Nevin Manimala

JAMA Netw Open. 2026 Jun 1;9(6):e2618248. doi: 10.1001/jamanetworkopen.2026.18248.

ABSTRACT

IMPORTANCE: Evidence continues to mount that ultraprocessed food (UPFs) may contribute to diet-related chronic diseases, including cardiovascular disease, obesity, diabetes, and some cancers. In the US, these conditions account for over 1 million deaths each year and cost the economy over $1.1 trillion in health care costs and lost productivity. This disease burden has intensified interest about the potential health impacts of UPF.

OBJECTIVE: To characterize the portfolio of research on UPF supported by the National Institutes of Health (NIH).

EVIDENCE REVIEW: All NIH-supported research projects included in this Special Communication were awarded between fiscal years 2016 and 2025. An initial 520 projects were identified using iSearch and were manually reviewed for a focus on UPF. All projects that met the inclusion criteria were coded for study design, health conditions, and UPF-specific topics. The research projects were collected in June 2025, and a review and analysis of the data using descriptive statistics were conducted between June 1 and December 31, 2025.

FINDINGS: A total of 81 NIH-supported UPF-specific projects were identified. Of these 81 projects, 58 studied various health conditions in relation to UPF consumption and 29 were interventional research, some of which examined the effects of food policies or lifestyle interventions on health outcomes. Forty-nine projects were coded as basic research, 32 of which examined human biological mechanisms of action from UPF exposure, and 5 studies included hybrids of human and vertebrate animal studies. The total number of NIH-supported projects has increased from 8 projects in fiscal year 2016 to 22 projects in fiscal year 2025, and funding for UPF-specific research increased from $3.3 million in fiscal year 2016 to $12 million in fiscal year 2025.

CONCLUSIONS AND RELEVANCE: NIH support for UPF-specific research has grown since fiscal year 2016. Most research projects have focused on the connection between obesity and UPF intake; fewer have used interventions to address food access and/or insecurity and food environment. This is a key research gap given the role of food environments as a driver of UPF consumption in different populations and their importance in improving health outcomes. Another critical research gap is mechanistic research to elucidate causal pathways linking UPF consumption to adverse health outcomes and validated biomarkers of UPF exposure and disease.

PMID:42284052 | DOI:10.1001/jamanetworkopen.2026.18248

Fam Med. 2026 May;58(5):359-362. doi: 10.22454/FamMed.2026.979674.

ABSTRACT

BACKGROUND AND OBJECTIVES: Increases in graduate medical education application volume led to the introduction of preference signaling-a tool within the Electronic Residency Application Service that allows applicants to signal their sincere interest to a limited number of programs. This study aims to evaluate how family medicine program directors used preference signals during the 2023-2024 recruitment season, the first year this tool was available to family medicine programs. Understanding program director perspectives on preference signal utility is crucial for determining the tool’s impact on the residency selection process.

METHODS: Data were collected through the Council of Academic Family Medicine Educational Research Alliance survey, which was distributed to Accreditation Council for Graduate Medical Education-accredited US family medicine residency program directors and included questions on preference signaling. We performed statistical analysis using χ2 testing and multivariable logistic regression to assess the association between preference signal use and aspects of resident recruitment.

RESULTS: The overall response rate to the question set was 308/767 (40.2%). Program directors generally used preference signals as a component of holistic review, which did not supersede factors such as applicant rotation experiences and geographic location preferences as influential to application review. Overall, preference signals did not significantly influence interview offers or applicant ranking.

CONCLUSIONS: Preference signals have been incorporated into the family medicine residency application review process but did not become a primary determinant in applicant selection during family medicine’s first year of utilization. Traditional factors such as rotation performance and geographic preference remain highly influential. Further research is needed to optimize the use of preference signals in family medicine residency recruitment.

PMID:42284041 | DOI:10.22454/FamMed.2026.979674

Fam Med. 2026 Apr;58(4):280-285. doi: 10.22454/FamMed.2026.317077.

ABSTRACT

BACKGROUND AND OBJECTIVES: The 2022 transition of USMLE Step 1 scoring to pass/fail altered a key metric used by programs to select students to interview for residency. This study explores family medicine clerkship directors’ (FMCDs’) perceptions of how students now distinguish themselves, particularly in relation to clerkship grading methodologies.

