Nevin Manimala

JAMA Netw Open. 2025 Dec 1;8(12):e2549815. doi: 10.1001/jamanetworkopen.2025.49815.

ABSTRACT

IMPORTANCE: It is unclear why areas of medicine overrepresented by female physicians receive lower pay. One theory is devaluation-that work done by women is systematically devalued over time.

OBJECTIVE: To assess whether an increase in the proportion of female physicians in a specialty is associated with a decrease in the median annual payments for that specialty.

DESIGN, SETTING, AND PARTICIPANTS: In 2022, a population-based, repeated cross-sectional analysis was conducted using routinely collected data of all active physicians in Ontario, Canada, from 1992-1993 (1993) to 2019-2020 (2020). For each year, the percentage of female physicians and total annual median payments for each specialty were calculated.

MAIN OUTCOME AND MEASURE: Random-effects linear regression models were constructed to evaluate the association between the percentage of female physicians and median payments overall. Additionally, we conducted a sensitivity analysis of the subgroup of physicians with 1.0 or more full-time equivalency (FTE).

RESULTS: The physician workforce increased from 18 572 in 1993 to 31 374 in 2020 with the number of female physicians increasing from 4151 (22.3%) to 13 205 (42.1%). The mean (SD) age for all physicians in 2020 was 49.6 (12.8) years, and for female physicians in 2020 was 46.2 (11.5) years. Median annual payments increased from $183 033 to $316 570. Regression results found that an absolute 1 percentage point increase in the percentage of female physicians in a specialty over 1 year was associated with a $2183 lower increase in median payments than expected overall (95% CI, -$3932 to -$434; P = .02) and a $3235 lower increase for female physicians (95% CI, -$4888 to -$1583; P < .001), but not for male physicians (-$554; 95% CI, -$2373 to $1264).

CONCLUSION AND RELEVANCE: This repeated cross-sectional study did not find evidence to directly support the theory of devaluation, yet the results underscore that occupational segregation, both across and within specialties, is associated with the gender pay gap. These findings should prompt medical leaders and policymakers to reconsider what activities are monetarily valued in medicine and whether these align with what patients and the public consider most valuable from a care perspective.

PMID:41400950 | DOI:10.1001/jamanetworkopen.2025.49815

JAMA Netw Open. 2025 Dec 1;8(12):e2549822. doi: 10.1001/jamanetworkopen.2025.49822.

ABSTRACT

IMPORTANCE: Low-dose vaginal estrogen (VE) is a safe and effective treatment for genitourinary syndrome of menopause (GSM). The frequency of VE prescribing for GSM is unknown.

OBJECTIVE: To evaluate VE prescriptions among women with GSM and to identify clinical phenotypes associated with VE claims.

DESIGN, SETTING, AND PARTICIPANTS: This is a retrospective, population-based cohort study of a 20% random sample of Medicare fee-for-service beneficiaries enrolled in Parts A, B, and D from 2006 to 2018. Women aged 66 years and older with a diagnosis indicative of GSM were included. Exclusion criteria included diagnoses of breast and/or endometrial cancer within 6 months of GSM diagnosis. Data analysis was performed from October 2023 to June 2024.

EXPOSURE: Diagnosis indicative of GSM.

MAIN OUTCOMES AND MEASURES: The primary outcome was the proportion of women with a VE prescription claim (cream, ring, or tablet) during the follow-up period, from first GSM diagnosis to the end of Medicare enrollment or the study period. To quantify associations between patient characteristics and the likelihood of VE claims, univariable and multivariable logistic regression analyses were conducted.

