Nevin Manimala

J Med Internet Res. 2026 Mar 26;28:e80517. doi: 10.2196/80517.

ABSTRACT

BACKGROUND: The integration of patient-generated health data (PGHD) into health care has the potential to significantly transform patient care and clinical practice. PGHD includes health-related data created by patients, enabling the collection of health data beyond traditional health care settings. The Veterans Health Administration (VA) has taken proactive steps to incorporate PGHD into health care through its Share My Health Data (SMHD) mobile app. Launched in 2023, the SMHD app allows veterans to securely share data from their personal digital health devices with the VA for clinical and research use. However, data characterizing patients who use such tools in real-world health care systems are lacking, creating an evidence gap for implementing PGHD-informed care equitably.

OBJECTIVE: This study aimed to identify the characteristics of patients using the VA SMHD mobile app, which allows veterans to share PGHD with the VA.

METHODS: We conducted a cross-sectional analysis of veterans who began using SMHD between October 2023 and September 2024 (n=3157, “SMHD users”). We collected demographic information, including age, sex, race/ethnicity, and rurality, and clinical information, including physiological and mental health conditions, from VA administrative data. We compared characteristics of SMHD users to a 10% random sample of veterans from the same underlying administrative data cohort that had never used the app (n=632,187, “nonusers”). Statistical analyses were performed using chi-square tests, independent t tests, and multivariable regression to assess the relationship between use and key characteristics.

RESULTS: Middle-aged veterans were more likely to be SMHD users (40-49 years: odds ratio [OR] 1.55, P<.001; 50-59 years: OR 1.37, P<.001), while veterans aged 60 years and over were less likely (60-69 years: OR 0.72, P<.001; ≥70 years: OR 0.24, P<.001). Female (OR 1.23, P<.001) and married (OR 1.31, P<.001) veterans were more likely to be SMHD users than male and unmarried veterans. In contrast, Black or African American (OR 0.62, P<.001) and rural (OR 0.82, P<.001) veterans were less likely to be SMHD users than White and urban veterans. Veterans in higher-income zip codes (OR 1.36, P<.001) were more likely to have used the app than those in lower-income zip codes. Clinically, SMHD users were more likely to have a service-connected disability (OR 1.81, P<.001), multiple physiological conditions (OR 1.86, P<.001), and multiple mental health diagnoses (OR 1.35, P<.001) versus none.

CONCLUSIONS: Veterans who used the SMHD app differed significantly from nonusers across several demographic and clinical characteristics. These insights identify specific demographic and clinical subgroups with higher and lower app adoption, providing an evidence base to inform targeted implementation and outreach and support strategies to promote enhanced engagement in PGHD-informed care.

PMID:41885918 | DOI:10.2196/80517

J Forensic Nurs. 2026 Mar 26. doi: 10.1097/JFN.0000000000000604. Online ahead of print.

ABSTRACT

BACKGROUND: Vaginal and cervical evidence collection is central to sexual assault medical forensic examinations (SAMFEs), yet comparative DNA outcomes for speculum-assisted versus blind swab techniques remain limited.

AIM: To compare blind swab and speculum-assisted vaginal/cervical collection methods with respect to male DNA outcomes to support patient-centered decision-making.

METHODS: Secondly, de-identified forensic medical and law enforcement data were analyzed. Outcomes included Y-screen positivity, Y-STR profile generation, and CODIS eligibility.

RESULTS: Among 117 analyzable cases, no statistically significant differences were observed between collection methods for any DNA outcome (all P>0.05).

CONCLUSIONS: Blind swab collection produced DNA outcomes comparable to speculum-assisted methods in this pilot study. Findings should not be interpreted as equivalent but suggest blind swabbing may be a reasonable option for some patients.

PMID:41885911 | DOI:10.1097/JFN.0000000000000604

J Glaucoma. 2026 Mar 17. doi: 10.1097/IJG.0000000000002715. Online ahead of print.

ABSTRACT

PRCIS: Masks have a multi-factorial impact on intraocular pressure measured with the Goldmann tonometer, reaching clinical significance in one-third of patients. Before making clinical decisions, repeated measurements without a mask or other tonometers should be considered.

PURPOSE: To investigate the impact of wearing face masks on intraocular pressure (IOP), the only manageable factor today in glaucoma, a blinding disease. Given the recurrent global outbreaks of respiratory infections (e.g., COVID-19, RSV, and measles), mask use remains a crucial measure to reduce transmission.