METHODS: Ten questions were included in the 2024 Council of Academic Family Medicine Educational Research Alliance survey, distributed to 173 FMCDs. Items investigated perceptions of student distinction, stress, and grading practices. Statistical analyses included descriptive statistics, Kruskal-Wallis tests, and Wilcox signed-rank tests.

RESULTS: Of the 83 respondents (48% response rate), 59% reported using pass/fail grading in the preclerkship phase, while only 22% used pass/fail grading in the clerkship phase. A majority (58%) indicated no changes to clerkship grading systems post-2022, though 20% had changed and 22% were considering changes, predominantly toward less-tiered methodologies. Regarding the impact of Step 1 changes on the students’ ability to distinguish themselves, 37% perceived harm, 14% benefit, and 48% neutrality. Despite this finding, 78% of FMCDs perceived that students were more stressed about distinguishing themselves. No significant associations were found between grading methodology and perceptions of distinction or stress.

CONCLUSIONS: FMCDs perceived increased student stress following the Step 1 pass/fail transition, yet largely believe that students still can distinguish themselves. Neither tiered nor pass/fail grading was viewed as a definitive solution. These findings underscore the need for standardized, competency-based assessment and clearer communication of distinguishing features in residency applications.

PMID:42284029 | DOI:10.22454/FamMed.2026.317077

J Med Internet Res. 2026 Jun 12;28:e64070. doi: 10.2196/64070.

ABSTRACT

BACKGROUND: Noncommunicable diseases (NCDs) account for over 70% of global deaths, with hypertension and diabetes serving as major contributors. The COVID-19 pandemic disrupted traditional health care services for NCDs and highlighted telehealth as a crucial alternative. Telehealth-encompassing synchronous and asynchronous electronic communication to deliver clinical services remotely-can overcome geographical barriers and enhance patient engagement. However, telehealth usability among health care professionals (HCPs) remains under-studied across low-, middle-, and high-income countries.

OBJECTIVE: This study aimed to examine which telehealth engagement patterns, technical infrastructure factors, and user profiles were most strongly associated with usability among HCPs and to descriptively compare these across 4 diverse countries: Brazil (high- to middle-income country), Ghana (low- to middle-income country), Honduras (low- to middle-income country), and the United Kingdom (high-income country).

METHODS: A multinational cross-sectional survey was conducted with 290 HCPs across 4 countries. Participants completed the System Usability Scale and provided data on telehealth engagement (eg, frequency, duration, and number of systems used), technical infrastructure (connection stability and support satisfaction), and their user profile (demographics, job role, and training received). Descriptive statistics summarized these patterns and usability scores. Multiple linear regression with bootstrap-based sensitivity analyses identified factors associated with telehealth usability. Given the nonprobability design, no formal inferential comparisons were made between countries. Instead, observed patterns were reported descriptively.

RESULTS: Higher telehealth usability scores were associated with greater connection stability (b=5.06, 95% CI 3.06-7.05), higher satisfaction with online support information (b=5.02, 95% CI 3.27-6.75), more frequent use (b=3.05, 95% CI 1.36-4.73), longer duration of use (b=1.59, 95% CI 0.49-2.68), and being a physician by profession (b=3.82, 95% CI 0.23-7.40). Average usability scores were highest among users in Ghana (mean 79.75, SD 14.19) and the United Kingdom (mean 79.00, SD 14.71), followed by Brazil (mean 72.01, SD 14.62) and Honduras (mean 63.09, SD 15.57). According to System Usability Scale guidelines, scores corresponded to “good” usability for users in Ghana, the United Kingdom, and Brazil and were below the “good” threshold for users in Honduras. While most users in Ghana (97/111, 87.4%), Honduras (31/38, 81.6%), and Brazil (57/80, 70.4%) reported using only 1 telehealth system, two-thirds of UK users (40/60, 66.7%) reported using 2 or more systems. User profiles also varied; prepandemic use was highest in Ghana (84/111, 75.7%) and lowest in Honduras (7/38, 18.4%). Other engagement patterns across countries were reported.

CONCLUSIONS: Telehealth usability is driven by technical infrastructure reliability, a robust online support infrastructure, and an “experience effect” from frequent and long-term engagement. Descriptive differences in engagement patterns and infrastructure highlight the need for tailored strategies to address setting-specific challenges. These are essential to optimize telehealth integration and improve health care outcomes for patients with NCDs worldwide.

PMID:42284018 | DOI:10.2196/64070

J Relig Health. 2026 Jun 12. doi: 10.1007/s10943-026-02699-y. Online ahead of print.

