Nevin Manimala

JAMA Netw Open. 2025 Dec 1;8(12):e2545996. doi: 10.1001/jamanetworkopen.2025.45996.

ABSTRACT

IMPORTANCE: Medicaid expansion under the Affordable Care Act broadened eligibility for government-funded health coverage. This may have improved access to early diagnosis and rapid treatment, potentially impacting survival in patients with resectable non-small cell lung cancer (NSCLC), a leading cause of cancer-related death in the US.

OBJECTIVE: To evaluate the association between state-level Medicaid expansion and all-cause mortality in patients with resectable NSCLC.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study of patients aged 20 to 64 years who were diagnosed with stage I to IIIA NSCLC used data from the Surveillance, Epidemiology, and End Results registry collected between January 1, 2006, to December 31, 2019, with outcomes administratively censored at 2 and 4 years. Data were analyzed between March 1 and September 10, 2025.

EXPOSURE: Medicaid expansion status of patients’ state of residence at diagnosis. Patients’ states of residence were categorized as nonexpansion, early expansion (2011), 2014 expansion, or late expansion (after 2014).

MAIN OUTCOMES AND MEASURES: Primary outcomes were 2- and 4-year all-cause mortality. Cox proportional hazards regression models within a difference-in-differences framework were used to estimate adjusted hazard ratios (HRs) for death. Secondary analyses evaluated postexpansion mortality trends and changes in early-stage (I-II) diagnoses using logistic regression.

RESULTS: Among 53 842 patients included in the analysis (24 849 [46.2%] 60-64 years of age; 27 027 [50.2%] male), propensity score-matched analyses showed lower 2-year mortality in states with early expansion (HR, 0.95; 95% CI, 0.91-0.99; P = .02) and 2014 expansion (HR, 0.91; 95% CI, 0.86-0.95; P < .001) compared with nonexpansion control states, whereas no significant difference was observed in late expansion states (HR, 0.95; 95% CI, 0.89-1.02; P = .15). All expansion groups showed decreased mortality. Mortality decreases were observed after the first 3 years and persisted throughout the study period. The proportion of early-stage diagnoses did not change post expansion, suggesting benefits may have been mediated by improved postdiagnostic care rather than earlier detection.

CONCLUSIONS AND RELEVANCE: In this cohort study of patients with stage I to IIIA NSCLC, Medicaid expansion was associated with lower mortality at 2 and 4 years. These findings suggest that expanded insurance coverage may have enhanced access to effective cancer care and improved population-level outcomes.

PMID:41324959 | DOI:10.1001/jamanetworkopen.2025.45996

JAMA Netw Open. 2025 Dec 1;8(12):e2546002. doi: 10.1001/jamanetworkopen.2025.46002.

ABSTRACT

IMPORTANCE: Some US states established state medical operations coordination centers (SMOCCs) during the pandemic to coordinate transfers and maximize care delivery when available beds were limited. Understanding their associations might inform their continued value in helping reduce delays and minimize strain during public health emergency conditions.

OBJECTIVE: To examine the association of SMOCC establishment with adult interhospital transfers (IHTs) during pandemic surges.

DESIGN, SETTING, AND PARTICIPANTS: This interrupted time series cohort study evaluated hospitalized adults (aged ≥18 years) from 8 US states. Data analysis was completed in March 2025.

EXPOSURE: SMOCC establishment. SMOCC initiation was adjudicated through a published survey and inquiries with state health departments.

MAIN OUTCOMES AND MEASURES: Outcome measures were immediate and long-term change in IHT by emergency medical services (EMS) agencies that continuously reported in the National EMS Information Systems database between June 1, 2020, and December 30, 2022. The inflection point (SMOCC establishment) was centered using relative dates while controlling for seasonality. Hospital occupancy stress was measured using daily hospital census and staffed bed counts and weighted by fixed bed capacity. Effect modification by increasing occupancy stress across study states was tested using an interaction term. Findings were validated in several subset analyses.

RESULTS: Across the study’s 8 states (Alaska, Colorado, Idaho, Maryland, North Carolina, Oregon, Utah, and Virginia), 441 709 transfers (median [IQR] age, 61.0 [44.0-73.0] years; 227 982 [51.6%] male) were analyzed, with 321 078 (72.8%) occurring after SMOCC establishment. SMOCC establishment was associated with an immediate increase (rate ratio [RR], 1.35; 95% CI, 1.05-1.74; P = .02) followed by a long-term decrease (RR, 0.94; 95% CI, 0.90-0.97; P < .001) in transfer rates. A significant increase in transfers per decile increase in occupancy stress was observed 40 weeks into SMOCC establishment (RR, 1.23; 95% CI, 1.06-1.42; P = .007). Findings were similar across transfers grouped by urbanicity, mode of transport, patient age, and acuity.

