Nevin Manimala

JAMA Netw Open. 2025 Jan 2;8(1):e2454699. doi: 10.1001/jamanetworkopen.2024.54699.

ABSTRACT

IMPORTANCE: Nearly all Medicare Advantage (MA) plans offer dental, vision, and hearing benefits not covered by traditional Medicare (TM). However, little is known about MA enrollees’ use of those benefits or how much they cost MA insurers or enrollees.

OBJECTIVE: To estimate use, out-of-pocket (OOP) spending, and insurer payments for dental, hearing, and vision services among Medicare beneficiaries.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional analysis used pooled 2017-2021 Medical Expenditure Panel Survey (MEPS) and Medicare Current Beneficiary Survey (MCBS) data for MA and TM beneficiaries (excluding those also covered by Medicaid). The analysis was performed from September 10, 2023, to June 30, 2024.

EXPOSURES: MA compared with TM coverage.

MAIN OUTCOMES AND MEASURES: The main outcome was receipt of eye examinations, corrective lenses, hearing aids, optometry and dental visits, and MA and TM enrollees’ and insurers’ spending for such services. MEPS and MCBS data were weighted to be nationally representative.

RESULTS: We included 76 557 non-dually eligible Medicare beneficiaries, including 23 404 from the MEPS and 53 153 from the MCBS. Weighted demographic characteristics of MA and TM beneficiaries were similar (54.7% and 51.9% female; 39.8% and 35.2% older than 75 years, respectively). Only 54.2% (95% CI, 52.4%-55.9%) and 54.3% (95% CI 52.2%-56.3%) of MA beneficiaries were aware of having MA dental and vision coverage, respectively. MA enrollees were no more likely to receive eye examinations, hearing aids, or eyeglasses than TM enrollees. After adjustment for demographic differences, MA and TM enrollees paid OOP $205.86 (95% CI, $192.44-$219.27) and $226.12 (95% CI, $212.02-$240.23), respectively, for eyeglasses (MA – TM difference, -$20.27 [95% CI, -$33.77 to -$6.77] or -9.0% [95% CI, -14.9% to -3.0%]); $226.82 (95% CI, $202.24-$251.40) and $249.98 (95% CI, $226.22-$273.74) for dental visits, respectively (MA – TM difference, -$23.16 [95% CI, -$43.15 to -$3.17] or -9.3% [95% CI, -17.3% to -1.3%]); and no less for optometry visits or durable medical equipment (a proxy for hearing aids). Nationwide, MA plans’ annual spending on vision, dental services, and durable medical equipment totaled $3.9 billion (95% CI, $3.3-$4.4 billion), while enrollees spent OOP $9.2 billion (95% CI, $8.2-$10.2 billion) annually for these services and other private insurers covered $2.8 billion (95% CI, $2.7-$3.0 billion).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of 2 nationally representative surveys, MA beneficiaries did not receive more supplemental services than TM beneficiaries, possibly because of cost-sharing and limited awareness of benefit coverage.

PMID:39808428 | DOI:10.1001/jamanetworkopen.2024.54699

Biometrics. 2025 Jan 7;81(1):ujae164. doi: 10.1093/biomtc/ujae164.

ABSTRACT

As a commonly employed method for analyzing time-to-event data involving functional predictors, the functional Cox model assumes a linear relationship between the functional principal component (FPC) scores of the functional predictors and the hazard rates. However, in practical scenarios, such as our study on the survival time of kidney transplant recipients, this assumption often fails to hold. To address this limitation, we introduce a class of high-dimensional partially linear functional Cox models, which accommodates the non-linear effects of functional predictors on the response and allows for diverging numbers of scalar predictors and FPCs as the sample size increases. We employ the group smoothly clipped absolute deviation method to select relevant scalar predictors and FPCs, and use B-splines to obtain a smoothed estimate of the non-linear effect. The finite sample performance of the estimates is evaluated through simulation studies. The model is also applied to a kidney transplant dataset, allowing us to make inferences about the non-linear effects of functional predictors on patients’ hazard rates, as well as to identify significant scalar predictors for long-term survival time.

PMID:39808421 | DOI:10.1093/biomtc/ujae164

J Med Syst. 2025 Jan 14;49(1):7. doi: 10.1007/s10916-025-02143-w.

