Nevin Manimala

J Acquir Immune Defic Syndr. 2026 Jan 1;101(1):95-102. doi: 10.1097/QAI.0000000000003765.

ABSTRACT

OBJECTIVE: To examine the association between mild kidney disease and coronary plaque parameters using coronary computed tomography angiography in people living with HIV (PWH) compared with people without HIV in Uganda.

DESIGN: Cross-sectional secondary analysis.

METHODS: We studied 165 participants aged >45 years with ≥1 cardiovascular risk factor (78 PWH on stable antiretroviral therapy, 87 HIV-negative). Kidney function was assessed using estimated glomerular filtration rate (eGFR) and albumin-creatinine ratio (ACR). Coronary artery disease (CAD) was characterized by segment involvement score (SIS), segment stenosis score (SSS), and coronary artery calcium score. Multivariable Tobit regression assessed associations of kidney function measures with CAD parameters, testing for differences by HIV status.

RESULTS: The median (interquartile range) age was 57.0 (53-62) years, 62.4% of subjects were female, and 87.3% had hypertension. Among PWH, mildly impaired eGFR (<90 mL/min/1.73 m2) was associated with higher SIS [β 3.31, 95% confidence interval (CI): 0.41 to 6.21, P = 0.03] and SSS (β 5.95, 95% CI: 0.54 to 11.36, P = 0.03). The association with SIS remained significant after adjusting for age, gender, and 10-year ASCVD score (β 2.58, 95% CI: 0.10 to 5.06, P = 0.04). Associations of ACR with coronary plaque were not statistically significant for participants with or without HIV (all P > 0.07).

CONCLUSION: In PWH, mildly reduced eGFR was associated with greater coronary plaque burden (SIS, SSS) but not coronary artery calcium; ACR showed no associations with any CAD measures. Incorporating kidney function measures into cardiovascular risk assessment may be valuable in HIV care.

PMID:41380171 | DOI:10.1097/QAI.0000000000003765

J Addict Nurs. 2025 Dec 5. doi: 10.1097/JAN.0000000000000686. Online ahead of print.

ABSTRACT

BACKGROUND: Stigma is a key barrier to accessing or receiving substance use services. Those with substance use disorders (SUD) who seek health care services experience stigmatizing attitudes and behaviors from health care providers, including nurses. Integrating substance use-related content into core courses for advanced practice nursing students may help reduce stigma and prepare them to assist patients with SUDs across various specialties where advanced practice nurses work. This exploratory descriptive study assessed advanced practice nursing students’ attitudes and stigma perceptions related to caring for people with alcohol and drug use.

METHOD: An online survey was used to obtain demographic information and responses to three established measures focusing on substance use-related attitudes, perceptions, and stigma. Data were collected from students (baseline group) scheduled to take core required “3P” courses (Physical Assessment, Pathophysiology, and Pharmacotherapy) into which enhanced substance use-related content was infused. A separate group (postcourse) completed the measures after the enhanced courses. Descriptive statistics were obtained for demographic data, and means and standard deviations were calculated for subscales and total scores of the Person-Centered Drug and Drug Problems Perception Questionnaire, the Person-Centered Alcohol and Alcohol Problems Perception Questionnaire, and the Opening Minds Scale to examine differences before and after the enhanced content.

RESULTS: Eleven students completed the baseline survey and 12 completed the postcourse survey. Although statistical comparison was not possible, postcourse responses reflected more favorable attitudes toward people with SUD.

CONCLUSION: The more favorable attitudes following the 3P courses are promising. Future research should use more rigorous pre-post or longitudinal designs.

PMID:41380164 | DOI:10.1097/JAN.0000000000000686

Obstet Gynecol. 2025 Dec 11. doi: 10.1097/AOG.0000000000006147. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine preferences for human papillomavirus (HPV) specimen self-collection, and collection location, in a nationally representative sample of reproductive-aged women in the United States.

METHODS: This cross-sectional analysis used household population-based data from the National Survey of Family Growth (January 2022-December 2023) and was limited to women aged 21-49 years without a history of hysterectomy or cervical cancer (sample n=4,465). Survey weights and design variables were applied to generate nationally representative population frequencies and percentages of preference for HPV self-collection compared with clinician collection, and preference for collection location (ie, at home or in office).

