Nevin Manimala

JAMA Health Forum. 2026 Mar 6;7(3):e260136. doi: 10.1001/jamahealthforum.2026.0136.

ABSTRACT

IMPORTANCE: Income is a key social determinant of health, yet its influence on health system performance may differ across settings. Cross-national comparisons can help identify where income-related disparities are most pronounced and inform targeted policy responses; the US and South Korea are 2 members of the Organisation for Economic Co-operation and Development with high poverty rates but different health systems.

OBJECTIVE: To compare health system performance and income-related inequalities in health system performance between the US and South Korea.

DESIGN, SETTING, AND PARTICIPANTS: This repeated cross-sectional study including nationally representative samples of noninstitutionalized adults from the US and South Korea used data from the Medical Expenditure Panel Survey (MEPS; 2010-2019), National Health and Nutrition Examination Survey (NHANES; 2009-2018), Korean Health Panel Study (KHPS; 2010-2019), and Korean National Health and Nutrition Examination Survey (KNHANES; 2010-2019). Data were analyzed from March 2024 to March 2025.

EXPOSURES: Annual household income, categorized into country-specific deciles.

MAIN OUTCOMES AND MEASURES: The main outcomes were 30 indicators across 6 domains: health care spending, health care utilization, access to care, health status, behavioral risk factors, and clinical outcomes. To evaluate income-related inequalities in outcomes, adjusted mean values across income deciles were estimated using regression models.

RESULTS: The sample included 224 168 US adults (female: 51.1% in MEPS, 51.7% in NHANES) and 179 452 South Korean adults (female: 52.4% in KHPS, 56.1% in KNHANES). Mean (SD) age was 46.6 (18.0) years in MEPS, 46.5 (17.4) years in NHANES, 47.7 (16.2) years in KHPS, and 50.5 (17.1) years in KNHANES. US adults had higher mean total health care spending (lowest income decile: $7852 [95% CI, $7456-$8247]; highest decile: $6510 [95% CI, $6218-$6802]) than South Korean adults (lowest decile: $1184 [95% CI, $1105-$1263]; highest decile: $1025 [95% CI, $950-$1100]) despite similar levels of self-reported good health. A 1-decile increase in income was associated with a difference of -$142 (95% CI, -$179 to -$104) in total health care spending in the US compared with -$33 (95% CI, -$41 to -$25) in South Korea. A 1-decile increase in income was associated with an increase of 2.4 (95% CI, 2.3-2.5) percentage points (pp) in self-reported good health in the US compared with 1.5 (95% CI, 1.4-1.6) pp in South Korea. Income-related disparities in preventive service use were also larger in the US, ranging from 0.2 (95% CI, 0.2-0.2) pp for cervical cancer screening to 4.0 (95% CI, 3.9-4.1) pp for dental checkups. In South Korea, disparities ranged from 0.6 (95% CI, 0.4-0.8) pp for dental checkups to 2.0 (1.8-2.2) pp for routine checkups. Similar income gradients were observed in access to care and behavioral risk factors. Differences in clinical outcomes were modest in both countries.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, income was associated with disparities in health system performance in both the US and South Korea, with larger differences by income in the US. The findings suggest that structural and systemic policy efforts are needed to address income-based health inequalities, particularly in the US.

PMID:41860537 | DOI:10.1001/jamahealthforum.2026.0136

Hum Vaccin Immunother. 2026 Dec;22(1):2640760. doi: 10.1080/21645515.2026.2640760. Epub 2026 Mar 20.

