Nevin Manimala

JAMA Health Forum. 2025 Aug 1;6(8):e252647. doi: 10.1001/jamahealthforum.2025.2647.

ABSTRACT

IMPORTANCE: Recent trends in drug-related overdoses among adolescents have highlighted the need for mental health and substance use disorder (SUD) treatment. However, the extent of these treatment gaps is understudied.

OBJECTIVE: To characterize the factors associated with the diagnosis of and treatment for mental health and SUD for adolescents.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used survey-weighted descriptive statistics and χ2 tests to estimate differences in characteristics and treatment receipt and included US adolescents and young adults aged 12 to 20 years who participated in the National Survey on Drug Use and Health in 2021 and 2022. Data were analyzed from February 2024 to February 2025.

MAIN OUTCOMES AND MEASURES: Primary outcomes included the prevalence of depression and suicidality-related mental health diagnoses, SUDs, and treatment rates for both conditions. Additional measures included treatment setting, socioeconomic and demographic characteristics, and health insurance-related factors.

RESULTS: From 2021 to 2022, 13% of participants had SUD and 24% had a mental health diagnosis during the previous year (mean [SD] age, 16.0 [2.5] years; 48.4% female individuals; 6.1% Asian, 13.9% Black, 25.7% Hispanic, and 49.9% White individuals). Only 10% of participants with SUD and 51% of adolescents with mental health diagnoses received treatment for their conditions, with higher rates of treatment among adolescents with comorbid SUD and mental health diagnoses. When comparing adolescents (aged 12-17 years) and young adults (aged 18-20 years) with SUD for treatment receipt, reductions were found in any mental health treatment (63% vs 51%; P = .03) and any SUD treatment (11% vs 8%; P = .01). Moreover, these lower rates were also found in more resource-intensive treatment settings, such as inpatient mental health care (14% vs 9%; P = .02) and specialty mental health facilities (47% vs 33%; P = .003). However, adolescents with opioid use disorder were less likely to receive medication treatment (11% vs 28%; P = .02). Treatment differences were associated with socioeconomic and insurance coverage factors. Compared with adolescents, young adults with SUD experienced increased poverty rates (20% vs 26%; P = .02), uninsurance rates (5% vs 10%; P = .05), and private insurance rates (49% vs 56%; P = .02) while receiving decreased Medicaid coverage (47% vs 33%; P < .001) and government assistance (34% vs 25%; P = .001).

CONCLUSIONS AND RELEVANCE: The results of this cross-sectional survey study suggest that adolescents and young adults with SUDs rarely received treatment. Adolescents are especially vulnerable to treatment gaps once reaching young adulthood, and medications for opioid use disorder are systematically underused, especially for adolescents.

PMID:40880104 | DOI:10.1001/jamahealthforum.2025.2647

JAMA Netw Open. 2025 Aug 1;8(8):e2526636. doi: 10.1001/jamanetworkopen.2025.26636.

ABSTRACT

IMPORTANCE: The illicit use of anabolic androgenic steroids (AAS) is common among recreational athletes, yet studies on adverse cardiovascular outcomes, especially in female AAS users, are sparse.

OBJECTIVE: To assess cardiovascular status in Danish male and female recreational athletes using AAS compared with not using AAS.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study in a single center in Denmark included recreational athletes aged 18 years or older who were active AAS users, previous users (defined as those who discontinued AAS use at least 3 months prior to the study), or nonusers, all recruited from fitness centers between March and December 2022.

EXPOSURE: Cumulative lifetime use of AAS.

MAIN OUTCOMES AND MEASURES: Presence of atherosclerosis (carotid, femoral, and coronary artery plaques) and cardiac function assessed by echocardiography. Linear regression was used to estimate regression coefficients for echocardiographic characteristics and logistic regression to estimate odds ratios (ORs) for carotid and femoral plaques, coronary artery calcium (CAC) scores, and coronary noncalcified plaques (NCPs).