METHODS: A prospective, randomized, controlled, and blinded clinical study. Adult patients without corneal pathologies or hypotony were recruited in the glaucoma clinic. Each patient underwent IOP measurements using the Goldmann applanation tonometer under three conditions: with a surgical mask, KN95 mask and without a mask as the control.

RESULTS: 47 patients (94 eyes) with various types of glaucoma, were enrolled. Past ocular history included an average of IOP-lowering medications of 1.7±1.5 (range 0 to 5), 25.5% had prior laser treatment for IOP control, and 19.1% had previously undergone glaucoma surgery. The mean difference in IOP readings between the masks ranged from 0 to 7.5 mm Hg with no statistical significance, P=0.116. No significant differences were found based on gender (P=0.560), laterality (P=0.384), number of IOP-lowering medications (P=0.730), history of previous glaucoma laser treatment (P=0.456), or surgery (P=0.425). Sixteen patients (34.0%) exhibited an IOP difference of 3 mm Hg or more between the conditions, although not statistically significant (P=0.546).

CONCLUSION: Masks exert inconsistent effects on IOP measurements. In approximately one-third of patients the differences reached clinical significance, although not statistically significant. These variations are presumably influenced by multiple factors, such as mask fit to facial structure, positioning, and alterations in breathing patterns while wearing masks.

PMID:41885902 | DOI:10.1097/IJG.0000000000002715

Biometrics. 2026 Jan 6;82(1):ujag046. doi: 10.1093/biomtc/ujag046.

ABSTRACT

Single-cell RNA sequencing (scRNA-seq) allows transcriptional profiling, and cell-type annotation of individual cells. However, sample preparation in typical scRNA-seq experiments often homogenizes the samples, thus spatial locations of individual cells are often lost. Although spatial transcriptomic techniques, such as in situ hybridization (ISH) or Slide-seq, can be used to measure gene expression in specific locations in samples, it remains a challenge to measure or infer expression level for every gene at a single-cell resolution in every location in tissues. Existing computational methods show promise in reconstructing these missing data by integrating scRNA-seq data with spatial expression data such as those obtained from spatial transcriptomics. Here we describe Laplacian Linear Optimal Transport (LLOT), an interpretable method to integrate single-cell and spatial transcriptomics data to reconstruct missing information at a whole-genome and single-cell resolution. LLOT iteratively corrects platform effects and employs Laplacian Optimal Transport to decompose each spot in spatial transcriptomics data into a spatially-smooth probabilistic mixture of single cells. We benchmark LLOT against several existing methods on multiple datasets from different measurement technologies, including in situ hybridization, Slide-seq, 10x Visium, and Visium HD. The results demonstrate that LLOT provides an interpretable and versatile framework for reconstructing spatial gene expression and inferring cell locations.

PMID:41885893 | DOI:10.1093/biomtc/ujag046

J Psychopathol Clin Sci. 2026 Mar 26. doi: 10.1037/abn0001126. Online ahead of print.

ABSTRACT

This article discusses the diagnosis and conceptualization of suicide. Addressing suicide and related phenomena is a top priority in mental health care but is not adequately reflected in the current categorical diagnostic system, the Diagnostic and Statistical Manual of Mental Disorders (DSM), Fifth Edition, Text Revision. Suicide demonstrates the pitfalls of categorical conceptualization of psychopathology and should be thoroughly examined within dimensional frameworks. This is particularly relevant as development of the newest iteration of the DSM-and renewed discussion of diagnosis and conceptualization of psychopathology-begins. The categorical nature of diagnosis has been critiqued at length, with the proposed alternative positing transdiagnostic dimensions that account for overlaps across and variations within diagnoses. Suicide and related phenomena do not appear as a distinct psychopathology/diagnosis in the DSM, Fifth Edition, Text Revision, instead comprising a symptom/criterion for only two of the almost 300 disorders. A transdiagnostic conceptualization of suicide aligns with historical and modern theories of suicide, none of which focus on psychiatric diagnoses as primary explanatory factors in suicide, and most of which emphasize transdiagnostic patterns of distress and biopsychosocial processes that better explain suicidal behavior. Discussion to date about limitations of the current diagnostic system regarding suicide has focused on adding suicide-related diagnoses or even positing an additional suicide-related axis when the DSM previously used an axial structure. Based on the characteristics of suicide and related phenomena described previously, the author hypothesizes that suicide-related processes comprise higher level dimensions-including a range of nonpathological (e.g., developmental changes in acceptance of death) to pathological phenomena and factors aligned with suicide theory (e.g., capability)-that interact with cross-cutting psychopathological and biopsychosocial factors to lead to varying phenotypes. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

PMID:41885890 | DOI:10.1037/abn0001126

Health Psychol. 2026 Mar 26. doi: 10.1037/hea0001605. Online ahead of print.