RESULTS: A total of 1 838 732 women with at least 1 GSM-related diagnosis were identified (median [IQR] age, 74 [69-81] years; median [IQR] follow-up, 8 [4-10] years). VE prescriptions were filled by 165 530 women (9.0%) at a median (IQR) of 15 (2-46) months after diagnosis. Older women (adjusted odds ratio [aOR] for >86 years vs 66-70 years, 0.59; 95% CI, 0.58-0.60) and those with higher Charlson Comorbidity Index scores (aOR for score ≥5 vs 0, 0.67; 95% CI, 0.66-0.69) were less likely to have a VE claim. When comparing GSM symptom groups, women with recurrent urinary tract infections were least likely to have a VE claim (aOR vs local sexual symptoms, 0.54; 95% CI, 0.46-0.64). Women with vulvovaginal symptoms (aOR, 2.70; 95% CI, 2.45-2.97) and GSM multimorbidity (aOR, 15.91; 95% CI, 14.41-17.57) were most likely to have a VE claim.

CONCLUSIONS AND RELEVANCE: In this large cohort study, 9.0% of female Medicare beneficiaries with a diagnosis indicative of GSM filled a VE prescription. Younger and healthier beneficiaries and those with GSM multimorbidity were more likely to fill a VE prescription. The majority of patients with GSM symptoms, including dyspareunia, vulvovaginal atrophy, and recurrent urinary tract infections, did not fill a VE prescription. Improving patient and practitioner education, revising the diagnostic code schema to capture the full breadth of symptoms, and validating GSM clinical phenotypes will help facilitate care and enhance our understanding of symptoms in research studies.

PMID:41400949 | DOI:10.1001/jamanetworkopen.2025.49822

Interdiscip Cardiovasc Thorac Surg. 2025 Dec 16:ivaf300. doi: 10.1093/icvts/ivaf300. Online ahead of print.

ABSTRACT

OBJECTIVES: This study develops a visual scoring system based on Chest Computed Tomography(CT) findings to assess donor lung function and explores its use for brain-dead donors.

METHODS: We conducted a retrospective cohort study of 151 donors after brain death managed by our local Organ Procurement Organization from January 1 to June 30 2024. A multidisciplinary team developed a chest CT evaluation protocol based on Fleischner Society guidelines. Lung lesions were scored lobe-by-lobe for statistical analysis.

RESULTS: Of 151 potential donors, 56 (37.09%) underwent lung transplantation. Transplanted lungs had a higher proportion of blood type O, better oxygenation index, lower C-reactive protein and procalcitonin level, and lower CT scores compared to non-transplanted lungs. A higher total lung score (TLS) was strongly and negatively associated with lung utilization (OR 0.643, p < 0.001). ROC curve analysis indicated good discriminative ability for the TLS alone (AUC = 0.803). Our findings establish that chest CT visual scoring is a valuable univariable tool for assessing lungs from brain-dead donors. Based on the CT scoring results, the overall utilization rate of potential lung lobes reached 79.22%.

CONCLUSIONS: In the evaluation of donor lungs, a high TLS demonstrates a significant negative univariable association with lung utilization rates and exhibits good univariable diagnostic accuracy. The TLS has the potential to serve as a powerful and practical screening tool for donor lung assessment. Our findings suggest that chest CT visual scoring holds potential importance in assessing lungs from brain-dead donors and provides meaningful insights into the evaluation of donor lung lobes. However, further studies with larger sample sizes are required to explore these findings in greater depth.

PMID:41400936 | DOI:10.1093/icvts/ivaf300

Int J Qual Health Care. 2025 Dec 16:mzaf123. doi: 10.1093/intqhc/mzaf123. Online ahead of print.

ABSTRACT

BACKGROUND: The specific impact of anticholinergic load on quality of life is understudied. We aimed to investigate relationships between anticholinergic load and quality of life in residential aged care facilities and differences between residents with and without dementia.

