Nevin Manimala

Ann Fam Med. 2025 Nov 24;23(6):515-523. doi: 10.1370/afm.240569.

ABSTRACT

PURPOSE: Reducing potentially preventable hospitalization (PPH), also known as ambulatory care-senstive conditions, is a global concern. This study linked data from Sax Institute’s 45 and Up Study on individuals aged 45 years and older from New South Wales, Australia, with Australian Medicare claims data to establish a causal relationship between continuity of care and acute PPH using a double machine learning model.

METHODS: We utilized 11 years of linked data (2007-2017) to analyze the impact of continuity of care on acute PPH, controlling for key patient characteristics (ie, age, multimorbidity status, cultural diversity, sex, education level, psychological status, physical limitation, smoking status, socioeconomic deciles). Estimation was done using a double machine learning technique with 4 algorithms (ie, least absolute shrinkage and selection operator, random forest, extreme gradient boosting, artificial neural network) to ensure robustness.

RESULTS: Among 54,376 participants, 27,634 individuals (50.8%) experienced at least 1 acute PPH episode during the 11-year study period. Our findings indicate that even a slight improvement in continuity of care can reduce the incidence of acute PPH compared with non-acute PPH. For example, the reduction in the probability of acute PPH compared with non-acute PPH ranges from 9.8% (95% CI, 1.1%-17.8%) to 23.5% (95% CI, 14.1%-32.4%) across 4 models when continuity of care increases from the 45th percentile (0.274) to the 50th percentile (0.301).

CONCLUSION: Continuity of care at the primary level plays a key role in reducing acute PPH. Policies focused on person-centered or integrated care should include initiatives to promote continuity of care and support general practitioners in improving continuity of care.The authors of this article have provided Hindi and Vietnamese translations of the abstract.

PMID:41285609 | DOI:10.1370/afm.240569

Ann Fam Med. 2025 Nov 24;23(6):546-551. doi: 10.1370/afm.250066.

ABSTRACT

Latinos face significant health disparities, particularly concerning chronic conditions such as cardiovascular disease, diabetes, asthma, and cancer. Primary care plays a critical role in managing and preventing chronic diseases, yet Latinos face multiple barriers to accessing quality care, including uninsurance, employment environments without health care benefits, systemic discrimination, and increased social risks. To address the intersection of these complex topics, the Primary Care Latino Equity Research (PRIMER) Center convened the second annual Latino Primary Care Summit, focused on this theme, “Chronic Conditions in Latinos: Trends, Innovations and Care for the Future” in April 2024. The Summit consisted of 7 expert presentations with breakout discussion groups and discussant commentary to the entire Summit group. Nine key themes were identified from presentation content, and from notes taken at each small group discussion. Themes included: (1) social factors such as economics, political power, and advocacy, (2) Latino narratives, (3) characteristics and unique experiences of Latinos, (4) Latino subgroups, (5) family/aging/generational differences, (6) health care workforce limitations and transformation, (7) primary care approaches, systems, and quality for Latinos, (8) technology, artificial intelligence (AI), and telemedicine, and (9) trauma across the life course. From these discussions, we offer the following recommendations to the US health services and primary care research community, in order to generate knowledge that will positively impact the outcomes of chronic conditions in Latinos in the United States. By addressing these multifaceted issues with comprehensive and culturally aware strategies, primary care can significantly improve chronic care delivery for Latino patients.

PMID:41285608 | DOI:10.1370/afm.250066

Ann Fam Med. 2025 Nov 24;23(6):535-538. doi: 10.1370/afm.240549.

ABSTRACT

Family physicians are key members of the rural health care workforce, which is inadequate for current needs. From the American Medical Association Physician Masterfile, we identified actively practicing US family physicians during 2017-2023 and their region of practice. We found a year-over-year decrease in family physicians practicing in rural areas, with a net loss of 11% nationwide over the 7 years studied. We observed the greatest percentage loss of rural family physicians in the Northeast and the least percentage loss in the West. Ensuring an adequate rural family physician workforce likely requires a tailored regional approach such as medical school pathway programs from rural communities.

PMID:41285597 | DOI:10.1370/afm.240549

BMJ Qual Saf. 2025 Nov 24:bmjqs-2025-019299. doi: 10.1136/bmjqs-2025-019299. Online ahead of print.

ABSTRACT

BACKGROUND: Artificial intelligence large language models (LLMs) are increasingly used to inform clinical decisions but sometimes exhibit human-like cognitive biases when facing nuanced medical choices.