RESULTS: Among eligible U.S. women, 42.9% preferred HPV self-collection, 28.5% preferred clinician collection, and 28.6% expressed no preference. An estimated 41.7 million (71.5%) U.S. women aged 21-49 years were open to HPV self-collection (either preferring it or having no preference), including 9.7 million women who were underscreened or never screened. Among women who were open to HPV self-collection, more than half (52.1%) preferred self-collection at home, 14.7% preferred to do self-collection in a doctor’s office, and 33.2% had no preference for location. More underscreened or never-screened women preferred HPV self-collection (54.0%) and at-home collection (59.3%) compared with those who were up to date with screening (40.3% and 50.2%, respectively, P<.001). Preference for self-collection also varied by race and Hispanic origin, education, income, parity, sexual orientation, and prior experience of nonvoluntary vaginal intercourse.

CONCLUSION: In this nationally representative study, more than 7 in 10 U.S. women aged 21-49 years were open to HPV self-collection for cervical cancer screening, with more than half favoring at-home collection. Preference was higher among women who were not up to date with screening. These findings provide timely evidence to inform future policy decisions and implementation strategies to improve access to cervical cancer screening.

PMID:41380156 | DOI:10.1097/AOG.0000000000006147

JMIR Mhealth Uhealth. 2025 Dec 11;13:e73512. doi: 10.2196/73512.

ABSTRACT

BACKGROUND: Approximately 1 out of 5 pregnant women develops depression. Internet-based cognitive behavioral therapy (iCBT) is an effective way to treat not only depression but also mild depressive symptoms or subthreshold depression. While numerous iCBT programs have been developed and tested through randomized controlled trials for various mental health conditions and specific populations, research on their effectiveness and application in the real world remains limited.

OBJECTIVE: This study aimed to examine the effectiveness of a previously developed iCBT program implemented in an existing app for improving depressive symptoms among pregnant women in a real-world setting.

METHODS: The previously developed iCBT program for preventing perinatal depression was already implemented in an existing app called Luna Luna Baby by MTI Ltd. The app aims to provide information to pregnant women about pregnancy and babies, and potential users can download it from the Japanese version of the Apple App Store or Google Play Store without any fee. The program does not require any additional fees. The log data stored on the app identified iCBT program users and nonusers, allowing us to conduct this retrospective cohort study. Data from September 2022 to September 2024 were extracted from the app after anonymous processing. The primary outcome was the score on the self-reported Edinburgh Postnatal Depression Scale (EPDS), which participants answer by themselves on the app. The exposure group was defined as completers of all 6 modules of the iCBT program. The nonexposure group was defined as users who did not use any module of the program and matched the baseline characteristics of the exposure group. The change in EPDS score before and after using the program was compared using effect sizes, and repeated 2-way ANOVA was conducted to test the difference between the exposure and nonexposure groups.

RESULTS: Data from 119 women who completed the iCBT program and 448 pair-matched controls were selected. The average EPDS scores at baseline were 7.24 (SD 5.30) in the exposure group and 7.25 (SD 5.18) in the nonexposure group. After using the iCBT program, the group mean EPDS scores changed by -0.69 (SD 4.92) and +0.99 (SD 5.56) over time in the exposure and nonexposure groups, respectively (Cohen d=0.31, 95% CI 0.11-0.51). The repeated 2-way ANOVA showed statistical significance in the interaction terms between the groups and the measurement time points (P=.04).

CONCLUSIONS: The previously developed iCBT program showed a significant effect with a modest effect size on decreasing depressive symptoms among pregnant women in a real-world setting. Future research should attempt to minimize dropouts and increase participation in the program.

PMID:41380149 | DOI:10.2196/73512

JMIR Mhealth Uhealth. 2025 Dec 11;13:e82465. doi: 10.2196/82465.

ABSTRACT

BACKGROUND: Sleep is essential for overall health and plays a critical role in the diagnosis of psychiatric disorders. Although polysomnography remains the gold standard for measuring sleep, its reliance on laboratory settings limits its feasibility for long-term, naturalistic monitoring, particularly for patients with mental disorders.