CONCLUSIONS AND RELEVANCE: In this cohort study of 8 US states, pandemic initiation of a SMOCC was associated with an immediate increase in transfer rates between hospitals of approximately 35% after establishment and, after a potential lag, appeared to meet an increasing demand for transferring patients during surges. These results suggest that activating SMOCCs during large-scale public health emergencies might improve access to care and mitigate transfer gridlocks, but their utility during routine times warrants study.

PMID:41324958 | DOI:10.1001/jamanetworkopen.2025.46002

JAMA Netw Open. 2025 Dec 1;8(12):e2546792. doi: 10.1001/jamanetworkopen.2025.46792.

ABSTRACT

IMPORTANCE: HIV preexposure prophylaxis (PrEP) is highly effective in HIV prevention; telemedicine is a promising avenue for delivering PrEP care.

OBJECTIVE: To explore telemedicine delivery of PrEP care (telePrEP) by the largest telePrEP company in the US.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective, single-arm cohort study used health record data of patients receiving telePrEP from MISTR LLC, a for-profit telehealth company, from November 27, 2018, to March 5, 2025. Patient characteristics and AIDSVu data were assessed to determine levels of PrEP use nationally. Retention in care was assessed for persons initiating PrEP in 2020, 2021, and 2022. Data were analyzed from March 5 to May 29, 2025.

EXPOSURE: Use of telePrEP.

MAIN OUTCOMES AND MEASURES: The primary outcome was the proportion of patients receiving telePrEP among all patients receiving PrEP in the US. Persons were classified as PrEP users if they received at least 1 day of prescribed PrEP in a calendar year.

RESULTS: From 2018 through 2025, 162 422 unique patients received telePrEP prescriptions from the telehealth company. Patients were predominantly young (mean [SD] age, 33.3 [10.3] years) and male (156 255 of 162 417 [96%]). Of 162 406 patients with data available, 19 610 (12%) were African American or Black, 12 075 (7%) were Asian, 39 744 (25%) were Hispanic or Latino, 82 222 (51%) were White, and 8755 (5%) were of other race or ethnicity. Most had not previously used PrEP (57 597 of 74 860 [77%]), and more than one-third (58 761 of 162 403 [36%]) were uninsured. Most users (131 875 [81%]) opted for home laboratory specimen collection as part of their care. TelePrEP use increased substantially from 6443 patients in 2020 to 110 068 in 2024. TelePrEP as a proportion of all national PrEP use was 2% in 2020, 9% in 2022, and 19% in 2024. Retention in care was similar for cohorts starting in 2020, 2021, and 2022; 67% (16 716 of 24 976) to 73% (4571 of 6287) were retained in the calendar year after initiation, 42% (8408 of 19 916) to 43% (2732 of 6287) in the second year, and 32% (2043 of 6287) to 33% (6546 of 19 916) in the third year. Annual care reinitiation ranged from 2% to 5%.

CONCLUSIONS AND RELEVANCE: This cohort study found that nearly 1 in 5 PrEP users in the US received their PrEP prescriptions from a single national telemedicine company in 2024. Most were new to PrEP and more than one-third were uninsured. TelePrEP provision benefits from facilitating policies such as Affordable Care Act coverage and the 340B Drug Pricing Program. The rapid growth and overall magnitude of telePrEP provision suggests that it is a critical part of HIV prevention infrastructure in the US that merits continued regulatory support.

PMID:41324957 | DOI:10.1001/jamanetworkopen.2025.46792

Psychol Health Med. 2025 Dec 1:1-19. doi: 10.1080/13548506.2025.2597470. Online ahead of print.

ABSTRACT

Alzheimer’s disease and kidney health have become serious and urgent public health issues. Bicarbonate and blood urea nitrogen is closely related to kidney function but the relationship of the bicarbonate, blood urea nitrogen and cognitive function which is one of the most important symptoms of Alzheimer’s disease is still unclear. In this study we aimed to examine the association of the bicarbonate, blood urea nitrogen and cognitive function. This study used the NHANES database, from which 2681 eligible individuals over 60 years of age were selected. We also extracted cognitive related tests, bicarbonate and blood urea nitrogen concentration to statistically analyze. Logistic regression and restricted cubic splines (RCS) were performed with confounding variables such as gender, age, race, body mass index (BMI), and alcohol intake. After adjusting for multiple factors, statistical analyses indicated significant correlations between bicarbonate, blood urea nitrogen, and cognitive function tests, with varying strengths across different tests. A stratified analysis by gender revealed that there are also differences in the results by gender. Based on the research, we concluded that bicarbonate, blood urea nitrogen are correlated with cognitive function in older Americans. This effect varied across populations.