METHODS: We tested whether new chain-of-thought reasoning LLMs might mitigate cognitive biases observed in physicians. We presented medical scenarios (n=10) to models released by DeepSeek, OpenAI and Google. Each scenario was presented in two versions that differed according to a specific bias (eg, surgery framed in survival vs mortality statistics). Responses were categorised and the extent of bias was measured by the absolute discrepancy between responses to different versions of the same scenario. The extent of intransigence (also termed dogma or inflexibility) was measured by Shannon entropy. The extent of deviance in each scenario was measured by comparing the average model response to the average practicing physician response (n=2507).

RESULTS: DeepSeek-R1 mitigated 6 out of 10 cognitive biases observed in practicing physicians by generating intransigent all-or-none responses. The four biases that persisted were post hoc fallacy (34% vs 0%, p<0.001), decoy effects (44% vs 5%, p<0.001), Occam’s razor fallacy (100% vs 0%, p<0.001) and hindsight bias (56% vs 0%, p<0.001). In every scenario, the average model response deviated substantially from the average response of practicing physicians (p<0.001 for all). Similar patterns of persistent specific biases, intransigent responses and substantial deviance from practicing physicians were also apparent in OpenAI and Google.

CONCLUSION: Some biases persist in chain-of-thought reasoning LLMs, and models tend to produce intransigent recommendations. These findings highlight the role of clinicians to think broadly, respect diversity and remain vigilant when interpreting chain-of-thought reasoning artificial intelligence LLMs in nuanced medical decisions for patients.

PMID:41285583 | DOI:10.1136/bmjqs-2025-019299

Psychogeriatrics. 2026 Jan;26(1):e70113. doi: 10.1111/psyg.70113.

ABSTRACT

BACKGROUND: This study aimed to develop and validate a Japanese version of the Essentialist Beliefs about Ageing (EBA-J) scale, examining its factor structure, reliability for internal consistency, and criterion validity.

METHODS: In total, 544 Japanese older adults (M_age = 73.81, SD = 6.47; 206 men, 338 women) completed the EBA-J scale along with assessments of subjective health and subjective age bias. This scale was developed through rigorous translation and cultural adaptation. Subjective health and subjective age bias (calculated as subjective age minus chronological age) were selected as criterion variables owing to their association with ageing beliefs and broad applicability across cultures. Using confirmatory factor analysis, we compared single- and two-factor models. Internal consistency was assessed using Cronbach’s alpha; criterion validity was evaluated via correlations between the EBA-J score, subjective health, and subjective age bias.

RESULTS: Confirmatory factor analysis supported a two-factor structure-perceived malleability and biological determinism-over a single-factor model. Both factors showed acceptable internal consistency (α = 0.83 and 0.76, respectively). Perceived malleability correlated positively with subjective health (r = 0.17) and negatively with subjective age bias (r = -0.15); biological determinism correlated negatively with subjective health (r = -0.13).

CONCLUSIONS: The EBA-J scale demonstrated a reliable two-factor structure with acceptable internal consistency. Its associations with subjective health and subjective age bias, which were small yet meaningful, provided initial evidence of criterion validity. Overall, the scale is useful for measuring beliefs regarding ageing in Japan, supporting cross-cultural studies of ageing perceptions.

PMID:41285568 | DOI:10.1111/psyg.70113

Epilepsy Behav. 2025 Nov 23;174:110805. doi: 10.1016/j.yebeh.2025.110805. Online ahead of print.

ABSTRACT

BACKGROUND: The efficacy of Managing Epilepsy Well Network (MEWN) self-management programs is well-established. The purpose of this study was to replicate the HOBSCOTCH program to evaluate program implementation and assess effectiveness on patient cognition, quality of life and self-management behaviors.

METHODS: Participants from clinical and community settings were recruited and randomized to intervention vs waitlist control. Program outcomes assessing quality of life, cognition, treatment adherence, depressive symptoms, and self-management behavior were measured at baseline and 3 months. Program staff provided survey data guided by the RE-AIM model regarding program delivery and acceptability, appropriateness, and feasibility. Data were analyzed using descriptive statistics, linear regression, and qualitative methods.

RESULTS: This predominantly female (69 %) and White (64 %) sample (N = 61) with active epilepsy (66 % had a seizure in the past year) also had a higher portion of Black (32 %) participants. Analyses yielded significant differences in cognition, quality of life and self-management behaviors between the two groups at follow-up. Staff indicated the packaged intervention, remote delivery, trained coaches and investment of leaders/clinical staff as intervention benefits. Implementation barriers included difficulty contacting participants and mental health concerns. Program appropriateness and feasibility ratings were high; 98 % reported that they very much or moderately enjoyed working with their coach and would recommend the program to others.

