). Analysis of repeated temperature measurements revealed a statistically significant between-groups effect (F = 7.2, P < 0.002). Using < 38.5 °C as a safety threshold for peak temperature, 8 cases (73.3%) in group 1 exceeded the threshold, 4 cases (27%) in group 2 reached the threshold, whereas neither group 3 nor group 4 exceeded it.

CONCLUSION: Tissue temperature demonstrates significant delayed and cumulative effects during ultra-high-power short-duration ablation. In our ex vivo model, longer inter-lesion intervals were associated with a more gradual temperature rise.

PMID:42313340 | DOI:10.1007/s10840-026-02361-3

J Appl Genet. 2026 Jun 18. doi: 10.1007/s13353-026-01079-2. Online ahead of print.

ABSTRACT

The mrk operon gene clusters encode type 3 fimbriae, involving in biofilm formation. Hence, we aimed to find out the distribution of mrk genes among uropathogenic Klebsiella pneumoniae (UPKP) strains. Moreover, mrk genes, hypermucoviscosity (HMV) characteristic and antimicrobial resistance (AMR) patterns and profiles were successfully, provided. From August 2023 to January 2024, 104 positive urine samples were collected. Standard microbiological and biochemical tests were employed to confirm the UPKP strains. Kirby-Bauer disc diffusion method was recruited to conduct antimicrobial susceptibility test (AST). The HMV characteristic in UPKP isolates was assessed using the string test. Finally, multiplex polymerase chain reaction (mPCR) was used to identify mrk genes distribution. Chi-square (χ²) and Fisher’s exact tests were utilized for statistical analysis. The mrk gene distribution varied among the UPKP isolates comprising mrkA (1.92%), mrkB (0.00%), mrkC (5.77%), mrkD (23.08%), mrkE (37.50%), and mrkF (83.65%). No mrk genes were detected among 13.46% (14/104) of UPKP isolates. The most common mrk gene patterns involved mrkF (32.70%), mrkE-mrkF (25.00%), and mrkD-mrkF (11.54%). In addition, the isolates exhibited diverse AMR profiles and phenotypes including: 65 multi-drug resistant (MDR) strains (nine groups, 42 patterns), 13 extensively drug-resistant (XDR) strains (nine patterns), nine pan drug-resistant (PDR) strains, 23 ESBL producers, and nine HMV isolates. None of the HMV strains displayed XDR, PDR, or ESBL phenotypes, suggesting limited horizontal gene transfer (HGT). Detailed analysis of mrk genes and AMR characteristics in UPKP, provides essential information for selecting effective prevention protocols and treatments for urinary tract infections (UTIs) and combating AMR.

PMID:42313334 | DOI:10.1007/s13353-026-01079-2

Wien Med Wochenschr. 2026 Jun 18. doi: 10.1007/s10354-026-01165-4. Online ahead of print.

ABSTRACT

BACKGROUND: Chikungunya virus (CHIKV) is an arthropod-borne virus belonging to the genus Alphavirus; it has been increasingly linked to neurological complications. This study aimed to highlight the neurological manifestations of chikungunya virus infection.

METHODS: This retrospective case series was conducted at the Aga Khan University Hospital, Karachi, Pakistan. Adult patients (aged 18 years and above) with typical arboviral prodrome (fever, arthralgias, myalgias) who tested positive for chikungunya IgM antibodies in serum and demonstrated new-onset neurological symptoms were included in the study. The sample size consisted of 18 patients. Descriptive statistics were used to demonstrate demographics and the clinical, radiological, and electrodiagnostic details of participants. Patients with neuro-chikungunya were trichotomized based on the extent of neuroaxis involvement into those with central nervous system (CNS) involvement, those with CNS and peripheral nervous system (PNS) involvement, and those with isolated PNS involvement.

RESULTS: This study found heterogenous nervous system involvement in chikungunya virus infection, including the brain, spinal cord, nerve roots, and peripheral nerves in variable combinations. The majority of patients in this cohort had CNS involvement (55%). Patients with widespread neuroaxis involvement tended to have a complicated hospital course leading to intensive care unit admission and even mortality.

CONCLUSION: The widespread neurological involvement seen in this study potentially points towards the possibility that chikungunya virus may affect the entire neuroaxis. Studies focusing on long-term sequelae are needed to ascertain the prognosis of neuro-chikungunya.

PMID:42313329 | DOI:10.1007/s10354-026-01165-4