ABSTRACT

Mental health disparities among Black adults remain a critical public health issue; however, few studies have examined gender differences in perceptions of faith-based mental health hub programs designed to reduce these disparities. Using an exploratory survey design, this study assessed gender differences in perceptions of service utilization, access, engagement, cultural humility, and satisfaction with a faith-based mental health hub programs. This program links, refers, and provides psychoeducation to adults with mental health needs through Community Health Workers. A descriptive analysis and a Mann-Whitney U-test (non-parametric test) were used. All program participants were invited to take part in the study, and we achieved a 65% response rate. Among Black respondents (N = 231), 79% were women, 52.1% were college-educated, and the majority were 46-55 years old (26.4%). Results revealed a statistically significant difference between men and women in access to services only (U = 3831.50, Z = -2.79, p = 0.005, r = 0.18). Women reported significantly higher access to services than men. In general, both groups reported high levels of satisfaction with services, perceived cultural humility, and strong engagement in and utilization of the program, with no significant differences noted. Findings underscore generally positive perceptions among Black adults regarding faith-based mental health hub programs. However, the underrepresentation and lower reported perceptions of men and emerging adults highlight an opportunity to expand outreach efforts. Further, the high proportion of participants with college degrees suggests that educational attainment does not eliminate barriers to care.

PMID:42284005 | DOI:10.1007/s10943-026-02699-y

Clin Exp Nephrol. 2026 Jun 12. doi: 10.1007/s10157-026-02896-9. Online ahead of print.

NO ABSTRACT

PMID:42283989 | DOI:10.1007/s10157-026-02896-9

J Neurooncol. 2026 Jun 12;178(2):61. doi: 10.1007/s11060-026-05661-w.

ABSTRACT

PURPOSE: To estimate the pooled incidence of symptomatic radiation necrosis (RN) following intracranial brachytherapy and explore associations between clinical and technical variables and RN risk.

METHODS: PubMed, Embase, Web of Science, and the Cochrane Library were searched from 1954 – 2024 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible human studies reported symptomatic RN after intracranial brachytherapy. RN ascertainment was secondarily classified as clear, partial, or unclear based on reproducibility of diagnostic criteria. A random-effects generalized linear mixed model was used to pool incidence rates, with subgroup analyses by tumor type, implant technique, isotope, dose rate, and prior radiation. Study quality was assessed using National Institutes of Health tools.

RESULTS: Eighty-three studies encompassing 3,666 patients were included. The pooled incidence of symptomatic RN was 5.67% (95% CI: 3.84%-8.29%; I² = 75.7%). RN ascertainment was clear in 25 studies, partial in 43, and unclear in 15. In sensitivity analyses, pooled symptomatic RN incidence was 8.71% among studies with clear RN definitions and 7.48% among studies with clear or partial definitions. Subgroup RN rates were 3.72% for low-grade gliomas, 8.44% for high-grade gliomas, 2.07% for brain metastases, and 8.98% for meningiomas. Isotope-specific rates were 5.83% for Iodine-125, 7.61% for Iridium-192, and 2.07% for Cesium-131. No statistically significant subgroup differences were observed.

CONCLUSIONS: Symptomatic RN occurs in approximately 5.7% of patients following intracranial brachytherapy, within the range reported for other focal radiation therapies. Subgroup findings were not statistically significant and should be interpreted in the context of clinical and methodological heterogeneity.

PMID:42283986 | DOI:10.1007/s11060-026-05661-w

Discov Ment Health. 2026 Jun 12;6(1):110. doi: 10.1007/s44192-026-00509-1.

ABSTRACT

BACKGROUND: Anxiety disorders are among the most prevalent mental disorders worldwide and impose a substantial burden on public health systems. This study aimed to comprehensively assess the global burden of anxiety disorders, examine long-term temporal trends, explore their associations with human resources for health (HRH), and project future disease burden.

METHODS: Data were obtained from the Global Burden of Disease (GBD) 2021 study. We first described the global burden of anxiety disorders in 2021 and its geographical distribution across countries and regions. We then analyzed temporal trends in incidence, prevalence, and disability-adjusted life years (DALYs) from 1990 to 2021. In addition, correlations between anxiety disorder burden and HRH were assessed. Finally, future trends from 2022 to 2050 were projected using multiple statistical models.