ABSTRACT

The “no-show” problem in healthcare refers to the prevalent phenomenon where patients schedule appointments with healthcare providers but fail to attend them without prior cancellation or rescheduling. In addressing this issue, our study delves into a multivariate analysis over a five-year period involving 21,969 patients. Our study introduces a predictive model framework that offers a holistic approach to managing the no-show problem in healthcare, incorporating elements into the objective function that address not only the accurate prediction of no-shows but also the management of service capacity, overbooking, and idle resource allocation resulting from mispredictions. Our approach simplifies preprocessing and eliminates the need for expert judgment in variable selection, thereby enhancing the model’s usability in routine healthcare operations. Our research revealed that key predictors of no-shows are consistent across various studies. We employed semi-automatic feature selection techniques, achieving results comparable to state-of-the-art approaches but with significantly reduced complexity in their selection. This method not only streamlines the feature selection process but also enhances the overall efficiency and scalability of our predictive models, making them more adaptable to diverse healthcare settings. This comprehensive strategy enables healthcare providers to optimize resource allocation and improve service delivery, making our findings relevant for healthcare systems globally facing similar challenges. Future work aims to expand the analysis by incorporating additional third-party data sources, such as weather and commuting activities, to explore the broader impacts of external factors on patient no-show behavior. To the best of our knowledge, this innovative approach is expected to provide deeper insights and further enhance the predictability and effectiveness of no-show mitigation strategies in healthcare systems.

PMID:39808378 | DOI:10.1007/s10916-025-02143-w

Aging Clin Exp Res. 2025 Jan 14;37(1):23. doi: 10.1007/s40520-024-02921-5.

ABSTRACT

OBJECTIVE: This study aims to analyze adverse drug events (ADE) related to romosozumab from the second quarter of 2019 to the third quarter of 2023 from FAERS database.

METHODS: The ADE data related to romosozumab from 2019 Q2 to 2023 Q3 were collected. After data normalization, four signal strength quantification algorithms were used: ROR (Reporting Odds Ratios), PRR (Proportional Reporting Ratios), BCPNN (Bayesian Confidence Propagation Neural Network), and EBGM (Empirical Bayesian Geometric Mean).

RESULTS: Screening for romosozumab-related AEs (adverse events) included 23 system organ categories (SOCs). PT (preferred terms) levels were screened for adverse drug reaction (ADR) signals. A total of 7055 reports with romosozumab as the primary suspect (PS) and 14,041 PTs induced by romosozumab as PS were identified. Common significant signals of general disorders and administration site conditions, musculoskeletal and connective tissue disorders have emerged. Specifically, unexpected AEs such as gastrointestinal disorder, respiratory, thoracic and mediastinal disorders also occur. Notably, fracture (n = 503, ROR = 107.8, PRR = 103.83, IC = 6.6, EBGM = 97.02) and bone density abnormal (n = 429, ROR = 343.65, PRR = 332.77, IC = 8.08, EBGM = 271.34) exhibited relatively high occurrence rates and signal strengths.

CONCLUSION: Our study identifies potential new AE signals and provides broader data support for the safety of romosozumab. In clinical application, doctors are provided with a warning to closely monitor adverse reactions to support their rational use in diseases such as osteoporosis.

PMID:39808360 | DOI:10.1007/s40520-024-02921-5

J Ophthalmic Inflamm Infect. 2025 Jan 14;15(1):6. doi: 10.1186/s12348-025-00453-1.

ABSTRACT

PURPOSE: To identify the macular retinal layer thickness changes in polyarteritis nodosa (PAN) patients without pathological findings appearing in color fundus photography (CFP), and to investigate the correlations with disease durations.

METHODS: A total of 24 PAN patients who had been for 3 years or more and underwent SD-OCT were recruited from the UK Biobank, with exclusions for diabetes, eye disease, or abnormal CFP findings. Only the right eyes were included, with each PAN patient paired one-to-one with a control matched for age, sex, and ethnicity. Paired t-tests or Wilcoxon Signed-Rank tests were used to assess the differences in thickness of different retinal layers between groups, followed by linear regression analysis to evaluate the correlations with disease durations.

RESULTS: PAN patients had significantly thinner retinal nerve fiber layer (RNFL) by 12.27% (mean ± standard deviation = 27.39 ± 8.94 μm for PAN patients and 31.22 ± 5.57 μm for controls, p = 0.048) and thinner outer plexiform and outer nuclear layers (OPL-ONL complex) by 10.67% (44.93 ± 6.59 μm for PAN patients and 50.31 ± 7.60 μm for controls, p = 0.032). Visual acuity and the whole macular thickness showed no statistical difference. The RNFL was thinned by 1.22 μm per year of disease progression (95% confidence interval: 0.12, 2.32, p = 0.042).

CONCLUSIONS: PAN patients without visual impairments or abnormal CFP findings may exhibit significant thinning in RNFL and OPL-ONL complex. SD-OCT may serve as a useful tool for early screening of ophthalmic changes in PAN.

