Nevin Manimala

JAMA. 2025 Feb 27. doi: 10.1001/jama.2025.1042. Online ahead of print.

ABSTRACT

IMPORTANCE: Health-related social needs are drivers of worse health and high health care spending. In North Carolina Medicaid’s 1115 waiver, the Healthy Opportunities Pilots (HOP) program allows for nonmedical services to address health-related social needs, such as healthy food boxes and housing navigation, financed by Medicaid, in 3 regions of North Carolina.

OBJECTIVE: To determine whether individual participation in the HOP program is associated with lower Medicaid spending.

DESIGN, SETTING, AND PARTICIPANTS: Comparative interrupted time series evaluation using North Carolina Medicaid data from March 2021 through November 2023. The 13 227 HOP enrollees were compared with 73 469 Medicaid beneficiaries reporting a health-related social need (a HOP eligibility criterion), but who were ineligible for HOP due to county of residence.

EXPOSURE: Participation in HOP.

MAIN OUTCOMES AND MEASURES: The primary outcome was the sum of spending by Medicaid on medical and HOP services per beneficiary per month. Secondary outcomes included health care use (emergency department visits, inpatient admissions, and outpatient visits).

RESULTS: Among 13 227 HOP and 73 469 comparison group members, the mean age was 23.4 (SD, 18.8) years, 63.9% were female, 42.4% were Black, and 57.4% were White (participants could report >1 race). Mean monthly preindex spending was $828 (SD, $5105). Of HOP enrollees, 89% received at least 1 HOP service, and 85% of services were food services. The comparative interrupted time series analysis estimated that spending increased at the month of HOP enrollment (change in level, $687; 95% CI, $420-$954). However, the trend in spending for HOP participants was differentially lower (change in trend, -$85 per beneficiary per month; 95% CI, -$122 to -$48; P < .001) relative to a counterfactual scenario without HOP. Taken together, these findings indicated that monthly spending was equivalent to estimated counterfactual expenditures by month 8 after starting HOP and lower thereafter. Emergency department visit trend was differentially lower for HOP participants (-6 per 1000 person-months; 95% CI, -8 to -4). There was no statistically significant differential trend in hospitalizations (-1 per 1000 person-months; 95% CI, -2 to 0) or outpatient visits (1 per 1000 person-months; 95% CI, -7 to 9).

CONCLUSIONS AND RELEVANCE: Results of this study suggest that the HOP program was associated with increased spending at enrollment, followed by a subsequently lower spending trend.

PMID:40014313 | DOI:10.1001/jama.2025.1042

Ann Nucl Med. 2025 Feb 27. doi: 10.1007/s12149-025-02028-5. Online ahead of print.

ABSTRACT

BACKGROUND: We planned this retrospective study to evaluate the effect of the central vs peripheral location effect on the success of selective internal radiation therapy (SIRT) with ⁹⁰Yttrium-90 (⁹⁰Y) glass microspheres in hepatocellular carcinomas (HCC).

MATERIAL AND METHODS: Thirty-eight patients diagnosed with HCC who were eligible for SIRT with ⁹⁰Y glass microspheres were included in this study. The location being central versus peripheral was defined as explained: Straight lines through the bifurcation of the right and left branches of the portal vein to the center of the HCC and the peripheral surface of the liver were traced on the same plane. The coefficient was determined as a ratio of the center of the HCC to the distance from the hilum of the liver at the portal vein bifurcation. Value under ½ accepted as central location (Group 1, n = 17), over ½ values are accepted as peripheral location (Group 2, n = 21). Treatment responses were analyzed after 2 months of the treatment with magnetic resonance imaging, and 2-deoxy-2-[¹⁸F]fluoro-D-glucose positron emission tomography/computed tomography ([¹⁸F]FDG PET/CT) for FDG-avid ones. Differences in treatment responses rates, treatment approach, the absorbed doses and the volumes of each liver segments between groups were investigated.