PMID:41324953 | DOI:10.1080/13548506.2025.2597470

Int J Aging Hum Dev. 2025 Dec 1:914150251401565. doi: 10.1177/00914150251401565. Online ahead of print.

ABSTRACT

The global rise in chronic noncommunicable diseases poses a growing challenge to healthcare systems, particularly in developing countries. This cross-sectional study aimed to investigate the associations between chronic diseases and mobility, balance, and visual memory in middle-aged adults. Ninety-seven participants aged 40-64 were categorized based on the Age-Adjusted Charlson Comorbidity Index. Assessments included the Timed Up and Go Test for mobility, the One-Leg Standing Balance Test for static balance, the Y Balance Test for dynamic balance, and the Rey-Osterrieth Complex Figure Test for visual memory. Individuals with chronic diseases had significantly lower scores in all outcome measures compared to those without (P < .05). However, after adjusting for confounders such as age, body mass index, education, and employment status, group differences were no longer statistically significant. Age, education level, static balance, and right foot dynamic balance were significantly associated with mobility. The results highlight the need for early assessment and preventive strategies targeting mobility, balance, and cognitive functioning in middle-aged individuals with chronic diseases.

PMID:41324948 | DOI:10.1177/00914150251401565

J Back Musculoskelet Rehabil. 2025 Dec 1:10538127251398406. doi: 10.1177/10538127251398406. Online ahead of print.

ABSTRACT

BackgroundLow back pain (LBP) is a common condition impacting the lumbar region, leading to significant dysfunction and diminished quality of life. This study focuses on understanding the burden of LBP in China and projects its incidence trends over the next 20 years. Data from the Global Burden of Disease Study 2021 (GBD 2021) was used to conduct the analysis.MethodsThe study employed multiple statistical approaches, including Joinpoint regression analysis, Age-Period-Cohort Model (APCM), Decomposition Analysis, and the Autoregressive Integrated Moving Average (ARIMA) model, to assess the trends in LBP prevalence, incidence, and Disability-Adjusted Life Years (DALYs) in China from 1990 to 2021 and predict future trends through 2041.ResultsIn 2021, LBP affected 628838475 individuals globally, with China accounting for 16% of this burden. Between 1990 and 2021, although the absolute number of LBP cases, incidence, and DALYs increased, the rates per 100000 people decreased. Age-specific analysis indicated LBP onset from age 5, peaking in the 55-59 age group. Females showed higher prevalence, incidence, and DALYs compared to males. Projections suggest the incidence rate will rise from 2343.78 per 100000 people in 2022 to 2560.92 per 100000 in 2041.ConclusionsThe findings highlight the increasing burden of LBP in China, emphasizing the urgent need for targeted prevention and treatment strategies. Future interventions should aim at reducing the impact of LBP to improve overall health and quality of life in affected populations.

PMID:41324923 | DOI:10.1177/10538127251398406

Subst Use Misuse. 2025 Dec 1:1-4. doi: 10.1080/10826084.2025.2592227. Online ahead of print.

ABSTRACT

OBJECTIVE: Since the 2018 Farm Bill, many new types of intoxicating cannabis products (ICPs) are widely sold throughout the United States. However, there is little information on popular brands, which is essential for understanding associated risks, marketing strategies, and major industry players who may oppose effective public health legislation. The current study identified popular ICP brands in vape shops across the U.S.

METHODS: In November-December 2023, telephone surveys were conducted for 520 vape shops across all 50 states, Washington, D.C., and Puerto Rico. Google Maps was used to locate 10 vape shops per state/territory. Shops were asked about the availability of THC products and popular brands. Responses were dual-coded, and descriptive statistics were used to describe popular ICP brands.

RESULTS: Vape shops in 48 states/territories reported selling ICPs. Overall, 74% of shops surveyed sold ICPs. Among these, 62% (N = 273) provided information about brands (N = 188 unique brands; average 2.4 per shop). The top ten brands identified were Torch (12.7%), Mellow Fellow (9.7%), Cake (8.4%), Modus (8.0%), Delta Extrax (7.6%), Hidden Hills (7.6%), Looper (7.2%), Urb (7.2%), Ghost (6.3%), and Space Gods (6.3%).

CONCLUSION: This is the first study to systematically document popular brands of ICPs sold in vape shops nationwide. Findings suggest substantial competition in the market including many popular brands. These brands provide a foundation for future research assessing the characteristics of products from these brands and use prevalence, the nature of the industries producing these products, and industry dynamics over time, all of which can help inform regulatory efforts.

PMID:41324909 | DOI:10.1080/10826084.2025.2592227

Integr Psychol Behav Sci. 2025 Dec 1;59(4):89. doi: 10.1007/s12124-025-09944-1.