METHODS: A retrospective cohort study of 21 residential aged care facilities in New South Wales, Australia. Residents aged ≥65 years for permanent care. Residents had their quality of life measured using the Quality of Life Aged Care Consumers tool in 2023 at baseline (July-September) and follow-up (October-December, the study outcome). Higher scores indicate better quality of life. Anticholinergic load of administered medications between two quality of life measures was evaluated using five existing scales: Anticholinergic Cognitive Burden, Anticholinergic Drug Scale, Anticholinergic Loading Scale, Anticholinergic Risk Scale, and Clinician-rated Anticholinergic Score. Associations between anticholinergic load from each scale and follow-up quality of life scores were examined using linear regression, controlling for age, sex, baseline quality of life scores, and other potential confounders. Interactions between anticholinergic load and dementia were tested. Analyses were conducted for overall cohort and a subgroup analysis was performed for residents with and without dementia.

RESULTS: A total of 927 residents (69.7% female) were included. One-point higher anticholinergic load measured on each of the Anticholinergic Loading Scale, Anticholinergic Risk Scale, and Clinician-rated Anticholinergic Score, was associated with lower quality of life scores at follow-up: -0.24 (95% confidence interval -0.47, -0.01), -0.26 (95% confidence interval -0.46, -0.05), and -0.25 (95% confidence interval -0.49, -0.01), respectively. Associations did not differ by dementia status. In a subgroup analysis, the associations remained statistically significant in residents without dementia (n = 501), but not in those with dementia (n = 426).

CONCLUSION: Our results indicate that, controlling for baseline quality of life, anticholinergic load was associated with lower quality of life at follow-up over a short period (up to six months).

PMID:41400935 | DOI:10.1093/intqhc/mzaf123

Pharmacoecon Open. 2025 Dec 16. doi: 10.1007/s41669-025-00621-y. Online ahead of print.

ABSTRACT

BACKGROUND: Health state utility values (HSUVs) are vital in cost-utility analyses (CUAs) that inform policymaking. However, suboptimal selection and application of HSUVs have been reported in areas such as cardiovascular disease and cancer. This study reviewed the methodological quality and appropriateness of HSUV in CUA use for interventions targeting infectious diseases in aging populations.

METHODS: A systematic search of the MEDLINE database was conducted to identify CUAs that evaluated interventions against six major infectious diseases from January 2000 to July 2025. Two reviewers independently screened the identified studies based on eligibility criteria. The two reviewers then assessed the included studies using a modified checklist that covered how HSUVs were selected, elicited, and applied. Findings are summarized by descriptive statistics across the entire period (January 2000 to July 2025) and three sub-periods (2000-2009, 2010-2019, and 2020 to July 2025).

RESULTS: Among the 146 included CUA studies, only 10 (7%) relied exclusively on original sources for HSUVs, while 78% used economic data, either alone or in combination with other secondary sources or assumptions. Most studies (78-91%) did not provide sufficient rationale or descriptions for the population or how HSUVs were elicited, and 42% failed to report all utility components. Complete comparability between the CUAs and reference data for the diagnosis, severity, and country was observed in only 51-60% of studies. Notably, fewer than half of CUAs reported HSUVs that were consistent with their cited sources, and 80% did not discuss the limitations associated with HSUV use. Most criteria showed limited improvements, and in some cases declines, between January 2000 and July 2025.

CONCLUSION: CUAs of infectious diseases in aging populations are frequently associated with suboptimal practices in how HSUVs are selected, elicited, and applied. These shortcomings highlight the need for cautious interpretation of CUA data and for greater methodological transparency. Improving the quality of economic evaluations will require systematic approaches to how HSUVs are selected and elicited, with increased investment in primary data collection and the creation of accessible utility databases.

PMID:41400916 | DOI:10.1007/s41669-025-00621-y

J Neurooncol. 2025 Dec 16;176(2):125. doi: 10.1007/s11060-025-05312-6.

ABSTRACT

PURPOSE: Meningiomas are common, mostly benign, and often asymptomatic. Minimizing surgical adverse events (AE) is essential to maintain a favorable risk-benefit balance. Traditional AE grading systems often failed to account for disabling complications like neurologic deficits, which led to the development of the multidimensional therapy-disability-neurology grade (TDN). This study evaluates risk factors and consequences of AE in meningioma patients using TDN.