PMID:39808358 | DOI:10.1186/s12348-025-00453-1

Neurosurg Rev. 2025 Jan 14;48(1):46. doi: 10.1007/s10143-025-03198-6.

ABSTRACT

Public and private medical institutes must adhere to the same standards of quality set by the Pakistan Medical & Dental Council (PMDC). However, studies have noted varied learning environments. The current study aims to assess opportunities and compare the differences in perceptions between the two sectors. An online survey was conducted among medical students, interns, and medical officers across Pakistan. Respondents were divided into two groups: private and public sector and the survey responses of the two groups were compared. Descriptive statistical analyses of responses were performed, and a chi-square test was used to obtain the p-values. 2,481 responses were collected (48.6% public vs 51.3% private sector). A higher proportion of public sector respondents reported neurosurgery within their curriculum (71.2% public, 58.9% private) ( p < 0.001), while a greater proportion of private sector respondents had less exposure to neurosurgery clerkships (58.5% public, 71.9% private). A higher proportion from the private sector reported that sufficient mentorship opportunities (38.3% private, 29.5% public) (p < 0.001) were provided by their medical college. More private sector respondents reported lack of work-life balance (39.5% public, 42.4% private), competitive work environment (55.9% public, 61.3% private) (p < 0.001) and financial burden (67.3% private, 60.8% public) (p < 0.001) as major barriers towards pursuing neurosurgery. Our study outlines key areas for improvement from the perspective of the learners themselves. These include increasing exposure to neurosurgery in medical colleges and affiliated hospitals and improving post-graduate training among all sectors. Addressing these concerns of the medical students, interns, recent graduates and medical officers can foster the pursuit of neurosurgery as a career in Pakistan. It is crucial to further investigate medical education in Pakistan and study differences in the public and private education sector globally.

PMID:39808338 | DOI:10.1007/s10143-025-03198-6

Eur Arch Otorhinolaryngol. 2025 Jan 14. doi: 10.1007/s00405-024-09172-0. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to identify factors predicting postoperative ICU admission, the need for orotracheal intubation (OTI), and the occurrence of supraglottic stenosis in children undergoing supraglottoplasty for laryngomalacia.

METHODS: A retrospective analysis was conducted on 31 children (Dear Reviewer, we would have greatly preferred to include a larger sample size. However, as you know, this type of management is rare, and we deliberately selected a 7-year period to ensure a minimum of 30 children while avoiding significant differences in management guidelines over time. Thank you for your understanding.) who underwent supraglottoplasty at Robert Debre University Hospital from February 2016 to June 2023. Patient demographics, medical history, pre- and postoperative findings, and outcomes were evaluated. Statistical analyses were performed using R software.

RESULTS: A total of 60% of patients required ICU admission postoperatively. Factors predictive of ICU admission included a history of genetic anomalies, younger age at surgery, poor weight gain, and preoperative enteral feeding. Among those requiring OTI, significant predictors included a history of neurological disease, abnormal vocal cord mobility, and intraoperative arterial oxygen saturation dropping below 90%. Two patients developed supraglottic stenosis, with a noted correlation to surgical technique and preoperative respiratory severity.

CONCLUSION: While supraglottoplasty is generally safe and effective, specific factors can predict the need for postoperative ICU care and intubation. The findings highlight the importance of thorough preoperative assessments and optimization of gastroesophageal reflux management to mitigate complications.

PMID:39808334 | DOI:10.1007/s00405-024-09172-0

Eur J Trauma Emerg Surg. 2025 Jan 14;51(1):14. doi: 10.1007/s00068-024-02750-1.

ABSTRACT

PURPOSE: This study aims to identify predictors of discharge to post-acute care in geriatric emergency general surgery (EGS) patients.

METHODS: This is a retrospective study of geriatric emergency general surgery (EGS) patients at a tertiary care facility between 2017 and 2018. Inclusion criteria were ≥ 65 years old and presented directly from home. Non-survivors or those admitted from a healthcare facility were excluded. The primary outcome was discharge to home versus post-acute care.

RESULTS: Out of 577 patients, the median age was 74, and 36.9% were discharged to a post-acute care facility. Factors predicting discharge to post-acute care were: mobility aid use (1.92, [1.19-3.11], p = 0.008), cerebrovascular accident (4.67, [1.99-10.94], p < 0.001), delirium (11.06, [2.29-53.43], p = 0.003), pre-operative transfusion (2.39, [1.13-5.08], p = 0.023), fall history (3.74, [1.90-7.36], p < 0.001), AKI (5.42, [2.61-11.25], p < 0.001), and lack of capacity to consent (4.11, [2.10-8.02], p < 0.001). Non-operative management was protective against discharge to post-acute care (0.38, [0.24-0.60], p < 0.001).