RESULTS: In 2021, anxiety disorders accounted for 53.91 million incident cases worldwide, with an age-standardized incidence rate of 678.25 per 100,000 population. The global number of prevalent cases reached 359.21 million, and the total number of DALYs was 42.51 million. China had the highest absolute number of cases, whereas Portugal had the highest age-standardized prevalence rate. Correlation analyses showed moderate associations between several HRH categories and the burden of anxiety disorders; traditional and complementary medicine practitioners were weakly negatively correlated with DALYs. Model-based projections suggest that the global burden of anxiety disorders may continue to increase over the next 25 years.

CONCLUSION: Anxiety disorders remain a major global public health challenge. These findings provide updated evidence on their epidemiological burden and may help inform health resource allocation and long-term mental health planning.

PMID:42283985 | DOI:10.1007/s44192-026-00509-1

Behav Res Methods. 2026 Jun 12;58(7):195. doi: 10.3758/s13428-026-03075-0.

ABSTRACT

Duration discrimination data collected with single-presentation tasks (e.g., bisection or temporal generalization tasks) or dual-presentation tasks (e.g., greater-less or same-different tasks) are usually analyzed by fitting psychometric functions. The independent variable in these functions is test duration measured in seconds or milliseconds. In contrast, the independent variable is log stimulus magnitude in psychometric functions for discrimination in other sensory modalities, most often because of the applicability of Weber’s law. We report a study aimed at determining empirically whether duration discrimination data are best described by psychometric functions of duration or log duration. We first conducted a simulation study to identify the design (type of task, number of test durations, number of trials, etc.) with which the generating psychometric function (of duration or log duration) fit the data substantially better than the impostor function. Based on these results, we conducted an empirical study with the same-different task that adaptively administered 1,200 trials over 11 test durations around the standard duration. We collected 45 datasets and fitted both types of psychometric function in each case. By the loglikelihood-ratio statistic, psychometric functions of duration fitted the data better in only 7 of 45 cases (15.6%), in agreement with simulation results obtained when data were generated by psychometric functions of log duration. Analysis of data from 69 published papers (totaling 17,000+ psychometric functions) also indicated better fit of psychometric functions of log duration in the expected proportion given the typically small numbers of trials per function.

PMID:42283983 | DOI:10.3758/s13428-026-03075-0

Saudi Pharm J. 2026 Jun 12;34(3):36. doi: 10.1007/s44446-026-00095-x.

ABSTRACT

BACKGROUND AND AIM: In the community pharmacy sector the concept of service quality is important. Pharmacists working in these settings provide useful services that go beyond merely dispensing medications. This study aimed to translate the short Perceived Service Quality Scale (PSQS-SF) to Arabic and to use this scale to assess the determinants of service quality of community pharmacies in relation to competitively priced high quality service and loyalty intention.

METHODS: A pre-validated short Perceived Service Quality Scale (pSQS-A-SF) was translated from English to Arabic, validated and approved by the original authors. The scale consisted of six questions assessing pharmacy service quality, two questions evaluating the perception of price competitiveness, and three questions measuring loyalty intentions. All of the items were rated on a 5-point Likert scale. Community pharmacy users have been approached to answer the survey and descriptive statistics were reported.

RESULTS: The pSQS-SF was successfully translated and culturally adapted to Arabic context (pSQS-A-SF) with minor modifications. A total of 207 respondents completed the survey. Perceived service quality was rated highly across most items, whereas perceptions of price competitiveness were lower. In confirmatory factor analysis, the measurement model showed improved fit after minor modification (deletion of one service-quality item), with acceptable factor loadings and composite reliability, although average variance extracted was marginal. Service quality was strongly correlated with loyalty intentions. In the structural model, higher perceived service quality predicted greater patronage loyalty (β=0.26, p=0.023) and prescription loyalty (β=0.41, p=0.002), while price competitiveness did not significantly predict loyalty outcomes; private health insurance showed a small positive association with patronage loyalty (β=0.156, p=0.022).

CONCLUSION: The Arabic version of the perceived service quality short-form demonstrates preliminary evidence of construct validity and reliability and can support evaluation of patient experience in Saudi community pharmacies. Perceived service quality-rather than price competitiveness-was linked with self-reported patronage loyalty in this sample. Further research should strengthen validation (including discriminant validity and broader sampling) and assess performance across settings and subgroups.

PMID:42283965 | DOI:10.1007/s44446-026-00095-x