METHODS: Pre- and perioperative factors associated with the occurrence and severity of AE at discharge and follow-up were retrospectively identified in a monocentric cohort of consecutive patients undergoing surgery between 2013 and 2022. Significant variables of the univariable analysis were consequently tested in a multivariable analysis. Statistical analysis to detect the relationship between TDN and clinical outcomes was performed.

RESULTS: 367 patients were included with a mean age at surgery of 60.8 years. A total of 95 AE at discharge and 144 AE at follow-up were recorded. Generalized linear models showed a relationship between the modified Rankin Scale on admission, tumor complexity as measured by the Milan Complexity Scale, and preoperative embolization with the frequency of AE at discharge and follow-up. A correlation between TDN, Karnofsky Performance Scale at discharge, and length of hospital stay was observed.

CONCLUSION: The severity of AE as classified according to TDN correlated with the length of hospital stay and functional outcome following meningioma resection in our cohort and may be predicted by specific pre- and perioperative factors.

PMID:41400878 | DOI:10.1007/s11060-025-05312-6

J Robot Surg. 2025 Dec 16;20(1):90. doi: 10.1007/s11701-025-03071-0.

ABSTRACT

Robotic surgery has become an integral part of minimally invasive surgical practice across a variety of disciplines. However, training structures, access, and perceptions of its clinical value vary significantly among surgeons worldwide. To assess global trends in robotic and laparoscopic/thoracoscopic surgery training, practice patterns, and surgeon-perceived clinical outcomes across a range of procedures. A cross-sectional, web-based survey will be conducted among surgical professionals worldwide. The survey includes structured quantitative items using Likert scales and multiple-choice formats comparing the conventional laparoscopic/thoracoscopic approaches. Data will be analyzed using descriptive statistics, subgroup comparisons, and regression models where appropriate. The study aims to identify variability in training pathways, perceived clinical benefits, and barriers to robotic surgery adoption, possibly informing curriculum development and policy changes to enhance equitable access and training.

PMID:41400869 | DOI:10.1007/s11701-025-03071-0

Environ Monit Assess. 2025 Dec 16;198(1):46. doi: 10.1007/s10661-025-14783-z.

ABSTRACT

Chlorination of drinking water is the most widely utilized disinfection technique; however, its reaction with naturally occurring organic matter causes the production of disinfection byproducts (DBPs), such as haloacetic acids (HAAs), which are the second most common DBP after trihalomethanes. This study investigates the occurrence and spatial variation of five HAA species (monochloroacetic acid (MCAA), dichloroacetic acid (DCAA), trichloroacetic acid (TCAA), monobromoacetic acid (MBAA), and dibromoacetic acid (DBAA)) in drinking water samples collected from eight locations in Jamia Nagar, New Delhi, during March-April 2023. Among these, only two species, i.e., DCAA and TCAA, were quantified, with mean concentrations of 13.97 ± 2.87 µg/L and 13.22 ± 3.47 µg/L, respectively, and total HAAs ranging from 20.81 to 34.95 µg/L. These concentrations were well below the maximum contamination limit of 60 µg/L given by USEPA, whereas no corresponding standards exist in India. Statistical analysis revealed strong positive correlations of HAA formation with residual chlorine, total organic carbon, and pH, while temperature exhibited a weak negative influence. Principal component analysis confirmed that residual chlorine, total organic carbon, and pH were the dominant contributors to HAA variability. Spatial mapping using kriging interpolation demonstrated higher HAA concentrations at sampling locations farther from the water treatment plant, indicating the effect of longer contact time between chlorine and organic precursors. The results highlight the need to consider HAAs in Indian drinking water standards and suggest that spatial monitoring can guide treatment upgrades and evidence-based policy making to ensure safe drinking water.

PMID:41400868 | DOI:10.1007/s10661-025-14783-z

Sci Prog. 2025 Oct-Dec;108(4):368504251406564. doi: 10.1177/00368504251406564. Epub 2025 Dec 16.