ABSTRACT

Objective: Gray’s reinforcement sensitivity, describing elementary motivational systems that mediate cognitive-affective and behavioral responses to punishing (behavioral inhibition system [BIS]) and Rewarding (behavioral activation system [BAS]) stimuli, has been most widely applied in the study of the motivational underpinnings of pain-related responses. Empirical findings regarding the associations of BIS and BAS with pain-relevant clinical outcomes are inconsistent, however. Drawing on personality systems interaction theory, the present cross-sectional study aimed at evaluating the mediating role of self-regulatory and volitional abilities in the relationship between BIS and BAS-Reward sensitivity and pain-related activity patterns. Method: Our data analyses were based on 579 patients (74.8% women) with musculoskeletal pain who filled in self-report questionnaires operationalizing the constructs of interest. The projected relations among three levels of observed variables (level of temperament, self-regulation as mediating level, and behavioral dimensions as outcome level) were statistically tested by mediation analysis based on structural equation modeling. Results: Consistent with our predictions, we found the facilitating effects of BIS sensitivity on activity avoidance, and maladaptive dimensions of persistence and pacing behavioral dimensions to be mediated by self-regulation and volitional facilitation. Full mediation was also observed for the negative associations of BAS-Reward with pain avoidance, activity avoidance, and excessive persistence. Conclusions: Our study complements previous work by emphasizing the importance of emotional self-regulation and volition in behavioral responses to pain. New perspectives on the role of BAS-Reward in chronic pain are opened up. Our findings indicate that multimodal interventions fostering emotional self-regulation should be increasingly incorporated into existing pain management programs. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

PMID:41885889 | DOI:10.1037/hea0001605

Rehabil Nurs. 2026 Mar 26. doi: 10.1097/RNJ.0000000000000537. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the effectiveness of a dedicated rehabilitation gym space for patients with Candida auris (C. auris) requiring contact isolation in an inpatient rehabilitation setting. This initiative had an aim of improving access to the therapy gym while maintaining infection prevention protocols for patients with C. auris.

METHODS: Through collaboration with hospital leadership and public health authorities, a secondary gym space was identified and converted exclusively for patients with C. auris. Data collected over 14 months included patients’ functional outcomes and infection transmission rates.

RESULTS: Twenty-five patients with C. auris were admitted to the rehabilitation facility between December 2022 and March 2024; 18 received in-room therapy, and seven received therapy in the dedicated gym. A greater proportion of patients using the dedicated gym achieved mobility improvement goals (57.1%) compared with those who received therapy in-room (35.7%). Self-care and mobility score improvement scores for the two groups were not statistically significant. There were no instances of in-facility transmission of C. auris.

CONCLUSIONS: Rehabilitation health care workers can safely support functional progress in contact-isolated patients by using dedicated therapy spaces, maintaining infection control, and optimizing patients’ functional outcomes. Although we had a small sample , findings suggest that mobility outcomes may improve when C. auris patients have access to a dedicated gym. Further monitoring is needed to assess long-term impact.

PMID:41885879 | DOI:10.1097/RNJ.0000000000000537

JAMA Netw Open. 2026 Mar 2;9(3):e263274. doi: 10.1001/jamanetworkopen.2026.3274.

ABSTRACT

IMPORTANCE: Given the common use of weight-inducing (WI) medications, it is crucial to understand the potential association of these medications with the effectiveness of obesity treatments.

OBJECTIVE: To assess the association between tirzepatide and weight reduction among participants with overweight or obesity who initiated WI medications during the SURMOUNT-1, -3, and -4 trials.

DESIGN, SETTING, AND PARTICIPANTS: This post hoc analysis of the phase 3 randomized clinical trials SURMOUNT-1 (December 4, 2019, to April 1, 2022), SURMOUNT-3 (March 29, 2021, to May 12, 2023), and SURMOUNT-4 (March 29, 2021, to May 18, 2023) assessed the association between tirzepatide and weight reduction among participants taking concomitant WI medications. Randomized participants (lead-in and randomized treatment period data) who started taking 1 or more WI medications for 3 or more months (≥1 week for oral corticosteroids) during the trial were included in the analysis. Statistical analysis was performed from July to December 2025 in the modified intent-to-treat population.