RESULTS: Of 164 participants, 80 (48.8%) were active AAS users (median age, 35 [IQR, 30-43] years; 61 men [76.2%]), 26 (15.9%) were previous users (median age, 36 [IQR, 28-51] years; 18 men [69.2%]), and 58 (35.4%) were nonusers (median age, 40 [IQR, 31-46] years; 42 men [72.4%]). Median cumulative lifetime AAS use was 2.2 (IQR, 1.2-7.2) years for active and 2.2 (IQR, 1.0-5.5) years for previous users. No group differences were observed when comparing the number of participants with femoral (active users, 15 [19.7%]; previous users, 5 [19.2%]; nonusers, 11 [20.8%]; P = .89) or carotid (active users, 24 [31.2%]; previous users, 12 [46.2%]; nonusers, 13 [24.1%]; P = .47) artery plaques or CAC scores (median score was 0 across all groups with range of 0-228 for active users, 0-800 for previous users, and 0-163 for nonusers; P = .36), whereas a statistically significant difference in the prevalence of coronary NCPs was found between active users (19 [23.8%]) and nonusers (6 [10.3%]) (P = .03). However, in confounder-adjusted logistic regression, longer cumulative lifetime AAS use was associated with higher odds of a positive CAC score (OR, 1.23; 95% CI, 1.09-1.39; P = .001) and presence of coronary NCPs (OR, 1.17; 95% CI, 1.05-1.30; P = .004). AAS use exceeding 5 years was associated with greater severity of calcifications (n = 94; χ2 = 9.78; P = .04). Echocardiography showed that cumulative AAS use was associated with worse left ventricular (regression coefficient: 0.08; 95% CI, 0.03-0.12; P = .002) and right ventricular (0.08; 95% CI, 0.03-0.13; P = .001) global longitudinal strain. Nearly all athletes (35 of 36) with more than 5 years of cumulative AAS use had ventricular mass greater than and left ventricular ejection fraction below the median of the normal range.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, cumulative lifetime AAS exposure was associated with adverse cardiovascular findings and impaired ventricular function in both sexes, and athletes with AAS exposure exceeding 5 years showed more severe calcification. The findings support measures to prevent AAS use by both men and women in recreational sports.

PMID:40880090 | DOI:10.1001/jamanetworkopen.2025.26636

JAMA Netw Open. 2025 Aug 1;8(8):e2529127. doi: 10.1001/jamanetworkopen.2025.29127.

ABSTRACT

IMPORTANCE: Postpartum uterine contraction pain manifests as a severe, intermittent lower abdominal discomfort caused by uterine contraction during the early puerperium. Transcutaneous auricular vagus nerve stimulation (taVNS) has demonstrated promising effects in managing both acute and chronic pain conditions; however, there remains a paucity of studies regarding the use of taVNS for alleviating postpartum uterine contraction pain.

OBJECTIVE: To investigate the effect of taVNS in alleviating postpartum uterine contraction pain among women receiving combined spinal-epidural anesthesia for elective cesarean delivery.

DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial was conducted from April 6 to August 31, 2024, at the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China. Participants were aged 18 years or older and scheduled for elective cesarean delivery. Statistical analysis was performed in September 2024. All analyses were conducted according to the intention-to-treat principle.

INTERVENTIONS: Participants were randomly allocated 1:1 to either the active taVNS group or the sham taVNS group. Both groups received the stimulation for 30 minutes each time, once a day, on the day of surgery and postoperative days 1 and 2.

MAIN OUTCOMES AND MEASURES: The primary outcome was the incidence of moderate to severe postpartum uterine contraction pain on the third postoperative day, evaluated using a visual analogue scale (uterine contraction pain was classified as moderate to severe if the score was ≥4). Secondary outcomes included peak uterine contraction pain and incision pain, postpartum anxiety, postpartum depression, postpartum recovery quality, and sleep quality.

RESULTS: A total of 156 women were recruited and randomized to the active taVNS group (78 patients; mean [SD] age, 31.5 [4.3] years) or the sham taVNS group (78 patients; mean [SD] age, 31.3 [4.5] years). The incidence of moderate to severe uterine contraction pain in the active taVNS group was 5.1% (4 of 78) compared with 28.2% (22 of 78) in the sham taVNS group on the third postoperative day (relative risk, 0.18 [95% CI, 0.07-0.50]; P < .001) The active taVNS group had lower median scores on the third postoperative day for incisional pain (visual analogue score: 2.20 [IQR, 2.00-2.50] vs 3.00 [IQR, 2.60-3.33]), depression (EPDS: 3.00 [IQR, 2.00-4.00] vs 5.00 [IQR, 3.00-6.00]), and anxiety (PRAQ-R2: 13.50 [IQR, 12.00-15.00] vs 15.00 [IQR, 13.75-17.00]), as well as significantly higher scores for recovery quality on the third postoperative day (ObsQoR-11: 104 [IQR, 103-105] vs 99 [IQR, 96-101]) and sleep quality on the second postoperative day (LSEQ: 52.00 [IQR, 50.00-55.00] vs 47.50 [IQR, 43.00-52.00]) compared with the sham taVNS group.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, taVNS significantly reduced uterine contraction pain, incisional pain, depression, and anxiety, and improved recovery quality and sleep quality compared with sham taVNS. These findings suggest that taVNS represents a novel and safe strategy for alleviating postpartum uterine contraction pain among women undergoing cesarean delivery and for promoting postoperative recovery.