ABSTRACT

Human papillomavirus (HPV)-associated cancers represent a substantial public health burden. This study analyzed the national burden of hospitalization and mortality from HPV-associated cancers in Brazil between 2011 and 2019. Outcomes included average annual numbers, crude and age-standardized rates per 100,000 population, and trends estimated via joinpoint regression for cervical, vulvar, vaginal, penile, anal, and head and neck cancers (oropharynx, larynx, and oral cavity). Between 2011 and 2019, HPV-attributable cancers accounted for an average of 29,155 hospitalizations (14.3 per 100,000) and 7526 deaths (3.7 per 100,000) annually across both sexes. Among females, there were an average of 24,921 hospitalizations (24.0 per 100,000) and 6430 deaths annually, largely driven by cervical cancer. Among males, there were an estimated 4234 HPV-attributable hospitalizations and 1096 deaths per year (4.1 and 1.1 per 100,000, respectively), with penile, anal, and oropharyngeal cancers being the largest contributors. Cervical cancer accounted for 74.3% of HPV-attributable hospitalizations, followed by anal (10.4%), head and neck (9.2%), and penile cancers (3.4%). Most HPV-associated cancers showed stable hospitalization and mortality trends over time. For cervical cancer, hospitalizations rose by 3.9% annually between 2016 and 2019, while mortality rose by 0.7% annually over the entire period. Anal cancer showed significant increases in both hospitalizations (AAPC = 3.1%) and mortality (AAPC = 10.9%). These findings underscore the need for continued efforts to prevent and reduce the burden of HPV-associated cancers in Brazil, including expanded cohort vaccination, consideration of higher-valency vaccines, and improved access to early detection and timely treatment for both sexes.

PMID:41860526 | DOI:10.1080/21645515.2026.2640760

J Am Dent Assoc. 2026 Mar 20:S0002-8177(26)00101-7. doi: 10.1016/j.adaj.2026.02.001. Online ahead of print.

ABSTRACT

BACKGROUND: Intraoral radiograph machines have evolved over the past century, but their design, especially the collimator, has changed little. Although circular collimation is easier to use, it exposes the patient to more radiation. Rectangular collimation reduces this dose by 50% through 60% but increases the risk of experiencing positioning errors. The authors aimed to determine whether the radioprotection benefits outweigh the technical disadvantages.

METHODS: This retrospective study included intraoral radiographs obtained by dental students with both standard circular collimation and rectangular collimation. Two independent blinded evaluators analyzed the radiographs to identify all types of errors and retakes.

RESULTS: The rates of cone cuts and cone cuts requiring retakes were 20.9% and 5.7%, respectively, with rectangular collimation. These rates were substantially higher than with circular collimation (1.8% and 0.7%, respectively). The differences in the proportion of retakes due to cone cuts between rectangular collimation (27.2%) and circular collimation (36.0%) were not statistically significant. Moreover, the overall retake rate was not significantly different between rectangular collimation (16.9%) and circular collimation (16.7%) (P = .922).

CONCLUSIONS: The number of retakes was not significantly higher with rectangular collimation, despite a significant increase in cone cuts. It should be recommended that clinicians with proper training use this type of collimation in conjunction with a positioning device due to the considerable reduction in radiation exposure.

PRACTICAL IMPLICATIONS: Special attention must be paid to cone positioning and clinical training to fully benefit from the radioprotective advantages of rectangular collimation.

PMID:41860525 | DOI:10.1016/j.adaj.2026.02.001

J Allergy Clin Immunol. 2026 Mar 20:S0091-6749(26)00173-9. doi: 10.1016/j.jaci.2026.02.035. Online ahead of print.

NO ABSTRACT

PMID:41860512 | DOI:10.1016/j.jaci.2026.02.035

JACC Heart Fail. 2026 Mar 19:103013. doi: 10.1016/j.jchf.2026.103013. Online ahead of print.

NO ABSTRACT

PMID:41860507 | DOI:10.1016/j.jchf.2026.103013

JACC Clin Electrophysiol. 2026 Mar 16:S2405-500X(26)00109-X. doi: 10.1016/j.jacep.2026.01.035. Online ahead of print.

ABSTRACT

BACKGROUND: Cardiac implantable electronic device (CIED) infection represents a significant cause of morbidity and increased health care costs in patients undergoing high-risk procedures.

OBJECTIVE: This study sought to describe the incidence of infection using two prevention strategies: chlorhexidine gluconate (CHG) pocket irrigation vs antibacterial envelope (ABE).

METHODS: In this retrospective observational study, patients undergoing high-risk CIED interventions (generator change, device upgrade, lead/pocket revision, cardiac resynchronization device implantation) between 2018 and 2024, in whom either CHG irrigation or ABE was used, were included. Propensity score matching using baseline and procedural characteristics (age, sex, previous infection, intervention within 60 days, type of device, type of intervention, PADIT [Prevention of Arrythmia Device Infection Trial] score, antibiotic used) was performed.