ABSTRACT

In this chapter, I draw inspiration from American psychologist Jim Lamiell to explore the original meanings of the terms “idiographic” and “nomothetic” as conceptualized by Wilhelm Windelband in 1894. Windelband critiqued the traditional division between natural and human sciences, proposing instead a new classification system that distinguishes scientific inquiries into idiographic and nomothetic fields. According to Windelband, scientific endeavors should be categorized based on the researcher’s goals: if the aim is to discover general, invariant laws governing physical and mental phenomena, the approach is nomothetic. In contrast, if the goal is to understand the uniqueness and depth of individual experiences, literature, or national moods-among other psychophysically neutral phenomena-the research is idiographic. This chapter demonstrates that historically, idiographic and nomothetic research were intended to complement and enrich each other. In the latter part of the paper, I contrast Windelband’s historical interpretation with modern views that often equate quantitative, statistical research (generalizations from samples to populations) with nomothetic research and single-case qualitative research with idiographic. I argue that this modern interpretation diverges from Windelband’s original concepts and suggest, in line with Lamiell, that population generalization may be more sensitive to cultural and historical contexts, thus aligning more closely with idiographic research than commonly assumed. Building on this analysis, I introduce the concept of synthography as a novel methodological framework aimed at integrating nomothetic and idiographic perspectives into a more comprehensive and culturally grounded approach to psychological inquiry.

PMID:41324849 | DOI:10.1007/s12124-025-09944-1

Mol Neurobiol. 2025 Dec 1;63(1):230. doi: 10.1007/s12035-025-05469-1.

ABSTRACT

Schizophrenia (SCZ) is a complex polygenic disorder influenced by genetic, epigenetic, and environmental factors. While numerous risk loci disease-associated methylation variants have been identified, their functional impact and contribution to disease risk remain largely unclear. This study addresses a fundamental yet underexplored question: how do non-coding allele-specific methylation (ASM) sites influence disease risk via gene regulation? We employed the Mendelian randomization (MR) method to integrate ASM data from monozygotic twins discordant for psychiatric disorders with brain eQTL and GWAS summary statistics to identify potential risk genes. The regulatory of the rs2280906 locus was investigated using dual-luciferase reporter assays, gene expression quantification, gene editing, methylation editing, and electrophoretic mobility shift assays. We used MR to prioritize these ASM locus associated with schizophrenia risk and demonstrated that the affected genes are enriched in energy metabolism pathways-suggesting that targeting energy dysregulation may represent a promising therapeutic avenue. We further elucidated the allele-specific, methylation-dependent mechanism by which ASM site rs2280906 regulates risk gene MYOM2. In healthy individuals, hypomethylation of the reference C allele permits MYOM2 expression. In contrast, affected individuals exhibit hypermethylation of this allele, leading to biallelic methylation, increased recruitment of repressive transcription factors, and MYOM2 downregulation. Our study uncovers new risk genes regulated by ASM and provide mechanistic insight into the rs2280906-MYOM2 axis in schizophrenia. Our work advances understanding of how epigenetic regulation contributes to disease susceptibility and inter-individual variability, and offers new avenues for the identification of causal variants and therapeutic targets.

PMID:41324836 | DOI:10.1007/s12035-025-05469-1

Prev Sci. 2025 Dec 1. doi: 10.1007/s11121-025-01860-5. Online ahead of print.

ABSTRACT

The COVID-19 pandemic had disparate impacts on Black and Hispanic Americans, as observed in mortality and infection rates. The mental health impact of the pandemic is less clear, with little research exploring mental health disparities and differences by state and region. Using the Behavioral Risk Factor Surveillance System (BRFSS), state-level differences in unhealthy mental health days were examined between 2019 and 2021 for White, Black, and Hispanic respondents. Nonparametric tests assessed group differences in unhealthy mental health days, while state-level within- and between-group difference scores highlighted areas with the greatest disparities. Both White and Black respondents experienced significantly more unhealthy mental health days in 2021 than in 2019; though Hispanic respondents reported more unhealthy days in 2021 than in 2019, this finding was not statistically significant. Black respondents, but not Hispanic, reported significantly more unhealthy mental health days than White respondents in 2021. Missouri had the worst outcomes for Black respondents, with the greatest increase in unhealthy mental health days between 2019 and 2021 and the greatest difference between White and Black groups in 2021. Regionally, the Northeast had the best outcomes for Black respondents and the Midwest had the worst. These findings can help identify population groups and geographic areas most in need of disaster-preparedness efforts and policy interventions for future public health emergencies. Practitioners and state health officials can use these findings to identify potentially impactful community interventions, or to develop infrastructure for addressing community mental health.

PMID:41324832 | DOI:10.1007/s11121-025-01860-5