TRIAL REGISTRATION: Chinese Clinical Trial Register Identifier: ChiCTR2400082716.

PMID:40880089 | DOI:10.1001/jamanetworkopen.2025.29127

JAMA Netw Open. 2025 Aug 1;8(8):e2530530. doi: 10.1001/jamanetworkopen.2025.30530.

ABSTRACT

IMPORTANCE: Although research has documented links between climate factors and violence, evidence specific to domestic violence (DV) remains limited, particularly in climate-vulnerable urban areas.

OBJECTIVE: To analyze the association between extreme heat events and DV-related calls to law enforcement in New Orleans, Louisiana, between 2011 and 2021.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used a spatially weighted time-stratified case-crossover design analyzing DV-related call data between January 1, 2011, and December 31, 2021, from the New Orleans Police Department. Statistical analysis was conducted from March to May 2024.

EXPOSURES: Daily mean Universal Thermal Climate Index (UTCI) data were used to define 6 extreme heat definitions based on thresholds (30 °C and 90th percentile) and durations (1, 3, or 5 consecutive days). Additional thresholds were considered in sensitivity analyses.

MAIN OUTCOMES AND MEASURES: The primary outcome was DV-related calls made. Calls were aggregated to zip code days, and conditional logistic regression weighted by cases per zip code day was used to evaluate the association between extreme heat and DV calls. Attributable fractions and attributable numbers of DV calls due to extreme heat exposure were calculated.

RESULTS: Of the 150 523 DV-related calls during the study period, 69.6% were classified as domestic disturbances, and 22.4% were classified as simple battery. Consistent positive associations were found between extreme heat and DV-related calls; for example, the likelihood of a DV-related call increased by 4% (odds ratio, 1.04; 95% CI, 1.02-1.07) when the mean UTCI was above 30 °C. Stronger associations were seen during prolonged exposure to extreme heat; when the mean UTCI exceeded the 90th percentile for 5 consecutive days, the likelihood of a DV-related call increased by 7% (odds ratio, 1.07; 95% CI, 1.03-1.12). Eliminating such heat wave events would most likely prevent approximately 245.0 DV-related calls (95% CI, 105.1-370.9) during the study period.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of the association between extreme heat and DV-related calls in New Orleans, DV-related calls were associated with extreme heat events, with the strongest associations observed during prolonged heat waves. These findings highlight the need to integrate climate adaptation with violence prevention strategies during such extreme heat events.

PMID:40880082 | DOI:10.1001/jamanetworkopen.2025.30530

Clin Pharmacokinet. 2025 Aug 29. doi: 10.1007/s40262-025-01560-x. Online ahead of print.

ABSTRACT

BACKGROUND: Suboptimal peak inspiratory flow rates (PIFR) are common in patients with chronic obstructive pulmonary disease (COPD), hindering effective medication dispersion and aerosol delivery. This study aimed to assess whether administering a preliminary bronchodilator dose via a pressurized metered-dose inhaler (pMDI) improves aerosol drug delivery via dry powder inhaler (DPI) in patients with COPD with suboptimal PIFR (< 60 L/min), compared with those with optimal PIFR (≥ 60 L/min).

METHODS: Overall, 24 patients with COPD were evaluated. PIFR was measured using the In-Check Dial^© G16, dividing patients into optimal and suboptimal groups. All patients received a 200 µg dose of salbutamol via Diskus^® DPI. Patients with COPD with suboptimal PIFR received two puffs (100 µg each) preceded by a preliminary salbutamol dose administered via pMDI^®. Urine salbutamol levels (USAL30) and salbutamol that was eluted from filters (SALF) were measured after 30 min to assess lung deposition through high-performance liquid chromatography (HPLC).

RESULTS: Patients with COPD with suboptimal PIFR without a preliminary dose had significantly lower USAL30 than the optimal group (4.99% versus 6.18%, p = 0.013). A preliminary dose improved USAL30 in the suboptimal group but did not reach statistical significance (5.45% versus 4.99%, p = 0.071).

CONCLUSIONS: A significant difference in aerosol drug delivery was observed between optimal and suboptimal groups without a preliminary dose, suggesting that inhaler selection in patients with COPD may need to be individualized on the basis of inspiratory flow capability. Administering a preliminary dose of pMDI^® before using a DPI minimally affects the suboptimal inhalation through DPI.