CONCLUSION: Early recognition of the role of these factors in influencing discharge disposition may help with clinical decision-making and discharge planning.

PMID:39808317 | DOI:10.1007/s00068-024-02750-1

Eur J Pediatr. 2025 Jan 14;184(2):134. doi: 10.1007/s00431-025-05980-6.

ABSTRACT

We aimed to determine the prevalence of gastroesophageal reflux disease (GERD) and oropharyngeal dysphagia as explanatory diagnoses, risk factors for acid suppression treatment, and risk factors for repeat hospital visit in infants hospitalized after brief resolved unexplained event (BRUE) using a multicenter pediatric database. We performed a multicenter retrospective database study of infants admitted with BRUE in the Pediatric Health Information System between 2016 and 2021. Data included diagnostic testing, explanatory diagnoses, treatment with acid suppression, and related repeat hospital visits within 6 months. Multivariable logistic regression models were used to determine risk factors for treatment with acid suppression and repeat hospital visit. Of 17,558 subjects admitted to 47 hospitals, 34% were given an explanatory diagnosis of GERD and 1.4% oropharyngeal dysphagia. Twelve percent were treated with acid suppression, with some centers having rates as high as 26%. Multiple factors, including most notably the GERD diagnosis, were associated with increased prescribing risk. Ten percent of subjects had repeat hospital visits. Subjects given an explanatory diagnosis of GERD (OR 1.66, 95% CI 1.48-1.86, p < 0.001) or oropharyngeal dysphagia (OR 2.13, 95% CI 1.55-2.91, p < 0.001) had increased risk for repeat hospital visit as did those treated with acid suppression. CONCLUSION: GERD as an explanatory diagnosis was associated with increased risk of repeat hospital visit, despite its conception as a benign, treatable condition. Treatment with acid suppression was common but did not prevent repeat hospitalization. Oropharyngeal dysphagia as an explanatory diagnosis was also associated with increased risk of repeat hospital visit.

PMID:39808308 | DOI:10.1007/s00431-025-05980-6

Diabetologia. 2025 Jan 14. doi: 10.1007/s00125-024-06353-8. Online ahead of print.

ABSTRACT

AIMS/HYPOTHESIS: Existing evidence on the relationship between intake of monounsaturated fatty acids (MUFAs) and type 2 diabetes is conflicting. Few studies have examined whether MUFAs from plant or animal sources (MUFA-Ps and MUFA-As, respectively) exhibit differential associations with type 2 diabetes. We examined associations of intakes of total MUFAs, MUFA-Ps and MUFA-As with type 2 diabetes risk.

METHODS: We used data from 51,290 women in the Nurses’ Health Study (1990-2016), 61,703 women in the Nurses’ Health Study II (1991-2017) and 29,497 men in the Health Professionals Follow-up Study (1990-2016). Using food frequency questionnaires and food composition tables, we calculated MUFA-P and MUFA-A intakes every 4 years and modelled their associations with type 2 diabetes using Cox regression models.

RESULTS: During 3,268,512 person-years of follow-up, we documented 13,211 incident type 2 diabetes cases. After multivariate adjustment, total MUFA intake was associated with higher type 2 diabetes risk, with HR for Q5 vs Q1 of 1.10 (95% CI 1.01, 1.22). MUFA-Ps and MUFA-As demonstrated divergent associations, with HRs of 0.87 (95% CI 0.81, 0.94) and 1.34 (1.23, 1.45), respectively. In substitution analyses, HRs were 0.92 (95% CI 0.86, 0.99) for replacing 2% of energy from trans fatty acids or 0.72 (0.66, 0.78) and 0.82 (0.77, 0.88) for replacing 5% from MUFA-As and 5% from the sum of saturated fatty acids and MUFA-As with MUFA-Ps, respectively. Substituting MUFA-As for saturated fatty acids and refined carbohydrates was associated with a 43% and 33% higher risk, respectively.

CONCLUSIONS/INTERPRETATION: Higher intake of MUFA-Ps was associated with lower type 2 diabetes risk, whereas increased intake of MUFA-As was associated with higher risk. Replacing saturated fatty acids, trans fatty acids and MUFA-As with MUFA-Ps may be beneficial for type 2 diabetes prevention.

PMID:39808307 | DOI:10.1007/s00125-024-06353-8