OBJECTIVE: This study assesses sleep-tracking reliability and alignment in healthy individuals and patients with mood disorders using wearables, nearables, and ecological momentary assessment, while examining measurement biases and the impact of seasonal and demographic factors on discrepancies across methods.

METHODS: We conducted a 14-day study in Finland and enrolled a total of 201 participants, comprising patients with a major depressive episode and healthy controls. Of these, 169 participants with sufficient observations were retained for further analyses. Participants’ sleep patterns (onset, offset, and total sleep time [TST]) were gathered daily from an actigraph (Actiwatch 2), a bed sensor (Murata SCA11H), mobile screen events, and a daily survey. The alignment between sleep measurement methods was evaluated using Bland-Altman plots and Pearson correlation. Linear mixed models were used to assess the effects of demographics, season, and disorder type on the sleep measures alignment.

RESULTS: Patients exhibited greater variability in sleep measures than healthy controls. For sleep onset, mean biases between devices were small and not statistically significant in either group, with moderate to strong correlations. In contrast, sleep offset showed significantly larger biases in patients: actigraph versus bed (+34.9 minutes; P=.01), smartphone versus bed (-45.3 minutes; P=.004), and actigraph versus smartphone (+78.7 minutes; P<.001), while controls exhibited minimal and nonsignificant differences. For TST, smartphone underestimates sleep compared to both bed sensors (-0.71 minutes; P<.001) and actigraphs (-1.35 minutes; P<.001). Across devices, TST correlations remained low, spanning r=0.12 (P=.58) to r=0.55 (P=.10) in controls and r=0.17 (P=.19) to r=0.43 (P=.002) in patients. Mixed models showed that older age was linked to better sleep offset alignment between actigraphy and bed sensors (β=-0.02, 95% CI -0.04 to 0.00; P=.048), as well as smartphone and bed sensor (β=-0.03, 95% CI -0.06 to 0.00; P=.03). Patients with bipolar/borderline personality disorder showed lower TST alignment, and alignment between smartphone and bed sensor was worse in females (β=-1.03, 95% CI -1.74 to -0.33, P=.004). Longer daylight duration was also associated with improved alignment in sleep offset and TST.

CONCLUSIONS: This study demonstrates the feasibility of using actigraphy, smartphone data, and bed sensors for sleep tracking in naturalistic settings with patients. It highlights measurement biases across devices, the impact of seasonal variations on sleep research in unique geographical regions like Finland, and key demographic factors influencing sleep measurement discrepancies.

PMID:41380148 | DOI:10.2196/82465

J Am Acad Orthop Surg Glob Res Rev. 2025 Dec 10;9(12). doi: 10.5435/JAAOSGlobal-D-25-00037. eCollection 2025 Dec 1.

ABSTRACT

INTRODUCTION: Interspinous process devices (IPDs) are a lesser invasive treatment option for lumbar spinal stenosis (LSS). The utility of IPDs has been debated, and no recent, large-scale representative database studies have examined utilization and revision surgery trends of IPDs.

METHODS: Patients with LSS undergoing IPD placement were identified from the 2017-2022 M170Ortho PearlDiver Database and stratified by direct lumbar decompression usage and levels treated. Yearly IPD utilization of the study populations was tracked, and notable changes in usage were identified. Provider specialties placing IPDs were assessed. Kaplan-Meier survival analyses followed 3-year subsequent lumbar operation rates.

RESULTS: A total of 10,422 patients with LSS undergoing IPD placements were identified, with a significant utilization increase from 2017 to 2020 (P = 0.027) and decrease from 2020 to 2022 (P = 0.039). These were done without direct decompression for 6183 (59.3%) and with direct decompression for 4239 (40.7%), with greater proportion performed without decompression over the years (P = 0.032). One-level procedures were 6,723 (64.5%) and two-level procedures were 3,699 (35.5%), with similar proportions over the years. Orthopaedic/neurologic surgeon utilization decreased, with pain specialists becoming the predominant providers using IPDs. Overall 3-year revision surgery rate was 12.0%, and no differences existed in revision surgery rates by decompression usage (P = 0.2) or levels treated (P = 0.3).