RESULTS: A total of 1,749 patients (median age 73 years [Q1-Q3: 63-81 years], female 42%; CHG: n = 1,118) were included. After a median follow-up of 459 days (Q1-Q3: 192-852 days), there were no statistically significant differences in the risk of CIED-related infection (0.8% vs 0.8%; HR: 0.89; 95% CI: 0.3-2.66; log-rank P = 0.83) between the CHG and ABE groups. After propensity score matching, a total of 714 patients, without statistically significant differences in baseline characteristics, were analyzed. There were no significant differences in the risk of CIED-related infection (1.1% vs 1.1%; HR: 0.97; 95% CI: 0.24-3.86, log-rank P = 0.96). No adverse events associated with CHG irrigation occurred.

CONCLUSIONS: In high-risk procedures, CHG irrigation resulted in a similar risk of CIED-related infection as treatment with an ABE, without any adverse events. The lower cost of CHG and widespread availability could result in more patients being treated, thus extending the benefits to patients with a lower risk of infection.

PMID:41860497 | DOI:10.1016/j.jacep.2026.01.035

Biometrics. 2026 Jan 6;82(1):ujag047. doi: 10.1093/biomtc/ujag047.

ABSTRACT

The analysis of covariance (ANCOVA) is a commonly used method for correcting bias and improving accuracy in estimating the average treatment effect in randomized clinical trials. In this paper, we focus on using ANCOVA for longitudinal outcomes, where mixed effects regression is the standard approach. The effectiveness of ANCOVA depends on the regression model specification, including how the baseline covariates were used. Unlike traditional methods, we do not assume that the mixed effects model is correctly specified, making our approach nonparametric in nature. We investigate the optimal ANCOVA approach for longitudinal outcomes and show that appropriate covariate adjustment can greatly improve the precision of treatment effect estimates. Unfortunately, determining the optimal ANCOVA adjustment is challenging because it relies on the relationship between longitudinal outcomes and baseline covariates, which is typically unknown. We propose to use cross fitting procedure to estimate the conditional expectation of longitudinal outcomes given baseline covariates to guide the specification of ANCOVA. We provide theoretical derivations and empirical evidence from numerical studies to demonstrate the superiority of our proposed nonparametric ANCOVA method over traditional ANCOVA approaches. Our approach is robust, flexible, and can be easily implemented in practice to improve the accuracy and reliability of treatment effect estimates in clinical trials.

PMID:41860475 | DOI:10.1093/biomtc/ujag047

Mol Nutr Food Res. 2026 Mar;70(6):e70437. doi: 10.1002/mnfr.70437.

ABSTRACT

The diet-PCOS relationship remains complex and requires further investigation. Among 1424 participants (12.3% suspected PCOS), dietary patterns were evaluated using NIH criteria via FFQ: exploratory factor analysis (EFA), EAT-Lancet dietary pattern (EAT-LDP), Mediterranean, plant-based indices. EFA identified four patterns: plant-forward (PFD), animal-protein (APD), red and organ meat (ROM), and fast-food (FFD). Multivariable logistic regression, adjusted for age, BMI, education attainment, marriage situation, physical activity status, frequency of ordering takeout, depression, anxiety and stress, showed: compared to the lowest adherence group, the highest APD quartile was associated with a higher prevalence of suspected PCOS (OR = 2.20, 95% CI: 1.42-3.41, P < 0.001); the highest EAT-LDP quartile was correlated with a lower prevalence of suspected PCOS (OR = 0.40, 95% CI: 0.16-0.83, P < 0.05). Mediterranean scores ≥5 are positively associated with suspected PCOS (score 5: OR = 1.63, 95% CI: 1.09-2.44; score >5: OR = 1.89, 95% CI: 1.23-2.89, both P < 0.05), while scores ≤4 are negatively associated with suspected PCOS (OR = 0.57, 95% CI: 0.33-0.95, P < 0.05). Plant-based indices showed no significant associations with suspected PCOS. Higher adherence to the EAT-LDP, lower adherence to the APD, and moderate adherence to the Mediterranean diet are associated with a reduced prevalence of suspected PCOS. Large-scale cohort studies are needed to confirm these findings and establish causality.