PMID:40880053 | DOI:10.1007/s40262-025-01560-x

Int J Clin Oncol. 2025 Aug 29. doi: 10.1007/s10147-025-02869-0. Online ahead of print.

ABSTRACT

BACKGROUND: Novel hormonal agents (NHAs), including enzalutamide, abiraterone acetate, apalutamide, and darolutamide, have improved survival in advanced prostate cancer (PCa). However, their potential neurological adverse effects (AEs)-notably cognitive impairment, seizures, and falls-raise safety concerns, particularly in older adults. This study aimed to compare the neurological safety profiles of NHAs in men with advanced PCa using a Bayesian network meta-analysis (NMA).

METHODS: We conducted a systematic review and Bayesian NMA following PRISMA-NMA guidelines. Comprehensive searches of PubMed, EMBASE, and Web of Science were completed through May 21, 2025. Eligible randomized controlled trials (RCTs) compared NHAs plus androgen deprivation therapy (ADT) with placebo, ADT, or other NHAs. Neurological AEs of interest included cognitive impairment, falls, and seizures. Bayesian random-effects models were used to calculate risk ratios (RRs) with 95% credible intervals (CrIs). Treatments were ranked using surface under the cumulative ranking curve (SUCRA) values.

RESULTS: Twenty-five RCTs with over 19,000 patients were included. No treatments showed a statistically significant increased risk of neurological AEs. Enzalutamide had the highest estimated risk for cognitive impairment (RR 3.88; 95% CrI, 0.697-22.1) and seizures (RR 13.8; 95% CrI, 0.983-1.07 × 10³), although not statistically significant. Darolutamide and nonsteroidal antiandrogens exhibited the most favorable neurological safety profiles across outcomes based on SUCRA rankings.

CONCLUSION: Although no NHA significantly increased neurological AEs, enzalutamide showed the highest estimated risk, while darolutamide and NSAAs ranked best for neurological safety. Darolutamide may be preferred in elderly patients, highlighting the need for further long-term safety data.

PMID:40880017 | DOI:10.1007/s10147-025-02869-0

Clin Transl Oncol. 2025 Aug 29. doi: 10.1007/s12094-025-04036-3. Online ahead of print.

ABSTRACT

BACKGROUND: History of malignant disease is a common exclusion criterion in clinical cancer trials, yet data on the impact of cancer survivorship on outcome in gastroesophageal cancer patients are scarce.

METHODS: Retrospective association analyses of self-reported prior or concurrent malignancies with patient characteristics, tumor characteristics, symptoms and overall survival (OS) were performed in 1491 gastroesophageal cancers patients treated between 01/01/2000 and 31/12/2021 at the Medical University of Vienna.

RESULTS: Of 1491 patients 255 (18%) had other primary cancer diagnoses, of which 185 (73%) occurred before, 52 (20%) at the same time as and 18 (7%) both before and at the same time as gastroesophageal cancer diagnosis. 205 (80%) patients had one, 43 (17%) had 2 and 7 (3%) had 3 other malignancies. History of other malignancies was associated with older age (p < 0.0001), squamous cell histology (p = 0.018), less aggressive localized tumor stages (p = 0.037) and fewer acid reflux (p = 0.011). There was neither an association between history of other primary malignancies nor the number of other cancer entities and OS (p = 0.47; p = 0.43).

CONCLUSION: Self-reported history of other malignant diseases is frequent in a real-life European gastroesophageal cancer cohort and was not statistically significantly associated with outcome, but rather with older age and squamous cell histology. Our data emphasize that cancer survivors should not be categorically excluded from clinical cancer trials due to fear of dismal prognosis. Prospective research is warranted to improve eligibility for this subgroup.

PMID:40880012 | DOI:10.1007/s12094-025-04036-3

Ir J Med Sci. 2025 Aug 29. doi: 10.1007/s11845-025-04073-5. Online ahead of print.

ABSTRACT

INTRODUCTION: Oesophageal reconstruction is a complex operation that continues to present a surgical challenge associated with significant morbidity and its associated sequelae. The conventional gastric conduit remains the gold standard reconstructive technique when available. Alternative conduits for oesophageal replacement become necessary when the stomach is unavailable with common options for conduit creation being the jejunum and the colon. The aim of this systematic review and network meta-analysis was to interrogate outcomes in oesophageal reconstruction with gastric pull-up, colonic interposition and jejunal flap.

METHODS: A systematic review of three electronic databases (PubMed, EMBASE and SCOPUS) was undertaken. An NMA as per the PRISMA-NMA guidelines. Statistical analysis was carried out using R and Shiny.