DISCUSSION: This study is first to report on the notable IPD utilization decrease from 2020 to 2022 after strong adoption from 2017 to 2020. This aligned with an increasing proportion placed without decompression and by pain specialists, with no revision surgery rate differences. Although the reason for this change over time is unclear, this study reports shifting physician practices with IPDs.

PMID:41380147 | DOI:10.5435/JAAOSGlobal-D-25-00037

Spine (Phila Pa 1976). 2025 Dec 10. doi: 10.1097/BRS.0000000000005591. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective single-center cohort study.

OBJECTIVE: To compare the predictive performance of the International Spine Study Group (ISSG) – Surgical Invasiveness Index (SII) and the European Spine Study Group (ESSG) – Adult Deformity Surgery Complexity Index (ADSCI) for outcomes after adult spinal deformity (ASD) surgery.

SUMMARY OF BACKGROUND DATA: In 2018, the ISSG and ESSG developed their surgical complexity indices specific to surgical treatment of ASD. However, no study has compared these two indices against one another, hindering surgeon decision-making.

METHODS: A retrospective single-center study of patients who underwent ASD surgery with complete baseline and two-year follow-up data were assessed via the ISSG-SII and the ESSG-ADSCI. The primary outcome measure was a composite binary outcome of any postoperative surgical or medical complications. Secondary outcomes included intraoperative estimated blood loss (EBL), operative time, length of stay (LOS), intraoperative complications, reoperations, and specific complications. We used multivariable logistic and linear regression to compare indices.

RESULTS: A total of 586 patients who underwent surgery for ASD (mean age: 57.6 y; 76.5% female; BMI: 27.1 kg/m²; mean ISSG-SII score: 94.7±36.4; mean ESSG-ADSCI score: 21.9±6.6) met inclusion criteria. After controlling for age, gender, body mass index, and Charlson Comorbidity Index, the ISSG-SII (aOR: 1.007; P=0.019) and the ESSG-ADSCI (aOR: 1.031; P=0.046) were statistically significant but weak predictors of any surgical or medical complication. Similar weak results were observed for EBL, operative time, and LOS were seen (all unstandardized ß<0.300). Similar poor performance was seen for intraoperative complications, mechanical complications, reoperation, distal junctional kyphosis, coronal imbalance, sagittal imbalance, or pseudoarthrosis.

DISCUSSION: ISSG-SII and ESSG-ADSCI demonstrated comparable but limited predictive ability across multiple surgical and postoperative outcomes among patients who underwent ASD surgery. While the results support practical utility, independent calibration is necessary prior to clinical application.

PMID:41380141 | DOI:10.1097/BRS.0000000000005591

N Z Med J. 2025 Dec 12;138(1627):42-54. doi: 10.26635/6965.7132.

ABSTRACT

AIMS: Despite dramatic declines in coronary heart disease (CHD) incidence in Aotearoa New Zealand over more than 50 years, the burden of CHD is still inequitable, particularly for Māori and Pacific peoples. We studied recent trends in first hospitalisations for acute coronary syndromes (ACS) by ethnicity.

METHODS: All first ACS hospitalisations (2005-2019) were identified from national administrative datasets. Population denominators were constructed using multiple linked national data sources. Trends in rates of incident ACS and incidence rate ratios (IRRs) were analysed for younger (20-59 years) and older (60-84 years) patients.

RESULTS: The ACS cohort (n=69,161) comprised 74.7% European, 14.2% Māori, 6.1% Pacific peoples, 2.8% Indian and 2.2% non-Indian Asian peoples. For younger patients, annual ACS incidence initially decreased in all ethnic groups but plateaued between 2013 and 2015 for Māori, non-Indian Asians and Europeans; the decline was minimal for Pacific peoples across the time period. In older patients ACS incidence initially fell for all groups, but plateaued for Māori from 2015, and slowed after 2014 for Europeans. IRRs, compared with Europeans, increased between 2005 and 2019 for younger Māori (IRR 1.5 to 2.25, p=0.017) and Pacific peoples (IRR 1.25 to 1.5, p<0.001), and for older Māori (IRR 1.35 to 1.6, p=0.006) and Pacific peoples (IRR 1.0 to 1.6, p<0.001).