RESULTS: In Group 1; mean age was 67. In 5 cases split infusion, in 10 cases tumor selective treatment approach were applied. According to PERCIST/mRECIST criteria treatment responses categories: complete response in 2/1 cases, partial response in 7/9 cases, stable disease in 3/4 cases, progressive diseases in 2/3 cases; respectively. AFP value decreased in 2 cases, increased in 7 cases, and was stable in 1 case. Mean absorbed doses were 347.9 Gy for tumor, 140.6 Gy for perfused normal tissue, and 26.1 Gy for the normal liver. In Group 2; the mean age was 71.5. In 5 cases split infusion, and in 1 case non-selective treatment approach were applied. According to PERCIST/mRECIST criteria treatment responses categories: complete response in 7/6 cases, partial response in 7/10 cases, stable disease in 2/2 cases, and progressive diseases in 3/3 cases; respectively. AFP value decreased in 9 cases, increased in 2 cases, and was stable in 2 cases. Mean absorbed doses were 495.9 Gy for tumor, 134 Gy for perfused normal tissue, and 17.3 Gy for the normal liver.There is no statistically significant difference in terms of gender, treatment response rates, tumor volumes, perfuse tissue volumes between 2 groups. However, tumor-selective approach and absorbed doses of the perfused normal tissue and the tumor were significantly higher in Group 2 (p = 0.007, 0.04, and 0.02; respectively).

CONCLUSION: Contrary to expectation, centrally located HCCs could be treated as successfully as peripherally located HCCs. However, the complete response rate in the peripheral located tumor is more frequent than centrally located ones.

PMID:40014290 | DOI:10.1007/s12149-025-02028-5

J Racial Ethn Health Disparities. 2025 Feb 27. doi: 10.1007/s40615-025-02335-7. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: To identify demographic predictors, with a focus on race and socioeconomic status, for advanced treatment modality, mortality, and increased length of stay (LOS) in upper gastrointestinal (GI) hemorrhage treatment.

METHODS: Hospitalizations with acute upper GI hemorrhage from 2016 to 2021 were identified in the Healthcare Cost and Utilization Project’s National Inpatient Sample. Cases were divided into interventional radiology (IR) and non-IR (endoscopic) treatments. Statistical analyses calculated significant odds ratios via 95% confidence intervals. The primary outcome of interest was mortality rate. The secondary outcome of interest was the mean LOS. Confounding factors affecting mortality were also examined.

RESULTS: There was no significant difference in likelihood of an IR procedure or mortality between White patients and both Non-Hispanic (NH) Black and Hispanic patients. NH Black patients had significantly longer LOS in days compared to White patients (12.61 vs 9.57) that persisted when matching for age and sex (13.78 vs 9.92), socioeconomic status (12.94 vs 10.07), chronic comorbidities (11.33 vs 8.88), blood transfusions (14.46 vs 10.21), and vasopressor use (14.43 vs 10.29) (p < 0.001). These LOS differences were not seen under matching conditions post-COVID-19.

CONCLUSION: This study presents racial disparities in LOS following acute upper GI hemorrhage, but no differences in advanced treatment utilization or mortality. Confounders were responsible for LOS differences in non-IR treatment, but NH Black patients had persistently longer LOS than White patients after IR treatment.

PMID:40014285 | DOI:10.1007/s40615-025-02335-7

J Racial Ethn Health Disparities. 2025 Feb 27. doi: 10.1007/s40615-025-02318-8. Online ahead of print.

ABSTRACT

OBJECTIVES: People from ethnic minority backgrounds are exposed to greater risk of patient safety events (such as healthcare-acquired infections and medication errors) occurring in their healthcare. However, evidence of the type and frequency of patient safety events occurring in cancer care among patients from ethnic minority background is lacking. This study sought to address this evidence gap.

DESIGN: A two-stage retrospective medical record review was conducted at four cancer services in two Australian states. Eligible medical records at each service that were identified as belonging to ethnic minority patients were reviewed by two clinician researchers in stage one, followed by authentication of extracted data by a site-specific cancer clinician in stage two. Descriptive statistics were used to report the frequency and type of safety events. Chi-square and independent sample T-tests were used to examine the association between safety events and patient socio-cultural indicators.

RESULTS: A total of 628 patient records were included. Of the 628 patient records, 212 (33.75%) documented at least one safety event. A total of 410 safety events were documented in the 212 patient records. Medication-related safety events were most commonly documented (121/410, 29.5%), followed by clinical process/procedure-related safety events (76/410, 18.5%) and patient accidents (60/410, 14.6%). The occurrence of a safety event was associated with patient records that documented ‘no interpreter was required’.

CONCLUSION: Patient safety events in cancer care occur frequently among patients from ethnic minority backgrounds. Unsafe cancer care for this population is associated with inadequate use of interpreters, lack of shared understanding and expectations of care processes linked to cultural and linguistic barriers. Approaches to enhance engagement are required.

PMID:40014284 | DOI:10.1007/s40615-025-02318-8

Res Child Adolesc Psychopathol. 2025 Feb 27. doi: 10.1007/s10802-025-01296-z. Online ahead of print.

