Nevin Manimala

J Racial Ethn Health Disparities. 2025 May 6. doi: 10.1007/s40615-025-02461-2. Online ahead of print.

ABSTRACT

INTRODUCTION: Pregnancy and childbirth traditionally bring worry or a sense of anxiety and distress, particularly among Black women that face historical and contemporary anti-Black racism. We employed two frameworks to assess manifestations of anti-Black racism, structural racism and obstetric racism, as predictors of worry about pregnancy and birth within the Black reproducing community.

METHODS: In a secondary cross-sectional analysis, we analyzed data from Black women in the Giving Voice to Mothers study who completed all relevant items (n = 260). We conducted descriptive analyses and logistic regression models to explore how worry about pregnancy and birth for the Black reproducing community varies with experiences of obstetric racism and different manifestations of structural racism.

RESULTS: Approximately 71% of the sample worried about pregnancy and birth for themselves and their community. Black women who experienced obstetric racism were statistically significantly more likely to be worried about pregnancy and birth experiences compared to Black women who did not. Furthermore, when structural racism was manifested and measured as hidden resources, among Black women reporting fewer pregnancy and birthing care options for women of color, those who experienced obstetric racism during care were 15.6 times more likely to worry about pregnancy and birthing experiences than those who did not (OR 15.667; 95% CI 1.348-182.058).

CONCLUSION: The findings demonstrate the complexity of racialized harm enacted against Black women during the perinatal period and underscore the ways in which obstetric racism and contexts of structural racism powerfully shape the meaning and subsequent emotional impact of pregnancy and birthing while Black.

PMID:40327291 | DOI:10.1007/s40615-025-02461-2

Adv Ther. 2025 May 6. doi: 10.1007/s12325-025-03183-x. Online ahead of print.

ABSTRACT

INTRODUCTION: This study used network meta-analysis (NMA) to evaluate the comparative efficacy of available advanced therapies for moderately to severely active Crohn’s disease (CD) versus the IL-23 inhibitor guselkumab.

METHODS: A systematic literature review was conducted to identify randomized controlled trials (RCTs) of advanced therapies in moderately to severely active CD. Bayesian NMAs were conducted for outcomes of clinical response, clinical remission, endoscopic response, and a combined outcome of clinical remission with endoscopic response, at the end of the maintenance phase (up to 1 year). Primary analyses included patients with varied prior inadequate treatment responses, with additional analyses conducted for specific subgroups. Re-randomized trials were normalized in several cases to mimic a standard treat-through design, incorporating data from additional sources, when necessary, for patients who had an inadequate response or experienced a delayed response following induction.

RESULTS: Of the 58 RCTs identified, 13 with maintenance endpoint data were ultimately included in the NMAs. Guselkumab 100 mg and 200 mg were more likely to be effective versus several comparators. Guselkumab 200 mg demonstrated significantly greater efficacy versus infliximab 10 mg/kg every 8 weeks and upadacitinib 30 mg daily for clinical response and clinical remission. For endoscopic response, guselkumab 200 mg showed significantly greater efficacy than ustekinumab, adalimumab, and upadacitinib. Significance was also noted versus ustekinumab on the combined outcome of clinical remission with endoscopic response. Similarly, guselkumab 100 mg demonstrated efficacy versus comparators across analyses. Guselkumab achieved higher rankings based on surface under the cumulative ranking curve. Findings of primary analyses within mixed populations were generally corroborated by subpopulation analyses.

CONCLUSION: Results of this NMA in moderately to severely active CD indicate a higher likelihood of guselkumab achieving each clinical and endoscopic endpoint analyzed at the end of the maintenance phase versus other advanced therapies assessed.

PMID:40327280 | DOI:10.1007/s12325-025-03183-x

AIDS Behav. 2025 May 6. doi: 10.1007/s10461-025-04741-8. Online ahead of print.