PMID:41860448 | DOI:10.1002/mnfr.70437

Nephrol Dial Transplant. 2026 Mar 20:gfag065. doi: 10.1093/ndt/gfag065. Online ahead of print.

ABSTRACT

BACKGROUND AND HYPOTHESIS: Primary membranous nephropathy (MN) and diabetes mellitus (DM) are common comorbidities, yet the impact of DM on the response to anti-CD20 monoclonal antibody therapy in MN remains unclear. We hypothesized that despite comparable B-cell depletion, MN patients with comorbid DM would exhibit a reduced treatment response compared to non-diabetic MN patients.

METHODS: In this retrospective cohort study, we included adults with primary MN who received at least one complete course of anti-CD20 antibody therapy. Propensity score matching (1:2) was applied based on age, sex, baseline eGFR, urinary protein and PLA2R antibody status. The primary outcome was remission (complete or partial) at 3,6,9,12 months. Secondary outcomes included immunological remission, B-cell depletion, and changes in renal parameters. Multivariable logistic regression, Kaplan-Meier analysis, and subgroup analyses were used to compare outcomes between MN patients with (MN+DM) and without diabetes (MN).

RESULTS: After matching, 207 patients were included (72MN+DM, 135MN). B-cell depletion and immunological remission rates showed no statistically significant differences between groups over the 12-month follow-up period. However, MN patients had significantly higher overall remission rates at 9 months (94% vs. 77%; OR=4.55, 95% CI=1.52-12.50, P<0.01) and at 12 months (97% vs. 86%; OR=5.26, 95% CI=1.25-20.00, P<0.05). Subgroup analyses confirmed consistently poorer responses in diabetic patients across multiple strata. Safety profiles were similar between groups.

CONCLUSION: Despite equivalent B-cell depletion, MN with DM patients show a reduced response to anti-CD20 antibody therapy relative to non-diabetic patients, underscoring that tight glycemic control, early supplementary anti-CD20 dosing for poor response, and combined immunosuppressive regimens may enhance their clinical outcomes.

PMID:41860432 | DOI:10.1093/ndt/gfag065

Ann Plast Surg. 2026 Mar 23. doi: 10.1097/SAP.0000000000004726. Online ahead of print.

ABSTRACT

BACKGROUND: Academic publishing underpins surgical decision-making, but the rapid adoption of generative artificial intelligence (AI) raises concerns about research credibility and patient safety. To the best of our knowledge, no prior pilot study has examined its presence in plastic and reconstructive surgery. Detection tools remain imperfect, and journals lack consensus on disclosure policies, leaving a gap between rapid adoption and effective oversight.

METHODS: This pilot analysis sampled 10% (n=67) of articles published between July 1, 2024, and July 1, 2025, across leading plastic and reconstructive surgery and burn journals. We assembled a matched control cohort from 2014 to 2015 using identical criteria. Articles were analyzed using a combined RoBERTa classifier and perplexity-based evaluation to flag potential AI-like textual characteristics.

RESULTS: At the article level, 18 of 67 articles (26.9%, 95% CI: 17.7-38.5) contained ≥1 flagged section, with 20 subsections (5.3%, 95% CI: 3.5-8.1) flagged. Flagged content clustered in methods (9.1%) and abstracts (7.5%), with lower prevalence in other sections. In our control cohort, 3 papers (4.5%, 95% CI: 1.5-12.5) and 3 subsections were flagged (0.9%, 95% CI: 0.3-2.7), representing ~6-fold and 5-fold increases, respectively. This difference was statistically significant at the article level (χ²=11.1, P<0.001).

CONCLUSIONS: AI-like textual characteristics were more frequently detected in contemporary plastic and reconstructive surgery publications than in the pre-AI cohort. Although detection does not confirm authorship, these findings underscore the need for clearer and more consistent disclosure, standardized and graded reporting policies, and reviewer training to enable responsible integration of AI into surgical publishing.

PMID:41860427 | DOI:10.1097/SAP.0000000000004726