ABSTRACT

Adverse Childhood Experiences (ACEs) are generally associated with impaired life functioning, including mental health. Prevalent globally, ACEs’ effects vary across cultural settings and groups. The present study assessed horizontal and vertical individualism and collectivism – key cultural dimensions – as moderators of ACEs’ relations to adolescent aggressive behavior. The study was conducted in Vietnam, a Southeast Asian nation with high levels of collectivism but with levels of individualism increasing with globalization. The cross-sectional study included 644 high-school students (mean age = 16.6 years; 54% female). Self-report measures assessed ACEs, adolescent aggressive behavior, and individualism and collectivism. Given collectivism’s focus on supporting one’s social communities, it was hypothesized that collectivism would serve as a protective factor for statistical effects of ACEs on aggression. All four moderator analyses involving collectivism supported this hypothesis; i.e., at high levels of collectivism, relations between ACEs and aggression were significantly smaller than at low levels of collectivism. Statistical effects were largest for vertical (endorsing hierarchical power structures) collectivism. In the one significant individualism moderator analysis, individualism served as a risk factor for (i.e., increased) statistical effects of ACEs on proactive aggression. Results highlight the importance of the horizontal-vertical sub-dimensions, as they may provide for more precise theoretical explanatory and intervention models. For instance, concern for the power hierarchy’s reactions (vertical collectivism) to one’s aggression vs. concern for harm to one’s groups (horizontal collectivism) by one’s aggression have different implications for prevention and treatment that may be useful for maximizing interventions’ effectiveness.

PMID:40014281 | DOI:10.1007/s10802-025-01296-z

Oral Radiol. 2025 Feb 27. doi: 10.1007/s11282-025-00811-8. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare the fractal analysis data of ultrasonography (USG) images of the submandibular and parotid glands before and after parenchymal stimulation to assess for any changes.

METHODS: The study was conducted by taking 240 USG images of bilateral parotid and submandibular glands of 30 patients before and after stimulation. Patients chewed gum for stimulating their salivary glands. Fractal analysis was performed on the USG images, and the data obtained were statistically compared.

RESULTS: The fractal analysis value of the USG images of the parotid gland was 1.45, both before and after stimulation, indicating no statistically significant difference (p = 0.866). In the submandibular gland, this value was the same before and after stimulation (fractal analysis = 1.42), showing no statistically significant difference (p = 0.748). Parotid and submandibular glands were compared. USG fractal analysis values before and after stimulation and the overall values were statistically significantly different between the different salivary glands (p < 0.05).

CONCLUSION: According to fractal analysis, there was no change in the parenchyma of the submandibular and parotid glands despite the stimulation. Submandibular and parotid glands could be distinguished by fractal analysis.

PMID:40014279 | DOI:10.1007/s11282-025-00811-8

Sleep Breath. 2025 Feb 27;29(1):114. doi: 10.1007/s11325-025-03271-w.

ABSTRACT

BACKGROUND: The rising rates of obstructive sleep apnea (OSA) and frailty among older adults are linked to higher mortality rates. Depression merges as a critical determinant associated with both OSA and frailty. This study investigates the impact of depression on the risk of developing frailty in older adults diagnosed with OSA.

METHOD: Data from 1,021 older adults diagnosed with OSA were analyzed. Participants were stratified into two groups based on their scores on the 12-item Geriatric Depression Scale (GDS-12) to evaluate differences in frailty incidence over time.

RESULT: Depression was identified in 113 patients (11.0%). Frailty developed in 276 patients during the median 52-month follow-up. The multivariate analysis indicated a significant link between depression and increased frailty risk (aHR = 2.65; 95% CI: 2.01-3.05; P < 0.001). Further subgroup analyses indicated that patients with moderate-to-severe OSA (aHR = 3.01; 95% CI: 2.20-4.10; P < 0.001) who also experienced depression faced a particularly heightened risk of frailty.

CONCLUSION: Depression is prevalent among older adults with OSA and constitutes an independent risk factor for frailty development. These findings underscore the need for targeted interventions addressing depression in this population to mitigate frailty risk.

PMID:40014277 | DOI:10.1007/s11325-025-03271-w

Biol Trace Elem Res. 2025 Feb 27. doi: 10.1007/s12011-025-04559-4. Online ahead of print.