MAIN OUTCOMES AND MEASURES: WI medication use was summarized for all treatment arms from weeks 0 to 72 (SURMOUNT-1 and SURMOUNT-3) or weeks 0 to 88 (SURMOUNT-4). A mixed model of repeated measures was used to assess percentage change in weight from week 0 to week 72 or week 88 in the efficacy analysis sets (excluding off-treatment data), with 1 or more postbaseline weight measures.

RESULTS: This post hoc analysis comprised the WI medication subgroups of SURMOUNT-1 participants (N = 442; mean [SD] age, 48.0 [12.5] years; 325 women [73.5%]; mean [SD] body weight, 105.9 [22.4] kg), SURMOUNT-3 participants (N = 100; mean [SD] age, 49.5 [12.0] years; 75 women [75.0%]; mean [SD] body weight, 102.7 [23.5] kg), and SURMOUNT-4 participants (N = 134; mean [SD] age, 51.8 [11.9] years; 91 women [67.9%]; mean [SD] body weight, 111.8 [23.7] kg). Approximately one-fifth of participants used 1 or more WI medications (SURMOUNT-1, 17.4% [442 of 2539]; SURMOUNT-3, 17.3% [100 of 579]; and SURMOUNT-4, 20.0% [134 of 670]). Among them, 72.9% in SURMOUNT-1 (322 of 442), 68.0% in SURMOUNT-3 (68 of 100), and 64.9% in SURMOUNT-4 (87 of 134) were taking 1 nonsteroid WI medication, with 2.0% in SURMOUNT-1 (9 of 442), 3.0% in SURMOUNT-3 (3 of 100), and 2.2% in SURMOUNT-4 (3 of 134) using 3 or more medications. The mean (SD) duration of treatment with nonsteroid WI medications was 50.9 (28.8) weeks in SURMOUNT-1, 50.9 (29.3) weeks in SURMOUNT-3, and 58.1 (34.9) weeks in SURMOUNT-4. The mean percentage weight change compared with placebo from randomization to 72 weeks for those treated with tirzepatide and using WI medication was -13.3% (95% CI, -16.0% to -10.7%) for 5 mg to -21.3% (95% CI, -23.9% to -18.7%) for 15 mg in SURMOUNT-1 and -26.1% (95% CI, -30.0% to -22.3%) for the maximum tolerated dose in SURMOUNT-3, and from randomization to 88 weeks, it was -18.6% (95% CI, -20.9% to -16.3%) for the maximum tolerated dose in SURMOUNT-4.

CONCLUSIONS AND RELEVANCE: In this post hoc analysis of 3 randomized clinical trials for participants taking at least 1 concomitant WI medication, tirzepatide treatment was associated with weight loss comparable with the primary study results. These findings suggest that people with overweight or obesity who require treatment with WI medications may be able to achieve clinically meaningful weight reduction with tirzepatide.

TRIAL REGISTRATION: ClinicalTrials.gov Identifiers: NCT04184622, NCT04657016, NCT04660643.

PMID:41885866 | DOI:10.1001/jamanetworkopen.2026.3274

JAMA Netw Open. 2026 Mar 2;9(3):e263515. doi: 10.1001/jamanetworkopen.2026.3515.

ABSTRACT

IMPORTANCE: Worldwide, 480 000 deaths are attributable to opioids annually. The risk that they pose to children through family members’ prescriptions is unknown.

OBJECTIVE: To quantify the association between opioid prescriptions dispensed to a household family member and a serious opioid intoxication event (SOE) in a child.

DESIGN, SETTING, AND PARTICIPANTS: This case-control, population-based study used data from Denmark’s comprehensive nationwide longitudinal prescription and health care registries over a 27-year period from April 1, 1995, to June 30, 2022. Among 3 761 618 Danish residents younger than 20 years, cases were individuals who experienced an SOE. For each case, there were 10 matched population-based controls without a prior SOE. Household family members were individually linked to case and control participants. Statistical analyses were performed between August 2024 and January 2025.

EXPOSURE: An analgesic prescription filled by a household family member within 3 months before a child’s SOE. The study included 3 categories of children whose family members were (1) exposed to prescription opioids, (2) exposed to nonsteroidal anti-inflammatory drugs (NSAIDs), and (3) unexposed.