CONCLUSION: HOBSCOTCH was effective in increasing cognition and quality of life in people with epilepsy in this replication study. A novel finding highlighted changes in the frequency of participants’ self-management behaviors. These findings have implications for healthcare systems incorporating evidence-based self-management programs for their patients.

PMID:41285072 | DOI:10.1016/j.yebeh.2025.110805

Int J Med Inform. 2025 Nov 20;207:106190. doi: 10.1016/j.ijmedinf.2025.106190. Online ahead of print.

ABSTRACT

BACKGROUND: Despite the increasing use of AI tools like ChatGPT, Claude, and Gemini in scientific writing, concerns remain about their ability to generate accurate, high-quality, and consistent abstracts for research publications. The reliability of AI-generated abstracts in dental research is questionable when compared to human-written counterparts. This study aimed to develop a framework for evaluating AI-generated abstracts and compare the performance of ChatGPT, Claude, and Gemini against human-written abstracts in dental research.

METHODS: The DAISY framework was developed to evaluate AI-generated abstracts across five domains: Data accuracy (D), Abstract quality (A), Integrity and consistency (I), Syntax and fluency (S), and Yield of human likelihood (Y). Reliability of the framework was assessed using Cohens Kappa (κ = 0.85) and Pearsons’s correlation coefficient (0.92) for inter- and intra- expert reliability and was found to be satisfactory. This study adopted a comparative observational study design. Eight research articles belonging to structured (n = 4) and unstructured (n = 4) categories were selected from reputable journals. Researchers trained in scientific writing wrote abstracts for these articles, while AI-generated abstracts were obtained using specific prompts. Ten dental experts evaluated the abstracts using this framework. Statistical analysis was performed using ANOVA and Tukey’s post-hoc test.

RESULTS: Human-written abstracts consistently outperformed AI-generated ones across all DAISY framework domains. Among AI tools, ChatGPT scored highest in all DAISY framework domains, followed by Gemini and Claude. Human-written abstracts achieved the highest human likelihood score (90.25 ± 4.68), while AI-generated abstracts scored below 50%, with Gemini scoring least (3.25 ± 1.75). The differences between the groups were statistically significant (P ≤ 0.05).

CONCLUSION: The DAISY framework proved reliable for evaluating AI-generated abstracts. While ChatGPT performed better than other AI tools, none matched the quality of human-written abstracts. This indicates that AI tools, though valuable, remain limited in producing credible scientific writing in dental research.

PMID:41285065 | DOI:10.1016/j.ijmedinf.2025.106190

Immunohorizons. 2025 Nov 24;9(12):vlaf064. doi: 10.1093/immhor/vlaf064.

ABSTRACT

Ficolins, encoded by FCN genes, are key pattern recognition molecules of the lectin complement pathway involved in immune complex clearance, a process often impaired in systemic lupus erythematosus (SLE). Genetic polymorphisms in FCN genes may influence disease susceptibility. However, their functional significance in SLE remains unclear. The present study aimed to investigate the association of selected FCN gene single-nucleotide polymorphisms (SNPs) with SLE, lupus nephritis (LN), and serum ficolin levels in a Western Indian cohort. Seven SNPs in FCN1 (rs2989727, rs1071583), FCN2 (rs7851696, rs17549193, rs7865453, rs17514136), and FCN3 (rs3813800) were genotyped in 200 SLE patients and 200 healthy controls using polymerase chain reaction (PCR) sequence-specific primer and PCR restriction fragment length polymorphism. Serum ficolin-1, -2, and -3 levels were measured using ELISA. Statistical analysis included χ2 test, Kruskal-Wallis test, and logistic regression to assess associations and calculate odds ratios with 95% confidence intervals. The analysis identified significant associations of FCN2 rs7851696, rs7865453, and rs17514136, as well as FCN3 rs3813800, with SLE susceptibility. Among LN patients, FCN1 rs2989727 and rs1071583, FCN2 rs17514136, and FCN3 rs3813800 showed significant associations. FCN3 rs3813800 was significantly associated with ficolin-3 levels, while FCN2 rs7865453 was associated with complement component 1q-circulation immune complex levels. These findings provide novel insight into associations of FCN gene polymorphisms with SLE and LN susceptibility, with genotype-phenotype correlations suggesting their biological relevance. Future longitudinal and mechanistic studies are warranted to validate these associations and explore their therapeutic potential.