ABSTRACT

Trace elements (TE) function as essential micronutrients involved in the biochemical and physiological processes of the human body. We evaluated the baseline serum concentrations of TE as a predictor of clinical outcomes in critically ill trauma patients and monitored the concentrations of TE during the patients intensive care unit (ICU) stay. A total of 89 patients were enrolled. Within the first 24 h of patients’ admission, concentrations of TE, zinc (Zn), selenium (Se), copper (Cu), manganese (Mn), and iron (Fe) were measured and monitored on the 5th and 10th day of patients ICU stay. The concentrations of Zn, Se, Cu and Mn were determined from serum using atomic absorption spectrophotometry, whereas the concentration of Fe using the photometric method. ANOVA and logistic regression analyses were used for statistical analysis with the level of significance set at 0.05. At the time of ICU admission, deficiency of Cu was observed in 11 out of 89 (0.13), Zn in 82 (0.92), Se in 5 (0.06) and Fe in 52 (0.58) patients, while excess of Mn was detected in 27 (0.30) and Cu in 3 (0.03) patients. A significant increase of Zn and Cu concentrations was observed from admission to 10th day (P < 0.001 for both), although Zn concentrations did not reach the lower limit of the reference interval. Logistic regression analysis found that only a low concentration of Zn at admission was associated with mechanical ventilation (OR = 0.78; 95%CI: 0.64-0.96; P = 0.018). Furthermore, the concentrations of TE at admission in critically ill trauma patients did not have an impact on the overall length of the ICU and hospital stay, nor on mortality.

PMID:40014249 | DOI:10.1007/s12011-025-04559-4

Environ Sci Pollut Res Int. 2025 Feb 27. doi: 10.1007/s11356-025-36171-3. Online ahead of print.

ABSTRACT

Ensuring accurate detection and attribution of abnormal releases of radioactive material is critical for protecting human health and safety. Most commonly, such detection is accomplished via active monitoring approaches involving the collection of physical samples. This is labor intensive and limits the temporal and spatial resolution of any detected events to a relatively coarse level. As an alternative first step towards passive monitoring, we developed an approach using eddy flux tower data records to identify signals from a known abnormal release and quantify the extent to which that signal also occurs at other times in the data record. Through two case studies, one of which targeted the Fukushima nuclear disaster and the other targeting an abnormal release event at a radioisotope production facility in Fleurus, Belgium, we tested our approach and identified several potential heretofore unidentified abnormal events that were consistent with atmospheric circulation patterns and/or wind direction from known release sites. Because our approach is relatively simple and is resistant to systematic errors in the observational record, it has broad applicability beyond specific constituents and ecosystem types to identify a wide variety of limited-duration anomalies in flux tower data to ensure human health and industrial safety.

PMID:40014241 | DOI:10.1007/s11356-025-36171-3

Obes Surg. 2025 Feb 27. doi: 10.1007/s11695-025-07747-2. Online ahead of print.

ABSTRACT

BACKGROUND: Obesity is a multifaceted problem for global healthcare, influenced by socioeconomic factors. Bariatric surgery is an effective treatment where less invasive management has been unsuccessful. The impact of socioeconomic deprivation on surgical outcomes is a novel area of research. The present study aims to investigate the effect of socioeconomic deprivation on bariatric surgery outcomes.

METHODS: Data was prospectively collected at a regional bariatric centre in Scotland. The study included patients who received either a Roux-en-Y Gastric Bypass (RYGB) or Sleeve Gastrectomy (SG) (2008-2022). Follow-up occurred postoperatively at 6 months, 1 year and annually thereafter. Socioeconomic deprivation was measured using the Scottish Index of Multiple Deprivation (SIMD) using residential postcodes to generate a deprivation quintile (Q1-5). The primary outcome was percentage total weight loss (%TWL). Secondary outcomes included postoperative complications, comorbidity status, nutritional status, length of stay and re-admissions. Grouped analysis was conducted to represent a more deprived group (Q1-3) and a less deprived group (Q4-5). Statistical analysis was carried out of the data. The study was carried out using the STROBE principles.

RESULTS: 316 patients were included (median follow-up, 7 years; median %TWL, 23.8%). There was no significant difference in median %TWL (p = 0.528), short-term (p = 0.619) or long-term (p = 0.164) complications and resolution (p = 0.472), improvement (p = 0.282) or exacerbation of comorbidities (p = 0.717) between socioeconomic quintiles.

CONCLUSION: Socioeconomic deprivation does not limit bariatric surgery outcomes and should not be a barrier to surgery.

PMID:40014237 | DOI:10.1007/s11695-025-07747-2