ABSTRACT

Accurate adherence measures to HIV pre-exposure prophylaxis (PrEP) are essential for identifying individuals with low adherence and providing tailored support. This systematic review summarizes evidence on the performance of PrEP indirect adherence measures and explores their potential use in clinical practice. Following a registered protocol (PROSPERO: CRD42020144733) we searched PubMed, Embase, LILACS and Web of Science until December 2024. We included studies that assessed PrEP adherence among individuals using daily oral PrEP with tenofovir disoproxil fumarate plus emtricitabine (TDF/FTC). The reference standard involved quantifying PrEP in dried blood spots or plasma, and index tests included self-reported adherence, pill counts, pharmacy records, electronic monitoring, or composite measures. We used QUADAS-2 to assess the risk of bias and applicability concerns. Twenty-three studies, which included 6649 individuals, fulfilled the inclusion criteria. Most were observational studies (n = 17, 73.9%), and the most common measure was self-report (n = 18, 78.3%). The performance of indirect measures was reported through accuracy statistics in 12 studies (52.2%), concordance in two (8.7%), correlation in eight (34.8%), and proportions in one (4.3%). The risk of bias and applicability concerns were generally low or unclear due to unclear reporting. This review underscores the wide heterogeneity of indirect measures used to assess PrEP adherence, with self-reports being the most frequently utilized. Despite some correlation with direct measures, these methods showed mixed evidence of accuracy, with studies reporting moderate discriminatory capacity for identifying high protective levels of TFV-DP. This finding limits the broader applicability of the measures and underscores the need for further research.

PMID:40327271 | DOI:10.1007/s10461-025-04741-8

J Cancer Educ. 2025 May 6. doi: 10.1007/s13187-025-02638-7. Online ahead of print.

ABSTRACT

In 2021, the US Preventive Services Task Force (USPSTF) issued a final recommendation to lower the initial age for colorectal cancer (CRC) screening to 45¹. At many institutions, trainees play a critical role in the implementation of CRC screening guidelines. The aim of the current study is to assess trainee awareness of recent changes to CRC screening guidelines. Trainees in surgical and non-surgical residency and fellowship programs at a single academic medical center were surveyed, in February of 2023, regarding awareness of recent changes to CRC screening guidelines. Additional information regarding trainee recommendations for various types of screening modalities and their perceptions of patient awareness was obtained. A total of 116 trainees responded to the survey, reflecting a 39% response rate. Of trainees recommending CRC screening, 75% recommended screening to be initiated at age 45, 13% at age 50, 6% at age 40, and 2% at age greater than 50. Trainee knowledge of screening guidelines came from medical school learning (70.7%) and USPSTF guidelines (82%). The most recommended screening modalities were colonoscopy (87%), fecal immunochemical testing (FIT) (31%), and fecal occult blood testing (FOBT) (15%). In comparing trainees who perform colonoscopies versus trainees from primary care specialties, there was no statistical difference between groups regarding knowledge on current screening guideline recommendations. Most trainees recommended CRC screening during their training. Unfortunately, many trainees were unaware of recent changes to CRC screening guidelines. These results revealed an important knowledge gap to be addressed among surgical and non-surgical trainees.

PMID:40327250 | DOI:10.1007/s13187-025-02638-7

J Assist Reprod Genet. 2025 May 6. doi: 10.1007/s10815-025-03496-4. Online ahead of print.

ABSTRACT

PURPOSE: The impact of oral GnRH antagonists on IVF treatment outcomes remains unclear. The aim of the study is to investigate the impact of GnRH antagonist over the outcomes of IVF.

METHODS: We performed an electronic search using MEDLINE® with the OvidSP interface PUBMED, Embase, Web of Science, and Cochrane Library up to December 16, 2024. We included experimental and non-experimental studies, assessing the role of oral GnRH during controlled ovarian stimulation protocols. Our main outcomes were cycle cancelation rate and mean number of mature oocytes retrieved at oocyte pickup (OPU) day.

RESULTS: We included four studies comprising 813 patients, of whom 452 women received oral GnRH antagonists and 294 received injectable subcutaneous GnRH antagonists. No statistical differences were noted in the meta-analysis between each outcome measured (cycle cancelation, mean overall and mature oocytes, fertilization rate, and blastulation rate). Using the GRADE criteria, the overall quality of the existing evidence was determined as moderate.

CONCLUSIONS: This is the first systemic review and meta-analysis to examine the usage of oral GnRH antagonists for ovulation suppression during IVF treatments. Our findings suggest the use of oral GnRH antagonists may be beneficial in infertility treatments; however, caution should be taken, as robust establishment of their effectivity and safety in clinical practice is still pending.

TRIAL REGISTRATION: Registration Number: PROSPERO study ID: CRD42024599730.

PMID:40327246 | DOI:10.1007/s10815-025-03496-4

J Patient Rep Outcomes. 2025 May 6;9(1):48. doi: 10.1186/s41687-025-00879-0.

ABSTRACT

BACKGROUND: Elexacaftor/Tezacaftor/Ivacaftor (ETI) is a therapy approved for cystic fibrosis (CF) that has given improved clinical outcomes in patients carrying the F508del mutation. There are few published data regarding ETI’s effects on patients’ quality of life (QoL). This study aims to (fill the data gap in current literature by assessing) evaluate the long-term effects of ETI on QoL.