PMID:41285030 | DOI:10.1093/immhor/vlaf064

Hum Reprod. 2025 Nov 24:deaf218. doi: 10.1093/humrep/deaf218. Online ahead of print.

ABSTRACT

STUDY QUESTION: Is male infertility independently associated with an increased risk of incident hypertension, ischemic and non-ischemic heart disease, diabetes, and/or cerebrovascular disease?

SUMMARY ANSWER: Fathers diagnosed with male infertility have a modestly increased risk of heart disease, diabetes, and hypertension compared with fertile fathers, after controlling for measured confounders; however, some important confounders remain inadequately measured.

WHAT IS KNOWN ALREADY: Cohort studies suggest that infertile men have an increased risk of incident cardiometabolic diseases, including diabetes, hypertension, heart disease, and cerebrovascular disease, although findings are mixed. The reasons for this association are unclear, but cardiometabolic conditions and male infertility share a wide range of shared etiological factors including age, chronic conditions such as obesity and obstructive sleep apnea, cancers and their treatments, environmental exposures such as pollution and pesticides, lifestyle factors such as smoking and cardiorespiratory fitness, autoimmune conditions such as lupus and Hashimoto’s thyroiditis, as well as congenital conditions such as cystic fibrosis and muscular dystrophy.

STUDY DESIGN, SIZE, DURATION: Our population-based cohort study included 445 909 men whose partner conceived a child between January 2009 and September 2016 in New South Wales (NSW), Australia. We excluded men with a diagnosis of infertility prior to 2009, men who were under the age of 14 at the time of the child’s conception, and men diagnosed with cardiometabolic conditions in the 6.5 years prior to their index date. The index date was the later of the date of the child’s conception or the date of the vasectomy for fertile men or the date of diagnosis of infertility for infertile men, i.e. the time when the exposure status was determined. From the index date, we followed participants for 5 years up until the latest available date of September 2021.

PARTICIPANTS/MATERIALS, SETTINGS, METHODS: The study was conducted in NSW, Australia. We determined infertility status by a diagnosis of male infertility in the Australian and New Zealand Assisted Reproduction Database, hospital records, or a record of fertility-related procedures. We assessed the following outcomes: incident hypertension, ischemic and non-ischemic heart disease, all heart disease, diabetes, and cerebrovascular disease. We calculated age-standardized prevalence rates at baseline. We mapped potential confounding pathways using directed acyclic graphs and controlled for measured confounders using inverse probability of treatment weighting and g-computation. We estimated adjusted marginal risk ratios (aRR) and adjusted marginal risk differences (aRD) using robust Poisson regression.

MAIN RESULTS AND THE ROLE OF CHANCE: The number of events and 5-year crude incidence rate for the outcomes were: hypertension (events: 17 433, fertile: 41.09 per 1000 population, infertile: 70.03 per 1000 population), all heart disease (events: 15 549, fertile: 36.44 per 1000 population, infertile: 59.88 per 1000 population), ischemic heart disease (events: 12 628 fertile: 29.24 per 1000 population, infertile: 47.1 per 1000 population), non-ischemic heart disease (events: 5183, fertile: 11.69 per 1000 population, infertile: 20.24 per 1000 population), cerebrovascular disease (events: 512, fertile: 1.14 per 1000 population, infertile: 1.78 per 1000 population) and diabetes (events: 7064, fertile: 16.05 per 1000 population, infertile: 27.59 per 1000 population). Compared with fertile men, men diagnosed with infertility demonstrated increased risk of incident disease for: hypertension aRR = 1.20 (95% CI 1.11-1.31, P < 0.001), aRD = 1.1% (95% CI: 0.6%-1.6%, P < 0.001); all heart disease aRR = 1.20 (95% CI 1.09-1.31, P < 0.001), aRD =0.9% (95% CI: 0.4%-1.4%, P < 0.001); non-ischemic heart disease aRR = 1.26 (95% CI 1.08-1.48, P = 0.004), aRD = 0.4% (95% CI: 0.1%-0.7%, P = 0.009); ischemic heart disease aRR = 1.13 (95% CI 1.02-1.25, P = 0.020), aRD = 0.4% (95% CI: 0.1%-0.7%, P = 0.028); and diabetes aRR = 1.28 (95% CI 1.12-1.46, P < 0.001), aRD 0.6% (0.2%-0.9%, P = 0.001). There was no significant difference in the incidence of cerebrovascular disease, aRR = 1.0 (95% CI 0.56-1.80, P = 0.996), aRD = 0.0% (95% CI: -0.1% to 0.1%, P = 0.996). These results remained consistent in sensitivity analyses, including an expanded exposure definition of infertility, a 10-year follow-up period, changing the outcomes of people who died in follow-up, and using an alternative index date.