MAIN OUTCOME AND MEASURES: SOE, defined as death, hospitalization, or emergency department visit due to opioid intoxication. The incidence rate ratio of SOEs among children whose family members redeemed an opioid prescription was compared with those in unexposed households and with those whose family members filled NSAID prescriptions. Conditional logistic regression was used to compute adjusted odds ratios (AORs), controlling for potential sociodemographic and mental health confounders. Subsequently, analyses were stratified by sex, age brackets (<13 vs ≥13 years), SOE calendar year, and hospital disposition. Finally, a sensitivity analysis was conducted restricting the interval between prescription dispensing and the SOE to 1 month.

RESULTS: A total of 2000 children (median age at SOE, 17.8 years [IQR, 15.7-19.0 years]; 1096 boys [54.8%]) experienced an SOE and were matched with 19 840 controls (median age at index, 17.7 years [IQR, 15.6-19.0 years]; 10 872 boys [54.8%]). Among 2000 cases, 1116 (55.8%) were hospitalized and 60 (3.0%) died. Having a family member fill an opioid prescription (319 cases and 1137 controls) was associated with increased odds of an SOE compared with unexposed children (1398 cases and 16 181 controls; AOR, 2.87; 95% CI, 2.45-3.38) and with children exposed to NSAIDs (283 cases and 2522 controls; AOR, 2.22; 95% CI, 1.81-2.72). Odds of an opioid-related death were nearly 4-fold higher compared with unexposed children (15 cases and 33 controls vs 42 cases and 496 controls, respectively; AOR, 3.70; 95% CI, 1.55-8.84). The association remained robust in stratified and sensitivity analyses.

CONCLUSIONS AND RELEVANCE: This study suggests that children of family members prescribed opioids had increased odds of opioid intoxication-related death and other SOEs compared with children of unexposed families or those exposed to nonopioid analgesics. Public health strategies to mitigate the opioid crisis should consider unique pediatric aspects that can reduce the likelihood of pediatric SOEs.

PMID:41885863 | DOI:10.1001/jamanetworkopen.2026.3515

JAMA Netw Open. 2026 Mar 2;9(3):e263529. doi: 10.1001/jamanetworkopen.2026.3529.

ABSTRACT

IMPORTANCE: Understanding how prior policies, systemic factors, and public health events have shaped mammography use among US women is essential for interpreting the 2024 US Preventive Services Task Force (USPSTF) recommendation update and identifying gaps to inform equitable public health strategies.

OBJECTIVE: To analyze mammography use trends in US women aged 40 to 49 and 50 to 74 years from 2002 to 2022 and assess variation by sociodemographic, health care access, behavioral, and geographic factors, including associations with the 2009 USPSTF recommendation and the COVID-19 pandemic.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from the Behavioral Risk Factor Surveillance System biennial cancer screening module (2002-2022). Joinpoint regression with a jump model was used to account for methodological changes in the Behavioral Risk Factor Surveillance System beginning in 2011. Data were analyzed from March to September 2025.

MAIN OUTCOMES AND MEASURES: The primary outcome was the average biennial percentage change in mammography use from 2002 to 2022, calculated as a weighted average of jump model-estimated biennial changes. Subgroup analyses were conducted by sociodemographic, health care access, behavioral, and geographic factors.

RESULTS: Among 2 619 292 US women, mammography use showed a downward trend, with nonsignificant biennial changes of -0.54% (95% CI, -1.25% to 0.16%) for ages 40 to 49 years and -0.16% (95% CI, -0.49% to 0.16%) for ages 50 to 74 years from 2002 to 2022. Declines were significant among young women without health insurance (-1.54%; 95% CI, -2.89% to -0.17%), current smokers (-1.36%; 95% CI, -2.43% to -0.27%), unmarried women (-1.10%; 95% CI, -1.61% to -0.59%), and non-Hispanic White women (-0.58%; 95% CI, -1.09% to -0.07%). Following the 2009 USPSTF recommendation, mammography use decreased significantly among younger non-Hispanic White (-0.88%; 95% CI, -1.59% to -0.16%), Asian (-2.45%; 95% CI, -4.20% to -0.25%), and uninsured (-2.39%; 95% CI, -4.57% to -0.16%) women, with no significant reduction among non-Hispanic Black women (-0.59%; 95% CI, -1.20% to 0.03%). Across both age groups, mammography use was consistently lower in Western than in Eastern states.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, mammography use did not significantly decline in the overall population; however, significant reductions were observed among non-Hispanic White, Asian, and uninsured women aged 40 to 49 years from 2010 to 2022. These findings highlight the need for clear, risk-based screening communication and targeted strategies to promote guideline-concordant decision-making, particularly among younger women.

PMID:41885862 | DOI:10.1001/jamanetworkopen.2026.3529