METHODOLOGY: A prospective observational study was conducted with thirty-seven severe patients that received ETI for compassionate use (group A), 184 received it for on-label use (group B). All carried one F508del mutation. Patients were assessed using the CFQ-R (Cystic Fibrosis Questionnaire-Revised). The evaluation time-points were pre-treatment (T0), and after 12 (T1) and 24 months (T2); group A was also assessed after 36 months (T3). Twenty-five patients completed 3 years of treatment and 65 patients completed 2 years of treatment, in groups A and B respectively.

RESULTS: At T1, median values for almost all areas of CFQ-R statistically significant increased in group A, particularly Physical Functioning (+ 25.0), Respiratory (+ 22.2) and Health Perception (+ 22.2).The Social Functioning area statistically significant increased at T2 (+ 5.6). At T3, these improvements remained stable. At T1, all areas of CFQ-R statistically significant increased in group B, particularly the Health Perception (+ 22,2) heading. At T2, these improvements remained stable. For both groups, the changes identified at the last follow-up showed no major differences by gender, age or genetic status.

CONCLUSIONS: Treatment with ETI significantly improved patients’ QoL in both groups at 12-24 months, these improvements remaining stable in patients tested at 36 months.

PMID:40327240 | DOI:10.1186/s41687-025-00879-0

J Immigr Minor Health. 2025 May 6. doi: 10.1007/s10903-025-01672-3. Online ahead of print.

ABSTRACT

To identify distinct and shared health barriers, priorities, and desired information within minority communities by immigrant status. Health needs assessment surveys were conducted at three different health fairs in San Antonio from October 22, 2022 to January 14, 2023. Data was compared using descriptive statistics by immigration status. Among 59 US-born and 55 non-US-born respondents, nutrition and mental health were the highest health priorities. Time was a greater barrier among US-born respondents (p =.007) while lack of insurance was a greater barrier among non-US-born respondents (p =.008). Although the US-born group had higher rates of insurance (74%) compared to the non-US-born group (64%) (p =.019), both had similar rates of having a primary care provider. The US-born group had a higher number of emergency department (ED) visits (p =.030). There are multiple commonalities and differences among health needs in ethnically diverse communities in South Texas. Future health interventions targeted toward minority communities should consider nutrition and mental health while also addressing unique barriers. Multiple factors such as access to free clinics, personal safety, language, and health insurance status are integral to minority group health.

PMID:40327238 | DOI:10.1007/s10903-025-01672-3

Phys Eng Sci Med. 2025 May 6. doi: 10.1007/s13246-025-01540-2. Online ahead of print.

ABSTRACT

Breast tissue is mainly a mixture of adipose and fibro-glandular tissue. Cancer risk and risk of undetected breast cancer increases with the amount of glandular tissue in the breast. Therefore, radiologists must report the total volume glandular fraction or a BI-RADS classification in screening and diagnostic mammography. In this work, a Maximum Likelihood algorithm accounting for count statistics and scatter is shown to estimate the pixel-wise glandular fraction from mammographic images. The pixel-wise glandular fraction provides information that helps localize dense tissue. The total volume glandular fraction can be calculated from pixel-wise glandular fraction. The algorithm was implemented for images acquired with an anti-scatter grid, and those without using the anti-scatter grid but followed by software scatter removal. The work also studied if presenting the pixel-wise glandular fraction image alongside the usual mammographic image has the potential to improve the contrast-to-noise ratio on micro-calcifications in the breast. The algorithms are implemented and evaluated with TOPAS Geant4 generated images with known glandular fractions. These images are also taken with and without microcalcifications present to study the effects of glandular fraction estimation on microcalcification detection. The algorithm was then applied to clinical images with and without microcalcifications. For the TOPAS simulated images, the glandular fraction was estimated with a root mean squared error of 6.6% for the with anti-scatter-grid cases and 7.6% for the software scatter removal (no anti-scatter grid) cases for a range of 2-9 cm compressed breast thickness. Average absolute errors were 4.5% and 4.7% for a range of 2-9 cm compressed breast thickness respectively for the anti-scatter grid and software scatter-removal methods. For higher thickness and glandular fraction, the errors were higher. For the extreme case of 9 cm thickness, the glandular fraction estimation yielded 5%, 13% and 16% mean absolute errors for 20%, 30% and 50% glandular fraction. These errors lowered to 1.5%, 9% and 13.2% for a narrower spectrum for the 9 cm. Results from clinical images (where the true glandular fraction is unknown) show that the algorithm gives a glandular fraction within the average range expected from the literature. For microcalcification detection, the contrast-to-noise ratio improved by 17.5-548% in clinical images and 5.1-88% in TOPAS images. A method for accurately estimating the pixel-wise glandular fraction in images, which provides localization information about breast density, was demonstrated. The glandular fraction images also showed an improvement in contrast to noise ratio for detecting microcalcifications, a risk factor in breast cancer.