LIMITATIONS, REASONS FOR CAUTION: The cohort includes men who fathered a child, so men who did not seek to, or were unable to, have a child, and men with poor access to the reproductive healthcare may not be included. This may generate selection effects, biasing the estimates toward the null. We were unable to adequately control for several confounders, including important lifestyle factors like smoking, diet, cardiorespiratory fitness, and alcohol intake, due to data limitations, which may bias estimates away from the null. It appears plausible that a combination of unmeasured and inadequately measured confounders may attenuate the observed estimates.

WIDER IMPLICATIONS OF THE FINDINGS: These findings suggest that male infertility may serve as an early indicator for a slightly heightened cardiometabolic risk, specifically relating to hypertension, diabetes, and various forms of heart disease. Our study is the largest on this topic, with extensive control for confounders. Our findings align with published research, indicating that men diagnosed with infertility have a slightly higher risk of incident diabetes, hypertension, and heart disease. From a public health perspective, fertility treatment may be an opportunity for earlier detection and intervention to help prevent the onset of cardiometabolic conditions in men diagnosed with infertility, particularly given that men generally have low rates of contact with the health system.

STUDY FUNDING/COMPETING INTEREST(S): The PhD candidacy of J.M. is supported by Medical Research Future Fund (MRFF) Emerging Priorities and Consumer Driven Research initiative: EPCD000007, 2020. M.K.O’B. and G.M.C. declare receiving payment to their institution by the same MRFF grant. G.M.C. reports receiving funding from an Australian MRFF grant paid to UNSW to support this work, and J.M. reports receiving PhD funding from the same MRFF grant. C.V. declares an unpaid role on Human Reproduction’s Editorial Board, and paid employment at the University of New South Wales (UNSW) until January 2023. The National Perinatal Epidemiology and Statistics Unit (NPESU), which belongs to UNSW, is custodian of the Australian and New Zealand Assisted Reproduction Database (ANZARD). Data from ANZARD were used in this study. G.M.C. also declares paid employment from UNSW. The remaining authors have nothing to declare.

TRIAL REGISTRATION NUMBER: N/A.

PMID:41285026 | DOI:10.1093/humrep/deaf218

JMIR Form Res. 2025 Nov 24;9:e80090. doi: 10.2196/80090.

ABSTRACT

BACKGROUND: Physical inactivity increases the risk of chronic disease and reduces life expectancy, yet adherence to physical activity (PA) guidelines remains low. SMS text messages are promising for promoting PA, but it is not clear what type of messaging is most effective. Messages with causal information, which explain why a recommendation is being made, may be more persuasive than messages containing only recommendations.

OBJECTIVE: This study aims to compare the effectiveness of causal versus noncausal SMS text messages for promoting PA in US adults.

METHODS: In this pilot study, we randomized US adults (n=28 in the analytic sample) aged 18-64 years to receive causal or noncausal SMS text messages roughly every other day for 2 weeks, following a 1-week baseline. PA was measured using Empatica wristbands during intervention and baseline periods, and the International Physical Activity Questionnaire – Short Form (IPAQ-SF) at baseline, postintervention, and 4 weeks later. The primary outcome was the change in mean metabolic equivalent of tasks (METs) per minute from baseline to intervention. The secondary outcomes were (1) PA differences on intervention and nonintervention days (mean METs/min), (2) changes in self-reported METs per week between surveyed periods, and (3) participant satisfaction. We used a linear mixed model to analyze our primary outcome, the Mann-Whitney U test and the chi-square test of independence to analyze quantitative secondary outcomes, and qualitative coding to analyze survey data.

RESULTS: The causal message group had a greater increase in mean METs per minute from baseline to intervention compared to the noncausal group with a moderate effect size (P=.01; Cohen d=0.54). In the causal group, PA was significantly higher on SMS text message days (mean 2.46, SD 0.12 METs/min) compared to nonmessage days (mean 2.25, SD 0.15 METs/min; P=.02), while there was no difference in the noncausal group (P=.54). No significant between-group difference was found in self-reported PA or satisfaction.

CONCLUSIONS: Causal information that links suggested PA to health outcomes can increase the effectiveness of SMS text messages promoting PA, indicating the value of incorporating causal information into intervention design. Our results provide further basis for just-in-time interventions, as activity was higher on message days. Further work is needed to better personalize message content and timing to maintain participant engagement.

PMID:41284987 | DOI:10.2196/80090