ABSTRACT

ObjectiveTo evaluate the role of rivaroxaban in preventing arteriovenous graft (AVG) thrombosis following endovascular intervention, assess the risk of recurrent thrombosis, and develop a clinically applicable predictive model.MethodsA retrospective analysis was performed on 108 patients with AVG thrombosis who underwent endovascular treatment at our center between October 2020 and October 2024. Patients were stratified into a rivaroxaban group (n = 71) and a control group (n = 37). Fifteen variables from the two groups were analyzed and summarized. Four machine learning algorithms (random forest, Support Vector Machine – Recursive Feature Elimination, Least Absolute Shrinkage and Selection Operator, and XGboost) were applied to identify risk factors for recurrent thrombosis. A predictive model was constructed using logistic regression and validated with an internal dataset.ResultsAmong the 108 patients, 69 were male and 39 were female, with ages ranging from 21 to 89 years. Fibrinogen levels were significantly lower in the rivaroxaban group (4.02 ± 0.87 vs. 4.59 ± 1.03, p < 0.01), More notably, the 12-month postprocedural patency rate was significantly higher in the rivaroxaban group (75%) than in the nonrivaroxaban group (17%), with a statistically significant difference (p < 0.01). No statistically significant differences were observed between the two groups in other aspects (p > 0.05). The model exhibited a C-index of 0.87 (95% CI: 0.78-0.95). The receiver operating characteristic and decision curve analysis curves demonstrated that the multifactor model had superior discriminative ability and net clinical benefit for identifying recurrent AVG thrombosis compared to single factors (AUC_{linear predictor} = 0.87, AUC_{rivaroxaban use} = 0.78, AUC_D-dimer = 0.60). Validation in the internal validation set and the entire cohort confirmed good calibration and efficacy (validation set: AUC = 0.86, entire cohort: AUC = 0.85).ConclusionRivaroxaban may exert a positive effect on maintaining the patency of AVG fistulas after endovascular treatment for thrombosis. The constructed nomogram prediction model can be used to predict the risk of recurrent thrombosis following endovascular treatment of AVG fistula thrombosis.

PMID:41400855 | DOI:10.1177/00368504251406564

Infection. 2025 Dec 16. doi: 10.1007/s15010-025-02712-8. Online ahead of print.

ABSTRACT

PURPOSE: We compared nationwide data on the clinical characteristics of deceased and non-deceased patients with Respiratory Syncytial Virus (RSV)-coded hospitalization to evaluate potential risk factors for in-hospital fatality by age group.

METHODS: Data from International Statistical Classification of Diseases (10th Revision)-based German Hospital Statistics for patients from 2010-2019 with a primary discharge diagnosis code for RSV-related pneumonia (J12.1), bronchitis (J20.5) or bronchiolitis (J21.0) were assessed by remote data retrieval. Selected underlying conditions and complications were reported stratified by age group and outcome.

RESULTS: Overall, 612 (0.3% of 205,352) RSV-coded patients died in hospital (103 children < 18 years, 51 adults 18-59 years, 458 seniors > 59 years). Children and adults with underlying chronic cardiovascular, neurological, immunological, or lower respiratory diseases had a higher risk of dying than those without (Odds Ratio 109, 58, 28, 6 in children, and 3, 3, 3, 2 in adults). In seniors, the risk was increased for patients with chronic neurological conditions (OR 1.3) but not for other underlying conditions. Acute respiratory distress syndrome, sepsis and pneumonia increased the risk of a fatal outcome in all age groups.

CONCLUSION: In-hospital fatality of RSV-coded patients varied considerably with age, chronic conditions and complications. Seniors were the most affected age group and may therefore benefit from the RSV vaccination recommended in Germany since 2024 for all over 75 years and seniors with pre-existing conditions.

PMID:41400853 | DOI:10.1007/s15010-025-02712-8