CONCLUSION: Rates of decline in ACS incidence have stalled or slowed for most younger ethnic groups, and for older Māori and Europeans. The differential rate of change between ethnic groups has resulted in increasing inequity for Māori and Pacific peoples across the age range.

PMID:41380123 | DOI:10.26635/6965.7132

N Z Med J. 2025 Dec 12;138(1627):36-41. doi: 10.26635/6965.7126.

ABSTRACT

AIM: To quantify the current state of the cardiology specialist workforce in Health New Zealand – Te Whatu Ora.

METHODS: The Cardiac Society of Australia and New Zealand sent a survey to all Health New Zealand – Te Whatu Ora cardiology departments in 2024, requesting information on specialist cardiac staff. Population information was obtained from Health New Zealand – Te Whatu Ora. International comparisons were obtained by website search.

RESULTS: Of 154 Health New Zealand – Te Whatu Ora-employed cardiologists, 119 (77%) were male, and 113 (73%) received cardiology training in New Zealand. Over half were aged >50, 35% >55, including 18% >60 years. Time in current position was 12±9 years and the vacancy rate was 14%. The current ratio of persons per cardiologist is 35,000. In the five districts with the highest proportion of Māori and Pacific peoples, this ratio exceeds the national average: Tairāwhiti 54,000; Counties Manukau 38,000; Lakes 61,000; Northland 52,000; Hawke’s Bay 47,000. For cities with cardiac surgery the ratio is 32,000 and without is 46,000. International ratios include: United States of America (USA) 15,000; Canada 25,000; United Kingdom (UK) 40,000 and Australia 25,000 persons per cardiologist.

CONCLUSIONS: Health New Zealand – Te Whatu Ora has an experienced but ageing cardiologist workforce, with many vacancies. Districts with higher Māori/Pacific populations have fewer cardiologists per capita than the national average of 1:35,000, which is similar to the UK, but less than the USA, Australia and Canada.

PMID:41380122 | DOI:10.26635/6965.7126

JMIR Med Inform. 2025 Dec 11;13:e77891. doi: 10.2196/77891.

ABSTRACT

BACKGROUND: Acute care use (ACU) represents a major economic burden in oncology, which can ideally be prevented. Existing models effectively predict such events.

OBJECTIVE: We aimed to quantify the cost savings achieved by implementing a model to predict ACU in oncology patients undergoing systemic therapy.

METHODS: This retrospective cohort study analyzed patients with cancer at an academic medical center from 2010 to 2022. We included patients who received systemic therapy and identified ACU events occurring after treatment initiation, excluding those with known death dates within the study period. Data on ACU-related expenses were gathered from Medicare claims and mapped to service codes in electronic health records, yielding average daily costs for each patient over 180 days following the start of therapy. The exposure was an ACU event.

RESULTS: The main outcome was the average daily cost per patient at the end of the first 180 days of systemic therapy. We observed that expense accumulation flattened earlier and more rapidly among non-ACU patients. This study included 20,556 patients, of whom 3820 (18.58%) experienced at least 1 ACU. The average daily cost per patient for those with and without ACU was US $94.62 (SD US $72.54; 95% CI US $92.32-$96.92) and US $53.28 (SD US $59.92; 95% CI US $52.37-$54.19), respectively. The average total cost per ACU and non-ACU patient was US $17,031.92 (SD US $13,056.63; 95% CI US $16,616.74-$17,445.09) and US $9591.06 (SD US $10,785.83; 95% CI US $9427.64-$9754.48), respectively. To estimate the long-term financial impact of deploying the predictive model, we conducted a cost-benefit analysis based on an annual cohort size of 2177 patients. In the first year alone, the model yielded projected savings of US $910,000. By year 6, projected savings grew to US $9.46 million annually. The cumulative avoided costs over a 6-year deployment period totaled approximately US $31.11 million. These estimates compared the baseline cost model to the intervention model assuming a prevention rate of 35% for preventable ACU events and an average ACU cost of US $17,031.92 (SD US $13,037).

CONCLUSIONS: Predictive analytics can significantly reduce costs associated with ACU events, enhancing economic efficiency in cancer care. Further research is needed to explore potential health benefits.

PMID:41380118 | DOI:10.2196/77891