PMID:40327237 | DOI:10.1007/s13246-025-01540-2

Community Ment Health J. 2025 May 6. doi: 10.1007/s10597-025-01471-y. Online ahead of print.

ABSTRACT

Young adults experiencing psychosis are at high risk for disengagement from their daily lives. Occupational therapy (OT) services play an important role in fostering participation, yet their intervention efficacy in Early Intervention in Psychosis (EIP) remains poorly understood. To determine the commonly utilized OT interventions and measurement tools that require further research to determine their efficacy and effectiveness. Cross-sectional, mixed-methods survey study. Quantitative descriptive statistics were completed on Microsoft Excel and qualitative thematic analysis was completed by two researchers using Dedoose. Online survey. Occupational therapy practitioners (OTPs) working on EIP programs in the United States were recruited through purposive and snowball sampling. The survey consisted of 24 closed and open-ended questions assessing use of interventions, outcomes tracked, and measurement tools. Study had 21 respondents. The most frequent interventions were self-regulation and activities of daily living (ADL). Self-regulation interventions were overwhelmingly sensory-based. Most commonly reported outcome measure was observation of participation in occupations. This study confirms the use of sensory and ADL-based interventions by OTPs in EIP programs. Findings suggest a strong sense of the role of OT within EIP as intervention use is relatively consistent across programs and focuses on client-centered, occupation-based interventions. Outcome tracking and quality improvement were gaps as most OTPs are not using standardized methods or not performing this. Additional study is required to determine the efficacy of commonly used interventions and to improve outcome measurement methods in EIP programs. Occupational therapy is an undervalued profession on teams that provide services to young adults dealing with the onset of a psychotic illness. This study is the first of many needed to demonstrate the impact OT services can have on the outcomes of the young adults who receive care for their psychotic illness. This study identifies what OT interventions are common, and what outcomes OT professionals track to determine their services’ impact on these mental health care teams. These results will help to build the needed research on how helpful these common interventions are for young adults facing psychotic illnesses.

PMID:40327230 | DOI:10.1007/s10597-025-01471-y

J Patient Rep Outcomes. 2025 May 6;9(1):47. doi: 10.1186/s41687-025-00885-2.

ABSTRACT

BACKGROUND: Assessment of patient readiness for hospital discharge has been advocated as an important component of discharge preparation. However, no measures focused on hospital-to-home transitions for patients receiving a palliative approach to care, or the associated difficulties in coping at home after hospital discharge, have been developed to date. Using a co-design approach, the purpose of this study was to (1) adapt two scales to a palliative care population, one of which was developed to assess readiness for the hospital-to-home transition and another developed to assess difficulty in coping post-transition and to (2) test the content validity of both scales from the perspectives of patients, family caregivers, and healthcare providers. The scales chosen for adaptation were the Readiness for Hospital Discharge Scale and Post-Discharge Coping Difficulty Scale.

METHODOLOGY: The research team made initial adaptations to scale language prior to developing three parallel versions of each scale to be patient-, family caregiver-, and healthcare provider-facing. We conducted content validity testing of the items on both scales by asking each participant group to rate scale items on their usefulness, and to provide suggestions on ways items could be improved. We calculated the Item Content Validity Index and a modified Kappa statistic for each scale item, and calculated the Scale Content Validity Index for each of the three versions of the scales. Refinements were informed by qualitative feedback provided by participants during the content validity process. Final refinements were informed by members of a Patient and Family Advisory Council, and healthcare provider research team members.

RESULTS: Moderate modifications were required to the three versions of both scales. Modifications included adding items, modifying item language, and adding examples in parentheses to enhance item context. Patients, family caregivers, and healthcare providers deemed the research team’s initial modifications to the scales useful, as evidenced by each scale yielding a Scale Content Validity Index of higher than 0.5.

CONCLUSION: The methodology provided can be used as an example of ways to engage and leverage the experiences of healthcare system users and healthcare providers throughout the outcome measures development process. The next steps will be to utilize the adapted scales as intervention outcome measures in a subsequent implementation study.

PMID:40327215 | DOI:10.1186/s41687-025-00885-2