RESULTS: In a total of 19 studies, 3927 patients were included; 79.5% (3123/3927) of patients underwent gastric pull-up; 13.5% (531/3927) of patients underwent colonic interposition; 7% (273/3927) of patients underwent jejunal flap as their reconstructive method. At NMA, there was no significant difference in anastomotic leak rates, mortality rates, stricture formation, necrosis and length of stay between the three reconstructive techniques. Trend results showed jejunal flap performed better than colonic interposition in length of stay and mortality rates.

CONCLUSION: At present, the gastric conduit is the conventional and first choice for oesophageal reconstruction ab initio after oesophagostomy. Colonic interposition and jejunal free flap represent viable options and are associated with non-inferior short-term surgical outcomes when gastric pull-up is not available or feasible.

PMID:40879993 | DOI:10.1007/s11845-025-04073-5

Wien Med Wochenschr. 2025 Aug 29. doi: 10.1007/s10354-025-01107-6. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Non-alcoholic steatohepatitis (NASH) is a severe form of non-alcoholic fatty liver disease (NAFLD), characterized by hepatic inflammation and damage due to fat accumulation. Psoriasis patients show higher NASH incidence due to overlapping risk factors like obesity and insulin resistance. The study aimed to determine the incidence of non-alcoholic steatohepatitis in patients with psoriasis vulgaris.

METHODS: This cross-sectional observational study included 80 adult patients diagnosed with psoriasis vulgaris. Psoriasis severity was assessed using the Psoriasis Area and Severity Index (PASI) score. All participants underwent abdominal ultrasonography to assess liver steatosis. Those with significant findings suggestive of fatty liver were further evaluated with transient elastography (FibroScan, EchoSens, Paris, France) to determine liver stiffness and controlled attenuation parameter (CAP) values.

RESULTS: Among psoriatic patient diagnosed with NASH, the mean PASI score was 8.8 ± 3.6 which was higher than those diagnosed with NAFLD and non-NASH non-NAFLD patients (6.7 ± 4.5 and 7.1 ± 3.9, respectively); however, this difference was not statistically significant (P = 0.19). The percentage of moderate and severe psoriasis was higher in NASH patients (68.75%) compared to NAFLD and non-NASH non-NAFLD subjects (57.1% and 46.5%, respectively).

CONCLUSION: NASH and NAFLD are linked to psoriasis severity and systemic metabolic dysfunction. Future studies with larger cohorts and prospective designs are needed to validate these findings and explore underlying mechanisms.

PMID:40879966 | DOI:10.1007/s10354-025-01107-6

Metabolomics. 2025 Aug 29;21(5):127. doi: 10.1007/s11306-025-02327-y.

ABSTRACT

INTRODUCTION: Fatty acids (FAs) are essential for cellular structure, metabolism, and inflammatory regulation. This study investigated FA profiles in Crimean-Congo hemorrhagic fever (CCHF), a severe viral illness with high mortality rates, to explore their potential as disease progression and severity biomarkers.

METHODS: 190 participants were included in the study, comprising 115 CCHF-positive patients, 30 CCHF-negative patients, and 45 healthy controls. FA concentrations were analyzed via gas chromatography‒mass spectrometry (GC-MS).

RESULTS: Statistically significant differences in specific FA levels were observed between the study groups. Compared with mild and moderate cases, severe cases showed distinctive FA profiles. Notably, higher omega-6/omega-3 ratios and linoleic acid to dihomo-γ-linolenic acid (LA/DGLA) ratios are associated with severe disease outcomes and poor prognosis and are correlated with inflammatory markers such as IL-6 and D-dimer. Pathway analysis was performed to identify disruptions in fatty acid biosynthesis and metabolism. Additionally, Cox regression analyses were conducted to determine key fatty acids associated with prognosis. Regression analyses identified several key fatty acids influencing prognosis, including myristic acid, phytanic acid, linoleic acid, gamma-linolenic acid, alpha-linolenic acid, oleic acid, behenic acid, cerotic acid, linoleic acid DGLA, omega-6 fatty acids, omega-9 fatty acids, and the omega-6/omega-3 ratio. Pathway analysis revealed that the disruptions in the most affected pathways were the biosynthesis of unsaturated fatty acids, α-linolenic acid metabolism, elongation, degradation, arachidonic acid metabolism, and fatty acid biosynthesis in CCHF pathogenesis.

CONCLUSION: This study highlights significant alterations in fatty acid metabolism and laboratory markers in CCHF. These findings provide insights into the pathophysiology of this disease and may guide future research on targeted therapeutic strategies.

PMID:40879927 | DOI:10.1007/s11306-025-02327-y